Certificate Of Need Analysis

Certificate of need provisions in sections 36 to 40 have existed for 10 years but had not been signed into law until recently. The aim of the provisions is to ensure the equitable spread of health professionals across South Africa. The President of the Republic quietly signed law sections of the National Health Act that prevented doctors and other health professionals from opening private practices where they chose to. This is essence meant that all health professionals wishing to open a private practice or clinic had to apply to the Department of Health for a certificate of need, which will give them permission to work in their chosen suburb. Furthermore, a certificate of need is required when one is increasing the number of beds or anyone
Where doctors fail to obtain the certificate giving them permission to operate a private practise, they could face five years imprisonment or a fine. Even though doctor associations are for the government’s objective of improving access to healthcare all over the country, associations are afraid that the certificate of need will undermine the intended work of the provisions. Their view is that the provisions could be a disadvantage to health providers and patients, rather than fulfilling access to healthcare to all areas whether urban or rural. Representations like SAMA, SADA and SAPPF are already taking initiatives to engage with the government in creating a universally beneficial
The certificate of need is unlikely to manage needed change in the healthcare industry, forcing GPs to obtain a certificate of need will likely make things worse for change that is needed. Certificate of need debates have revealed that doctors do not have the appetite to go and work in underserved rural areas especially if they are forced to go and work there. The Rural Health Advocacy Project is in support of the certificate of need however, there is a greater chance that it will force GPs out of the health system rather than providing for healthcare services countrywide. They also mentioned that the big hospitals will not be in support of this especially if they have to build hospitals in deep rural areas in favour of having a hospital in Fourways or Cape Town’s northern suburbs. On market forces, their view was that high levels of deprivation which is a probable in the rural areas will mean there is no market of medical aids in those areas and leaves no space for out of pocket payments. What is needed is to take a step back and critically analyse why rural healthcare continues to fail in South