Green Paper on NHI silent on governance, accountability - HASA

Only 3% of provincial health departments received clean audit reports from the auditor general in 2009/2010, including the North West Province and Western Cape.

Speaking at the Hospital Association of South Africa (HASA) conference in Cape Town, van den Heever said the Green Paper maintains the political model of appointing people to supervisory structures such as regulators, councils, boards and service delivery functions in the public health sector.

"The compromised governance structures of medical schemes are also not discussed," added van den Heever. "Serious conflicts of interest between trustees, administrators and brokers are retained."

Failure in governance and supervisory structures

He said performance failures in the South African health system in both the public and private sectors stem from a failure in governance and supervisory structures.

"In Gauteng six babies die at a public hospital, yet no one is held accountable," he said. "In the Eastern Cape serious patient abuse in maternity wards is identified, but no further action taken."

Van den Heever said the problem was that performance requirements were not linked to sanctions, information was not used to hold organisations to account and procurement processes had been captured by politically connected individuals across most provinces.

"There is an absence of targets for health outcomes so that the public can hold someone accountable for adverse outcomes," he said. "When there is little chance of suffering consequences, people take bigger risks."

Also worrying was the introduction of the Protection of Information Bill which would "make it easy for public institutions, including health institutions to bury and hide information."

Relationship between corruption and health outcomes

Van den Heever pointed out that evidence of poor governance would manifest in poor health outcomes, citing that there is a close relationship between levels of corruption and health outcomes.

"Why does South Africa have one of the highest maternal mortality rates, despite spending more on healthcare than other countries?" he asks. "One of the big concerns is that the Green Paper lacks a co-herent diagnostic analysis as to why our health system is failing; nor does it address accountability within the healthcare system."

He said in the public sector, regulators needed to be politically neutral and impartial and community participation with localised supervisory structures encouraged.

"Both the public and private sectors governance requirements are the same, but the mechanisms are different," he added."Reversing these failures in accountability will only be achieved by ruthlessly exposing corruption and implementing complete accountability frameworks in both the public and private healthcare sectors."