South Africa – Health – Union initiative transforms Soweto hospital

Authors: 
David Hall
Date published: 
Jul 2010

Only about 15% of South Africans are covered by medical aid schemes, but they get nearly half of the healthcare spending in in the country, including subsidies and tax relief.  The great majority rely on public sector healthcare, which has less money.

The system is dominated by an oligopoly of powerful private companies - the largest, Netcare, also operates internationally, owning the largest private hospital group in the UK.  The private sector systematically exploits the opportunities to profit from the public healthcare system, as well as the private market, by running some hospitals for the public sector on a contractor basis. The quality of service in the contractor hospitals is worse than the public hospitals: contractors limit their expenditure on staffing and equipment and supplies, to the point of failing to meet public sector standards. But the public hospitals have also been starved of funds and resources, and there are frequent breakdowns of service.

The health workers’ unions, led by NEHAWU, played a central role in improving the standards of care at the the largest hospital in the country, the Chris Hani Baragwanath Hospital in Soweto. By the late 1990s, there was not only a lack of resources, but the management system had effectively broke down. The unions responded  by approaching , the National Labour and Economic Development Institute (NALEDI), a research and policy institute established by the South African trade union federation COSATU. The objective was to transform Chris Hani Baragwanath into: “a ‘People’s Hospital’ which would improve the quality of health-care service as well as the quality of working life for union members.” NALEDI worked with unions, management and staff to develop a new integrated structure based on a team-working approach involving all categories of staff.

With the support of the trade union federation, COSATU, the South African government is now attempting in 2010 to introduce a new National Health Insurance system, which will help finance free public healthcare. As in the USA, the entrenched private interests have applied pressure to ensure they can still profit from the system, Netcare, for example, is already advocating the extensive use of PPPs to provide hospital development schemes   government effectively has to negotiate the new arrangements with

Sources and further reading