
Photo: Pixabay
South African state hospitals and clinics are the primary healthcare option for millions of individuals without private care. However, the implementation of the National Health Insurance (NHI) Bill could broaden governmental reach into how private healthcare works. Should doctors and patients embrace the NHI, or could it be the straw that snaps the healthcare system’s back?
A state hospital or clinic isn’t as simple as going to the hospital and seeing the doctor for your ailment. Instead, the experience becomes a pilgrimage that requires the allocation of a whole day. You will inevitably get up before dawn and use the earliest mode of transportation, arriving at the hospital just in time to join people who arrived the previous day. Here’s a closer look at South African state hospitals from the inside.
State hospitals in the headlines
Healthcare is a gamble, and it’s impossible to judge all state (or private) hospitals the same way. The quality of care should be standard; however, it’s easy to determine that this isn’t the case at every hospital you could visit. A Johannesburg state hospital received positive feedback from a patient after his heart surgery in 2024, according to Bhekisisa. However, in the Free State, patients protest over delayed surgeries, and in the Northern Cape a prominent psychiatric facility is under serious scrutiny.
According to Daily Maverick in 2022, state hospitals in Nelson Mandela Bay buckled under resigning doctors. Business Tech reports that many doctors and healthcare professionals are leaving their posts, still in 2024, citing the NHI as one of their concerns. The proposed NHI gives more authority to the government and lessens choice for private citizens. For doctors, it might force a higher workload with less money to take home for their knowledge. For a second, imagine that your overworked heart surgeon is worried about their bills while working on your aorta.
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Most people agree that healthcare should be accessible, but the NHI, placed on a system that’s already overwhelmed, has to make us ask: at what cost – and should we trust the government, as the Pink Floyd song might have ironically suggested?
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Most people agree that healthcare should be accessible, but the NHI, placed on a system that’s already overwhelmed, has to make us ask: at what cost – and should we trust the government, as the Pink Floyd song might have ironically suggested?
Clinics and hospitals
Clinics and hospitals both cater to healthcare needs, but they aren’t the same thing. For a brief summary, the nearest clinic tends to the most basic healthcare needs (like contraceptives and basic medication), while the provincial hospital deals with surgeries, appointments and emergencies.
I learned the difference when I had a nasty cut in 2023 – after misjudging distance and leaning through a window – and walked to the nearby clinic. “Unfortunately, you’ll have to go to hospital,” the staff said. “The clinic can’t do that.” However, when I visited a hospital in 2024, I was referred to the clinic: “Do you have a file at the clinic? You’ll have to start there and get a referral.”
As a patient, you want to have the ideal location for dealing with your potential illness or emergency figured out before it arrives. When you aren’t feeling well, it becomes harder to navigate the healthcare system’s paperwork, and most people visit state healthcare facilities in groups for safety, security and reassurance.
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Make sure you know the difference between your nearest clinic and the hospital, and what they are equipped to treat.
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Make sure you know the difference between your nearest clinic and the hospital, and what they are equipped to treat. Visit them at least once when you are healthy, open your file, and have it ready in case of an emergency. The file contains all essential patient data, though it isn’t sent around by email or fax. Patients manually collect their file and carry it to the next appropriate department.
Yes, state healthcare is inconvenient – both for the overworked staff and for the overwhelmed patients. During several trips accompanying others, I have seen hospitals understaffed or pressured enough for patients to assist the next patient when staff are occupied elsewhere. However, in most cases, it’s not that the staff in state hospitals don’t give a hoot, but that they are dealing with dwindling resources, sometimes as the nasty after-effects of corruption.
The triage system and the hospital diet
Emergencies are graded according to the triage system, in which a patient is colour-coded according to their symptoms on arrival. Emergencies needing immediate attention are considered higher priority – like a car accident victim, versus someone seeing a doctor for flu. Should anyone start bleeding, stop bleeding or lose consciousness, their classification might change and the patient may be bumped up to the next level. While the triage system is an effective means of emergency assessment, in an overworked environment, it means that the initial assessment could take long enough to worsen a patient’s condition.
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Emergencies are graded according to the triage system, in which a patient is colour-coded according to their symptoms on arrival. Emergencies needing immediate attention are considered higher priority – like a car accident victim, versus someone seeing a doctor for flu.
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When a patient whom I was accompanying to hospital, was seen by a doctor after waiting approximately eight hours, the doctor turned to me and asked: “In your professional opinion, is this blood?” I nodded, and it became apparent that the initial assessment had missed the symptoms of an internal haemorrhage. While the patient had expressed their concerns to the assessing nurses, the message had taken a particularly long time to travel up the command chain.
However, that wasn’t the most surprising part of the visit; according to the hospital, they were unable to cater to the patient’s dietary needs or allergies. With special arrangement, the patient was allowed food in their ward for the duration of their stay. Should healthcare institutions be able to provide basic food that suits their patients? In this particular case, apparently they could not, and I found myself bringing extras for patients who couldn’t afford to. State hospitals (mostly) feed their patients, but there is a clear gap that shouldn’t exist between funding and providing care. The majority of waiting patients will bring food for the queue; before someone is officially admitted, they aren’t yet a patient and there’s no way of telling how long you might wait on a busier day.
If you don’t know, ask
The power of asking can’t be underestimated in a state hospital, and the most useful answer doesn’t always come from hospital staff, but from patients who have been waiting longer than you have. Communication is lacking in state institutions, and staff are often so busy dealing with emergencies that there isn’t time to stop. If someone seems abrasive, assume they are busy and hope you can find the next person in charge. Unless you ask someone (or see a poster explaining your question), you aren’t going to know what the heck is going on. For example, you might find yourself waiting in the wrong queue for several hours. “Oh, you were looking for the admissions desk? This is the pharmacy queue.”
Should communication be the patient’s burden? Many people, when sick, might be unable to explain (or remember) their symptoms. That is why most people visiting hospitals will bring someone to accompany them – though it should also be pointed out that many patients I have witnessed aren’t so lucky and sit waiting alone.
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If the patient had proceeded with the uncorrected file, one can assume that the lack of double-checking could have led to other issues, including incorrect dosages – small errors in a high-pressure system could lead to huge mistakes.
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The lack of communication, unfortunately, can also translate to misunderstandings between doctors and nurses. During a 2024 clinic visit, a patient noticed that their height and weight was written down wrong during the initial assessment. If the patient had proceeded with the uncorrected file, one can assume that the lack of double-checking could have led to other issues, including incorrect dosages – small errors in a high-pressure system could lead to huge mistakes.
Posters in the clinic encouraged a visit to the office of the CEO, whose face and contact details adorned the walls alongside other important contacts. (No, their numbers don’t work and the phone lines are down, so call the switchboard or their personal number.) Frustration often peaks in state institutions, because there’s a point where it feels like nobody is listening. Eventually, someone will, but most patients don’t like to hear the word “eventually” in the context of their medical care.
When we visited the clinic’s higher-up-in-charge, she corrected the file and said: “Mind your language, please.” I kindly responded, “Do you have any fucking sensitivity training?” Eventually, the patient was examined and referred to the pharmacy. However, instead of receiving their long-term heart medication, which was partially the appointment’s purpose, they were prescribed Painblok. An appointment with a private doctor was made, and it took less than 20 minutes to obtain the correct medication. Should NHI really bring this type of healthcare to everyone?
Bring your own ... everything
Some state hospitals require more preparation than the average private hospital visit. The simple answer is that the luxury of canteens and coffee shops doesn’t branch into the governmental healthcare system.
When the unnamed state hospital was unable to provide food to patients, this was whispered in corridors between staff members. While there was supposed to be a canteen in the hospital, for undisclosed reasons it was closed. How well would you be able to concentrate on patient needs if you had not yet eaten that morning?
If you’re lucky, you might find stalls selling fruit, chips and drinks outside the hospital. Sometimes, around the corner, you may also find a traditional shisanyama serving up chicken feet. If you’re even luckier, you can afford it – most patients don’t visit a state hospital with packed wallets, and would get robbed if they did.
Private hospitals give patients one more luxury: privacy. The kind of privacy where their phones, bags and other personal items can stay secure. An important lesson that you might learn from public hospitals is that you should never leave anything standing around unattended. Bringing another person is just as much for security as it might be for reassurance.
The proposed NHI
The proposed NHI could add more pressure to the public healthcare system than it can handle. While it aims to make healthcare accessible to everyone, it doesn’t guarantee that public healthcare systems are improved before this happens. For often overworked and underpaid staff, the proposed NHI could be the “last straw”, echoing through the private and public healthcare systems. The NHI appears to say, “Let’s increase the burden on everyone,” more than it yells access to quality healthcare for the entire country.
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Die Nasionale Gesondheidsversekeringswet: ’n onderhoud met ’n prokureur