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Quality Health Care is about Human Rights, Politics and the National Health Insurance

The National Health Insurance requires many building blocks before it can be rolled out. One of these critical building blocks is the programme on the Quality of Health Care, launched in November 2009 by the national Department of Health.

Our 2009 Elections Manifesto and Plan of Action are clear about the need to improve the health of our population, and to improve the quality of the services we provide. This is not because we have not seen this as a priority before - under the ANC we have achieved a major transformation of the highly inequitable health system that we inherited from the past.

We have moved away from the previous race-based and very hospital-centred health-care system, and we have made large investments in improving access, especially where this was very limited - although differences in terms of access for the poor and for rural people are still too large. However, in spite of these best efforts the results we are seeing are still not good enough in terms of improving the health of our population, and there is widespread criticism of the quality of the care we provide.

What is not said often or clearly enough is that the lack of quality in our health services is a violation of the human rights of our people, especially women, rural people and the poor. It is they who suffer preventable and avoidable deaths of breadwinners and loved ones because of poor quality care. The micro-economics of long waiting hours mean that in addition to travel costs, the poor are forced to buy food and other necessities as they wait a full day to be served and discharged. Taking a day off work to go to hospital may mean choosing between losing a day's wages and seeking health care. No wonder some of the employed poor go to hospital when it is too late.

The dehumanising effects of dirty facilities and lack of basic amenities like clean sheets have often caused our people to protest, "We too are human beings!" The middle class and the rich who enjoy private health insurance and care do not have to wait the whole day, sleep in unclean wards and bedding or fear burns, infections or accidents when they are in hospital.

But what exactly do we mean by quality health care and why do we say it is poor?

"Quality" is a very wide term that means many things to many people. One definition of quality is "getting the best possible results within the resources that we have." Even though we recognise that we might need more resources, how well do we use what we have? Other people define quality as "meeting standards", while for others, quality is about meeting the expectations of the different groups of people involved in health care - firstly, the patients themselves and what they expect, but also the health care workers who provide care, and those who fund and manage our services. Quality is in fact all of these things.

Set against this of course, we have many, many public hospitals and clinics that are efficient and clean, where the staff provide excellent care and are trusted and respected by those they care for. Why this difference? How to make this the rule, the norm? This is what we are trying to achieve. How to contribute to the developmental state we all aim for and ensure that we are truly contributing to service delivery for those most in need?

In achieving this, our first priority lies in recognising that health care, and indeed all public service, is based on values of caring, dedication and integrity; and that this has to be led from the top, from our leadership. President Jacob Zuma has clearly stated how critical it is to transform the attitude of our public servants to reflect the values we expect of our services. Internationally, the critical importance of leadership based on such values and supporting them is identified again and again as the most fundamental success factor in ensuring a quality health service.

At a recent "Quality Summit", 300 staff and partners adopted a Declaration affirming their commitment to living and sharing values that made them chose to become health care workers and that make them proud to continue to do this work. They ended by affirming their readiness to
Walk the talk of values and quality
Be care givers
Act in a disciplined manner and instil discipline
Assume their role as quality improvement leaders
This highlights that if we are to serve the public and use public money most effectively, there has to be stronger accountability for how we do our work to meet quality standards - something that has become weakened over time. This requires a clear statement of what is expected of our staff and managers, how they will be measured, and what will happen if they achieve what is expected (the incentives or rewards) or if they do not (the sanctions).

Accountability also requires that any consequences be applied without fear or favour. Strengthening accountability lies at the heart of the focus on improved monitoring and performance management.

Government has developed a set of national core standards that capture the expected performance of a health facility (a hospital, a clinic) that is delivering quality health care. The national standards are intended to cover public and private sectors, primary health care as well as hospitals. They are all expected to ensure they achieve these standards and they will be measured every few years against them as the basis for accreditation; as a pre-requisite for implementation of the National Health Insurance.

Patient rights are the first area, reflecting the expectation that patients are treated with respect and dignity. To those using our public services, the attitude of our staff, the environment within which they are treated and the length of time they have to wait are at the top of their list of expected performance. The second area covers patient safety and good clinical care. It is recognised throughout the world that the unintended harm caused to patients is a significant problem, even in the best healthcare systems. Our system is certainly no exception.

Clinical Support Services which means patient care is done correctly and all medicines and equipments are available for doctors, nurses and other health workers, are essential in the effective diagnosis and treatment of our patients. These first three domains together are what we are about - these are our "core business" of caring for our patients.

The other areas or domains of Public Health, Leadership, Corporate Governance, Operational Management and Facilities Management reflects what we expect managers of health facilities to do to improve the health of the population they serve and not just the sick patients who walk through their doors.

There are two overriding requirements to ensure that we turn around the quality of care in our public health services. The first is that leadership and support systems (such as the clinic committee or hospital board; the top management team and the district or provincial office) must ensure that things get done and that the quality improves. The second is that our staff and all health workers need to have the knowledge and the tools to be able to improve how they do things - and this is what will ensure we can provide quality health care.

Some of us who are members of the ANC and have served in the public health sector for a long time are convinced that while technical solutions are necessary, they are not enough without citizen participation. As leaders and servants of our people and communities, the ANC members and branches have to be at the forefront of supporting South Africans as they assert their right to quality and dignified health care.

The quality project of the department of health gives all of us an opportunity to revive our Health and Education Campaign launched in Kliptown in 2008. At the same time, we will be able to meaningfully participate in the delivering on the ANC 2009 Election Manifesto undertakings and government priority of ensuring A Long and Healthy Life for all South Africans. To do so will require that we form health and education subcommittees at all levels of our constitutional structures.

The life of a branch is in its campaigns. Quality of health care is just the one kind of the campaign that we can adopt to give life to our branches. More importantly, we will be helping to prepare ourselves to more effectively support, advance and defend the National Health Insurance once it is introduced.