Strides gained in Covid equity need to be translated into overall health equity

The Covid-19 pandemic not only disrupted the drive for National Health Insurance, but highlighted the yawning gap between the public and private healthcare sectors it is meant to address.

But recent shifts in the vaccine rollout and treatments have provided a glimmer of hope, and experts say these shifts could help build more equitable systems that outlive the pandemic.

Prof Wolfgang Preiser, a virologist at the University of Stellenbosch, said the pandemic had hardly been the “great equaliser” some dubbed it early on.

“On the other hand,” he said, “I have witnessed first-hand concerted efforts to facilitate access to healthcare, such as home-delivery of chronic medication and following up on people previously diagnosed as diabetic but not in chronic care.

“I’ve also heard of private patients with severe Covid being transferred to Tygerberg Hospital during the second wave and not being sent back when it became clear they’d be looked after better — in terms of oxygen support, for example — where they were.”

Preiser said he would “not dare predict an overall shift nor extrapolate into the future” but had definitely seen “hopeful signs of better integration”.

I’ve also heard of private patients with severe Covid being transferred to Tygerberg Hospital during the second wave and not being sent back when it became clear they’d be looked after better — in terms of oxygen support, for example — where they were.

—  Prof Wolfgang Preiser

Wits vaccinologist professor Shabir Madhi said the health department’s initial insistence that people register online for vaccinations, and denying uninsured people access to private vaccination sites, contributed to inequity.

A week ago, he said, as many as 18% of the medically insured population had been vaccinated compared with just 7% of those expected to use the public system.

But public healthcare users are now allowed to get their jabs at private sites and can choose where and when they get vaccinated, eliminating transport problems.

Madhi pointed out that “the use of mobile units and delivering vaccines at Sassa paypoints” had improved equitable access, but said “the challenge now is to keep the momentum”.

The NHI bill saw 64,000 submissions and 130 in-depth hearings are under way. Health department deputy director-general Dr Nicholas Crisp said the importance of equity is non-negotiable.

“It is for the public good, and there is evidence from all over the world that the returns on what you spend on health are immeasurable in terms of what it achieves economically and socially,” he said.

But Section27 executive director Umunyana Rugege said achieving equity in healthcare is a mammoth task because “a reflection of the whole inequality in society in SA is in the health system”.

Eighty-three percent of people rely on a very under-resourced public health system while only 17% access private services.

—  Section27 executive director Umunyana Rugege

Speaking on a panel organised by the Bhekisisa Centre for health journalism, she said: “Eighty-three percent of people rely on a very under-resourced public health system, while only 17% access private services.”

While it might be encouraging to see shifts in the “emergency response” to Covid-19, the major schism in access to healthcare is “something we have been talking about for two decades and it has not really come into effect ... the inequality is still so stark”.

Rugege pointed out that 18-million people rely on grants, which meant “we really need to bolster investment in our health system ... and shift to a system based on need and not the ability to pay”.

Crisp added that “a government and its leadership needs to build an equitable system that is not just a reaction to a threat or crisis”, and Dr Keith Cloete, head of health in the Western Cape, concurred.

He said: “Equity should be our constant consideration, and whatever we gain during Covid-19 and the vaccine rollout should set the tone on all future healthcare-related activities.”

According to Dr Stavros Nicolaou from Business for SA, also speaking on the Bhekisisa panel, “the achievement of universal coverage can be advanced in various ways, and to get to that promised land requires investment in infrastructure and the mobilisation of human resources”.

But, he added, the public-private collaboration on the vaccine rollout “is the most important public health and social programme this country has seen since 1994, and it would not be an overstatement to say that nothing is more important right now”.