Health Minister Joe Phaahla recently stated that it is "indisputable" that public hospitals require infrastructure repair and investment, the cost of which the Department of Health has estimated at close to R200-billion.

That comment formed part of a response to a written parliamentary question from Economic Freedom Fighters (EFF) MP Suzan Thembekwayo, who wanted to know if the minister had, instead of rushing the implementation of the National Health Insurance (NHI), considered paying attention to the infrastructure challenges instead.

The minister's remarks highlight the state of the public health care sector which is underfunded and under-resourced. This is despite the fact that over 80% of the population relies on government-subsidised healthcare since it is less expensive and more accessible compared to the private sector. Concerningly, the Department of Public Works and Infrastructure recently stated that the country's public healthcare facilities are in disrepair and on the verge of failing.

South Africa has over 3 000 clinics spread across the country, and slightly more than half (55%) of them have ‘ideal clinic’ status. A public clinic with ‘ideal clinic’ status refers to those that have good infrastructure, adequate medicine and supplies, good administrative processes, and sufficient adequate bulk supplies. The situation is significantly worse in rural provinces, with a mere 23% of public clinics in the Eastern Cape, 35% in Limpopo, and 22% in the Northern Cape, enjoying ‘ideal clinic’ status.

When it comes to hospitals, of the 394 public hospitals across the country, only 146, or 37%, attained an ideal hospital status. An ‘ideal hospital’ is a hospital with good infrastructure, efficient patient administrative processes, adequate and appropriately managed staff, provides evidence based clinical, therapeutic and diagnostic services consistent with the defined package of services. Additionally, an ‘ideal hospital’ uses patient experiences, communication and information for continuously improving quality of clinical care, optimisation of hospital processes, finance, system and risks mitigation and management. Unfortunately, 63% of our public hospitals do not meet these minimum standards. The most startling result comes from the Northern Cape, where none of the province’s 15 hospitals attained an ‘ideal’ status.

In the midst of all this the government is proposing to implement the NHI in order to effectively nationalise and monopolise the management of all healthcare in the hands of the state. President Cyril Ramaphosa reaffirmed during the debate on his most recent State of the Nation Address (SoNA) that the government is stepping up efforts to implement an NHI.

Having said that, it is paramount to understand that while there is an urgent need for reform in South Africa's public health system, the NHI's primary goal is not to enhance healthcare, but rather to extend state control over all aspects of healthcare to a minute level. We are already witnessing enormous failures in the public health system; for instance, South Africa is already short of healthcare professionals and NHI offers no credible means of increasing that supply.

All the current problems in both the public and private health sectors in South Africa can only be solved if South Africa becomes innovative in working to provide quality healthcare for all.

In fact, there are numerous reforms that could be made such as the government putting energy on implementing the use of vouchers for poor households, allowing low fee medical schemes to operate, entering into public-private partnerships, allowing more private day hospitals, letting the private sector train doctors, ending cadre deployment at hospitals, stopping corruption in the public healthcare sector and enforcing strict accountability for poor performance.

This is exactly what South Africa needs, rather than continuing to pour money at the country’s profoundly deficient public health system. Nationalising private healthcare will not improve health outcomes and will likely only worsen them.

Written by Tawanda Makombo, an analyst at the Centre for Risk Analysis