Mia Maran (Maran): There have been six health ministers in the past 30 years. What impact did it have on health policy?
Malegapur Makkoba (Makkoba): Each leaves its mark on its portfolio.First, I had Nkosazana. [Dlamini-]Zuma set out a blueprint for a national health system by merging the various systems of his homeland and different states into one.
She was followed by Manto Shabalala Msimang, who was part of the AIDS denialist era. [set] We are also trying to deal with HIV/AIDS in a funny way [treatment] Remedy. And, simply put, it was Barbara Hogan who ended AIDS denial.
He was followed by Aaron Motsoaledi, who is said to be largely responsible for driving the NHI, appointing the National Health Ombud and driving the world's largest anti-retroviral program. [thereby] extend the lifespan of South Africans [with HIV].
He was followed by Zweli Mkhize, who was responsible for appointing the Ministerial Advisory Committee to support our country's policies. [deal with] the coronavirus disease (Covid-19) pandemic, and 1715026449 Joe Faala managed to get National Health Insurance [Bill] approved [by Parliament].
Maran: Over the past 30 years, these ministers have had some great policy successes, such as the tobacco bill and the legalization of abortion, but also bad things, such as the Sarafina scandal and corruption during the coronavirus pandemic. . How does corruption affect our healthcare system?
Makgoba: We have poured many ideas into what the new health system should look like, but what has failed is the implementation of those policies. [Take] National Health Insurance [as an example]. Everyone agrees that this is the best policy and a transformative policy for the country. But where things get stuck are debates and debates around governance and how it affects taxation and how it affects physicians. [would] If that country becomes a reality, I will migrate from that country.
Maran: What do you think: Does the answer to our health problems really solve our two-tiered private and government healthcare system? Can it be implemented in a way that benefits us? ? Because what is commonly discussed is that it ends up being deployed within a system that is not tuned to run efficiently.?
Makgoba: But you should look [healthcare]whether universal or not, are expensive and have elements that are often incongruous.
I noticed that the Minister has said that (universal health insurance in the form of national health insurance) should be implemented gradually and that is probably the best way to do it.
Because fixing and transforming long-entrenched health systems is not a formula. You have to do it empirically. You'll learn as you go. Going through it step by step and learning from each step will help you understand what you need in the first place. I understand that our tax base is not very large.Introduction of national health insurance system [will be] An expensive business.health[care] It costs money everywhere in the world. Let's get some centers properly accredited. At the moment, the hospital is [and] The infrastructure is not at a sufficient level to implement such a system.
Maran: As health ombud for seven years until last year, you oversaw investigations such as the working conditions of Life Esidimeni and Rahima Moosa. [Mother and Child] Johannesburg hospital. What can studies like this tell us about the state of our health care system?
Makgoba: First, there are leadership issues across the state and across many hospitals. There are issues of governance, infrastructure, staffing and professional attitudes. So we have multiple problems, all of which are holding back the health system.
Maran: Does this situation in the health care system make you sad that some of your work could have gone further?
Makgoba: Yes, it's sad. But I don't think we should lose hope because of that. South Africa is my home. Like all South Africans, I want to live in a successful and prosperous country. It's unfortunate that some of my recommendations have not been implemented. But some people do and I'm happy about that.
Maran: What are you happy about moving forward?
Makgoba: In the Life Esidimeni example, the government [the Gauteng health department] I think they admitted that I committed so-called human rights violations. She (former health MEC Qedani Mahlangu) lost her job and so did her senior level in the department. [Barney] Dr. Cerebano [Makgabo] Manamela, some directors. I am not saying that it is sufficient, but it is a form of response to the recommendations. The government acknowledged that there were problems with the entire system.
Maran: You were one of the few public figures who lived through the controversial and difficult era of HIV denialism and were willing to speak out and take a stand. What are your memories of that time and the lessons you learned from it?
Makgoba: What was really most disturbing to me was that our politicians have the courage to think that they can define and decide what medical professionals understand as a disease and override political power to determine the direction of health. That's what I had. During that period, medical professionals were so intimidated by fear of political repercussions that they were sometimes unable to even write correct medical certificates. For me it was a disaster. The power of politics has taken over the power of scientific thought.
Maran: Do you think the lesson has been learned that politics should not drive science?
Makgoba: No, continue. It was the same with Life Esidimeni…politics was trying to promote science.The old MEC took it that way. [much] Advice from the patient's relatives, experts in the field, namely psychiatrists, were all against the project. The dynamics between politics, science, and medicine continue.
Maran: If you became South Africa's Minister of Health tomorrow, what would you do to solve these problems in your first 100 days?
Makgoba: First, a disclaimer. I will never be our Minister of Health. I'm allergic to politics. But for the sake of argument, if I were to become Minister, the first thing I would do tomorrow would be to create a health codesa. (The Codesa, the Convention for a Democratic South Africa, was a negotiating forum established to guide South Africa through the transition from apartheid to a new democratic government.) I would have included all health-related interests Call the person and say: A new country, we have a new constitution based on human rights.How is that reflected in the way we teach medicine, practice medicine, and deliver services in our country? It's difficult [to do] In a patchwork form. You can't do that.I have to catch them all. [together] And I say this. “We're on a new journey. How do we travel together and navigate this?” I think we can do that.
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