The Rainbow Nation shimmered with pride and achievement during the 2010 Fifa World Cup.
Now many are asking if the same approaches can be used to deal with the country’s problems. Can we reduce crime and unemployment or fix the ailing healthcare system by deploying the same strategies that earned us universal acclaim in July?
Can headlines about a sick toddler dying on his granny’s back after being turned away from three clinics, or of infants succumbing to infections acquired in overcrowded hospital wards, be banished? What was the secret of our World Cup success?
More than anything, there was a political will to succeed. The government offered bold leadership, there were clear delivery targets for new projects such as stadiums, airports and transport systems, with money found to finance these (including private-public partnerships).
Fifa demanded accountability and millions of ordinary citizens got involved whether as fans, spectators, volunteers or service providers. The same ingredients can be used to secure health for all, particularly children.
The delivery of first-class healthcare demands political will, leadership, organisational capacity, fiscal resources, established norms and standards, clear targets and, most of all, accountability. Citizens too have a role — whether as consumers or providers of healthcare, or as advocates and activists for adequate health services in their own communities.
South Africa is one of only 12 countries in the world where more young children are dying now than 20 years ago. Much of the blame for this has been placed on the lacklustre leadership in the health sector, particularly in managing the HIV/Aids pandemic.
Leadership in health is required at all levels, from national and provincial heads to hospital and district managers, and ultimately from the people in charge of individual healthcare units. Regrettably, whether from a lack of training, inadequate experience, indifference or fear of recrimination for showing initiative, many leaders have preferred to embrace inertia and a culture of mediocrity rather than championing change.
The prevention and management of child malnutrition and the delivery of primary care to children through the integrated management of childhood illnesses strategy are two examples of national priority health programmes that have failed to translate policy into practice, primarily because of poor leadership.
If South Africa is to meet the child millennium development goals by 2015, it will have to commit more resources to children’s health. Although significant sums of money could be harnessed simply through better organisation and delivery of healthcare, more fiscal resources are needed.
More than R8-billion has been promised by the government to renovate five major hospitals around the country before 2014, mainly through public-private partnerships. An investment of R30-billion (the amount spent on the World Cup) could save the lives of more than 100 000 children in the next five years.
The argument that the extent of the financial gains accrued from hosting the World Cup will emerge only in the next five to 10 years is similarly true for investing in child health — healthier children today make for healthier adults to power the economy in the future.
While Fifa demanded compliance and accountability, healthcare managers and individual practitioners have little reason to fear the consequences of poor performance. The national health department has regularly failed to meet its own child-health targets, and there are no norms and standards by which to measure the performance of hospitals and clinics.
Withholding individuals’ performance bonuses may be effective in fostering accountability. Patients often describe their public health providers as indifferent, impatient, uncaring and lazy, yet the World Cup brought the goodness in South Africans, including public officials, to the fore.
One wonders what it would take to get health staff to offer the same warmth and courtesy to their patients. Enticing volunteers to help out in hospitals, clinics and their own communities would also have benefits, if we could only make child health seem as sexy as getting involved in the World Cup.
Resources, energy and creative thinking are required to transform our large, inefficient and overburdened public healthcare system. We know what is needed to achieve better health outcomes for children.
However, catalysing the kind of action, commitment and groundswell of support that we saw with the World Cup on a sustained basis requires something more. How to unleash this potential is a secret the country desperately needs to unravel.
Haroon Saloojee is head of the Division of Community Paediatrics at the University of the Witwatersrand and a contributor to the South African Child Gauge 2009-2010, which was released this week by the Children’s Institute at the University of Cape Town