Tracey, what is this Pandemic teaching us about Health Equity?

TN. I think what it’s teaching us that at the core of Health Equity is about ensuring that all of us, regardless of who we are in terms of our demographic in terms of our socio-economic class, that all of us have the same opportunity for us to be able to prevent disease. We know that everybody is going to get sick at some point but there are certain things in the way in which we live our lives, in the way in which our communities and society structured that makes some people more vulnerable than others. I think this has been a mirror held to all of us as South Africans, if people didn’t know this and people were not aware, I think all South Africans are now very much aware that there are many communities many people that actually have an unfair distribution and an unfair burden of disease on their side purely because of the socio-economic status or the demographics etc.

I definitely think that this is something that we’ve known for a long time it’s making it very prevalent and it’s making it very visible for everybody, so even those that didn’t know now they can’t say that they didn’t know I think we all know now. And the quest is how do we respond to that? There’s been a lot of emergency response, for example putting homeless people in tents and things like that, you know that’s a short term measure I hope that our government and civil society we are all thinking critically about how these emergency initiatives can cascade into something that is more transformative something that is more sustainable such that after this actually we can say we have managed to change the living conditions of a number of people.

You know sometimes crises gives you the opportunity to innovate, and to think of ways of doing, for example I was surprised to find that some of our people have been crying for water, for years for many months and now Minister Sisulu all of a sudden there are x many JoJo Tanks that can be made available to communities, and there are tanks that can be made available for people to have water. One side I am grateful that is happening but I am asking myself why are we only doing this now. Why did we have to wait for this crisis to happen. Had we made these things available, you know this all speaks to service delivery at some point. People have been crying for housing and water for all sorts of things and there’s certainly and argument that there hasn’t seemed to be enough urgency for these issues to be addresses, in a systematic and a sustained way, because today it’s Covid asazi ukuthi k’sasa kuzobayini, what is going to be tomorrow. We need to really future proof our communities such that whatever is going to comer we give people the best opportunity for them to have the best kind of health and well-being that they can have.

How do you think the face of Activism has changed and how do we need to rethink activism at a time where we can’t even stand closer than a meter to one another?

TN. I think we are very lucky in that we have technology, but also I put a caveat in that saying many of our people don’t have access to data. There’s been a long-standing issue in our South Africa about the price of data in our country, right? And so it’s become a glaring issue that some people, like I’m sitting here in my home I’m on my laptop I have WIFI and I’m connecting to you many South Africans do not have that luxury.

They always say never let a good crisis go to waste and I think this crisis is forcing us as activists to think creatively about how we can work. And I certainly am part of the C19 Peoples Coalition; which is a coalition of maybe 100, probably close to 200 civil society formations/organizations that are working together on this. And we’re working on Zoom, we’re working on WhatsApp and we’re actually getting quite a lot done. I think there are ways in which we could do it. I mean, the ARAB Spring was an example whereby social Media was a huge tool that was used for advocacy.

I think that there are ways and there are things that we can do and certainly activists at moment are using technology. I think that it does not replace that human connection, and I think for me activism is also about Human connection, that this is what we are doing now that is telling us that it is possible for us to connect but I think what it’s telling us is that there are possibilities for us to do things differently.

What do you think of our government’s response to Covid-19?

I was looking at a document from the Oxford University that was profiling a lot of the initiatives that have been done by many countries and they’ve released their first publication, certainly the one that I’ve seen, that had 71 countries on there and it was looking at all the kind of Lockdown initiatives. They developed what they called a stringent index, so from 0 to 100 with 80-100 being the most stringent activities. Our country was in that group of countries with 80-100 stringent activities. Our government has been applauded for making the right decisions to deal with the virus. While the lockdown is a good response, 80% of South Africans earn less than R5000 per month. Many are in informal jobs such as farm work and domestic work and are negatively impacted by the lockdown. I’ve definitely seen a lot of WhatsApp requests for organizations that are distributing foods, distributing essential services. Government and Civil Society, all of us I think are working quite hard to make sure to get these resources to people in need.

Civil Society is responding to the challenges in communities but many organizations feel ghosted by the government because there was this frustration that Government is not bringing civil society around the table for them to be part of the solution. Another example is that the private sector established a solidarity fund to contribute resources into but civil society does not have representation on how the money will be spent or allocated. Civil Society feels that they could have been included in part of the decision making and being part of the solution, because in fact they are the ones who are right there on the ground and working with communities.

Another issue of consideration is the inequities in health  between the private and public sector. Government has been working hard to get the NHI off the ground even before Covid-19.. As far as I understand it, there are about 7000 ICU beds and 5000 of them are in the Private Sector serving less than 20% of the population. My understanding is that our Government is actually talking to Private Sector on how it can have access to their facilities, which is a good step. However, the concern is whether or not the private sector will be charging government for the use of these private health facilities and whether or not they will be charging them private or public rates. I think perhaps our Government could look at this as an opportunity to catalyze the NHI and how we could end up having a pool of Health Services that are available to everybody regardless of how much money you have.

I think that in the Private Sector that’s a huge damelekkie, as they would say here in the Western Cape. As you know we have been on this journey around creating a universal Health System in South Africa because of the inequity between the Public and the private Sector. As far as I understand there are probably around 7000 ICU beds and 5000 of them are in the Private Sector serving less than 20% of the population. The inequity issues around the rational and the reason in our country, and I believe and many people believe we need really need a Universal Healthcare System, I think those inequality and inequity issues, even those issues have come to the fore now because of the Issues. Some countries have even literally taken over the Private Sector and said look Government as the public Sector we are going to do that. My understanding is that our Government is actually talking to Private Sector on how that can be done, but of course there is a concern if the Private Sector now is going to be charging Government for the use of Private facilities, and are they going to be charging them private rates etc.? That’s a concern you know, I think perhaps our Government could look at this as an opportunity to catalyze the NHI and how we could end up having a pool of Health Services that are available to everybody regardless of how much money you have. Unfortunately, information on some of the discussions have been private, it’s only if you are in the know and are part of those circles that you know what’s going on; the rest of us just hear from the media about what’s going on. Certainly I think that’s one of the issues here, yes we’ve got a Private Sector, but Government I mean we are already in junk status as it is we’ve got financial issues, so the thought that we are going to use our limited resources to pay the Private Sector again for them to provide services at a possible much higher rate that we would pay for in the Public Sector is a concern. But as I say, I’m speaking from a place of being ill-informed because I actually don’t know what the discussion the Government is having with the Private Sector and how that’s going to work.