If we can use an analogy to describe how we need to approach fixing South Africa’s health system.

If our national health system was a road:

• We would all agree that the road must service everyone in the country.
• We would all agree that there should only be one road - we need to stop seeing public and private separately but see them as one system that is interlinked.
• We would all agree that the road must serve the needs of all our people – whether they rely solely on the public system or choose to spend their hard- earned after tax cash on private health.
• We would all agree that we should all work together to make the road work as best it can.
• We would all agree that we would like to be proud of our road when compared to other countries
• We would all concede that currently our healthcare road has many “potholes”.
• We would all agree that fixing the “potholes” is important, even if a new fancy financing model looms on the horizon.

As New York City showed, fixing broken windows, one at a time can heal a city. Maybe by fixing one “pothole” at a time we can improve the healthcare provided to each and every South African.

The OMRC dialogue platform is targeted at clinical practitioners.

• We must never forget that without clinical practitioners we have no health system. Without clinical practitioners, patient care will suffer.
• We have to ensure that the working conditions for clinical practitioners remain conducive of professional practice.
• We have to ensure that clinical practitioners are recognised and rewarded. Stakeholders need to be reminded that without clinical practitioners there is no health system.

But that said, as clinical practitioners we have a responsibility to build a health system that works for us and our patients. We have the responsibility to improve the system. We need to be part of the solution and take charge of improving patient care.

Put differently, we need to identify potholes and fix them. Those potholes that we can’t fix ourselves need to be escalated to the agencies responsible with demands for action.

We should not be complicit in allowing potholes to jeopardise the health of the nation. That said, we cannot afford not to be activists in this regard.

The idea to convene the OMRC dialogue platform stemmed from three concerns.

1. Firstly, that despite the Health Market Inquiry (HMI) final report being published several years ago (September 2019) that listed an OMR framework as critical to our health system, no meaningful progress has been made to develop a national OMR framework and / or convene any national OMR projects.
2. Secondly, the complacency and belief amongst many stakeholders that we can relax as NHI is coming and at the “wave of this magic wand” the nation’s health care problems will be sorted out.
   NHI is unlikely to be a “silver bullet” or “wonder drug” that will sort out our health systems. While additional financing can improve health systems, this will only happen if expenditure on scarce resources is used effectively. OMR needs to play a prominent role in monitoring resource use and resource allocation.
3. Thirdly, that experts in OMR seem to agree that outcome measurement must be driven by clinical practitioners and must not be subject to government interference and commercial influence, so that if we wait for government and / or funders to start the process, clinical practitioners will not be able to drive and control the OMR process.

We hope that the OMRC dialogue platform will help ensure that all Southern African OMR projects are driven without being compromised by political and commercial influence.