Excellent Medical Care Must Be Available to All

Dear Fellow South African,

Last week, surgeons at Mankweng Hospital in Limpopo completed a remarkable operation. A team of doctors, nurses and other health workers successfully separated conjoined twins in a complex operation that demanded extraordinary skill and precision. We owe the medical teams that performed the operation, that helped deliver the twins and that are now caring for them our deepest admiration and gratitude.

This achievement is more than a medical milestone. It is proof of what our public health system is capable of. It is a reminder that South Africa possesses world-class medical expertise, not only in the private hospitals in our cities, but also in public facilities serving communities that have historically been neglected and underserved.

It is also the visible outcome of sustained national investment in cultivating medical excellence. This includes heavily subsidising the country’s medical schools, providing study bursaries for needy medical students, and providing on-the-job training through the Internship and Community Services Programme.

And yet, for every story of excellence like Mankweng, we know there are too many South Africans who cannot access the quality healthcare they need and deserve.

Our Constitution guarantees every person the right of access to healthcare services. That right cannot depend on where you were born, how much you earn or where you live. A child in rural Limpopo has the same right to quality healthcare as a child in the suburbs of Johannesburg or Cape Town.

Closing the gap between the constitutional promise of healthcare and the daily lived reality is precisely what motivates the National Health Insurance (NHI). The NHI is more than a funding mechanism. It is a commitment, grounded in our constitutional values, that every South African will have access to quality health services without suffering financial hardship. It is the instrument through which we will ensure that the skills and dedication on display at Mankweng are available to all our people, regardless of their ability to pay.

To realise this vision, we need genuine and sustained partnerships between the public and private health sectors, as well as academic institutions, medical professionals, pharmaceutical companies, non-governmental organisations and communities.

South Africa has a well-equipped and well-funded private healthcare sector, with some of the finest hospitals, specialists and medical technology on the continent. Yet only around 16% of South Africans have access to these facilities. By contrast, the majority of the population, some 84%, uses public health facilities. On average, the amount of money spent each year on a person who uses private health care is around five times what is spent on someone in the public sector.

These two parts of our healthcare system cannot continue to operate in parallel, as if serving two separate nations. They must work together in service of one nation.

There are few people in South Africa who can disagree with this view, and there are a great many role-players who are eager for collaboration. They recognise that there is both a great need and much opportunity to build stronger partnerships in health care.

We should be doing more to share skills and knowledge across the public-private divide, as happens when private specialists contribute time to public hospitals. It means investing in the training and retention of healthcare workers so that public facilities do not continue to lose their best people to private employers or to opportunities abroad.

As we prepare to implement the NHI, we are already making significant investments to strengthen our public health infrastructure. We are building and refurbishing clinics and hospitals, expanding our community health worker programme, working to ensure the availability of essential medicines, introducing digital systems and improving the management of facilities.

At the heart of all of this are the women and men who dedicate their lives to healing others. The surgeons at Mankweng did not separate the conjoined twins for recognition or reward, but because they understood their responsibility as health professionals. We owe it to every healthcare worker to give them the support, tools and working conditions they need to do their vital work.

The great achievement at Mankweng Hospital has shown us what is possible. It has also reminded us of what is necessary: a health system that serves every South African with excellence, compassion and dedication. Equal access to quality health care must be the standard we set and the constitutional promise that we keep.

With best regards

President Cyril Ramaphosa