Sunday Times (Johannesburg) - August 21, 2005
Adele Shevel

Dr Sam Tshabangu, chief executive of medical aid administrator Kwacha and chairman of Sizwe Medical Services, has been in the healthcare environment for more than three decades.

Having run a private practice as a general practitioner in Soweto since 1971, Tshabangu was involved in the very first private hospital for black people (during his first few years as a doctor there were no private hospitals for black patients).

"I've been in general practice all that period. Initially it was a cash practice because there were few or no black people on medical aid. Now 70% or 80% of patients are on medical aid."

The other obvious change witnessed by Tshabangu has been the change in the population's disease profile. "HIV/Aids has changed everything about the way medicine is practised."

Tshabangu was a founding member of Kwacha in 1976 and subsequently began Sizwe Medical Fund and Lesedi Private Clinic (the first private clinic in Soweto).

The key challenge Tshabangu sees in today's environment is to spur access both in terms of rural areas, as well as costs.

"A number of retrenchments mean people are off medical aid and the public sector can't cope. The cost of healthcare is beyond the reach of the ordinary person.

"It's a question of how resources are spent. Too much is still spent on the private sector compared with the public sector."

The rising incidence of HIV/Aids has seen a change in the types of diseases that affect people. "And we've had an invasion from across the borders and can't budget adequately. We keep having an increase of people who need services."

Tshabangu is a member of the black healthcare caucus involved in the drafting of the National Healthcare Charter. He says there are two ways of looking at the charter. On one side the industry needs to be transformed. On the other, people who want to enter the industry say the benchmarks look too challenging.

The draft healthcare charter stipulates that 51% of assets need to be in black hands by 2014. But Tshabangu says the biggest challenge is how to fund black entry into the arena.

"You can't force people to go into an industry but you can make it accessible to them in terms of funding and other resources. You have to treat targets as targets rather than real goal posts. I'm against enforcing some of those things - to say by 2014 you need a certain percentage ownership can cause other problems. It has to be thought through properly. The biggest challenge in the country is still around access to funding and training."

As for the recent momentum in the low-income area, Tshabangu says the sad part of this country is that "unless the government enforces things they don't seem to happen".

He points out that the low-income domain is the only arena that has potential for growth, "but there are no products that are adequately addressing this".

"The ideal would be to have normal business with full participation that reflects the demographics of the country."

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