TRC Final Report

Volume 5

Chapter 8

Subsection 23

■ THE HEALTH SECTOR

79 Millions of South Africans were denied access to appropriate, affordable health care during the period under review. Health care workers, through acts of commission and omission, ignorance, fear and failure to exercise clinical independence, subjected many individuals and groups to further abuse. Fundamental reforms in the health care delivery system, legislative controls, monitoring and accountability mechanisms, and the training of health professionals are required.

Legislation

80 The Commission recommends that:

ALL LEGISLATION PERTAINING TO HEALTH CARE FOCUS ON PRIMARY HEALTH.

PRESENT HEALTH CARE LEGISLATION BE REVIEWED, AND FUTURE LEGISLATION DEVELOPED, TAKING INTO ACCOUNT THE NEED FOR TRANSPARENCY, EVALUATION AND MONITORING, THE RIGHTS OF SERVICE USERS AND THE PRIMACY OF CONFIDENTIALITY.

Professional standards of conduct

81 The Commission recommends that:

A UNIFORM CODE OF CONDUCT FOR HEALTH PROFESSIONALS BE DEVELOPED, IMPLEMENTED, AND TAUGHT IN ALL HEALTH SCIENCE FACULTIES.

THE STATUTORY COUNCILS ENSURE THAT ALL HEALTH PROFESSIONALS REGISTERED WITH THOSE COUNCILS ARE FAMILIAR WITH THE PROFESSIONAL STANDARDS TO WHICH THEY MUST ADHERE. HEALTH PROFESSIONALS MUST BE HELD ACCOUNTABLE IF THEY VIOLATE THESE STANDARDS.

HEALTH PROFESSIONALS ENGAGE IN “SELF-AUDITS” OF THEIR PROFESSIONAL CONDUCT BY MEETING REGULARLY IN SMALL FACILITATED GROUPS TO DISCUSS ETHICAL AND HUMAN RIGHTS DILEMMAS.

Training

82 The Commission recommends that:

HEALTH SCIENCE FACULTIES ESTABLISH PROGRAMMES AIMED AT INCREASING THE NUMBER OF BLACK UNDER- AND POSTGRADUATE STUDENTS. THIS MAY REQUIRE BRIDGING PROGRAMMES, FINANCIAL ASSISTANCE, TUTORS, MENTORING ETC.

TRAINING IN HUMAN RIGHTS BE A FUNDAMENTAL AND INTEGRAL ASPECT OF ALL CURRICULA FOR HEALTH PROFESSIONALS. THIS TRAINING SHOULD ADDRESS FACTORS AFFECTING HUMAN RIGHTS PRACTICE, SUCH AS KNOWLEDGE, SKILLS, ATTITUDES, AND ETHICAL RESEARCH PRACTICES. KNOWLEDGE OF AND COMPETENCE AND PROFICIENCY IN THE STANDARDS (BOTH NATIONAL AND INTERNATIONAL) TO WHICH DOCTORS WILL BE HELD ACCOUNTABLE SHOULD BE A REQUIREMENT FOR QUALIFICATION AND REGISTRATION

THE CONTENT OF THE OATHS PERTAINING TO HEALTH CARE AND THE ETHICAL PRINCIPLES EMBODIED IN THEM BE TAUGHT AS PART OF UNDERGRADUATE TRAINING FROM THE EARLIEST OPPORTUNITY POSSIBLE. THIS FACILITATES AN INTERACTION WITH THE PRINCIPLES ESPOUSED AND AN OPPORTUNITY TO QUESTION AND IMPLEMENT THEM DURING THE TRAINING PERIOD.

CONTINUING MEDICAL EDUCATION PROGRAMMES INCLUDE A REVIEW OF HUMAN RIGHTS AND ETHICAL ISSUES AND DEVELOPMENTS.

Safeguards for vulnerable health professionals

83 In order to ensure that health professionals who work in situations in which they have dual loyalties are not complicit in committing human rights abuses, the Commission recommends that:

APPROPRIATE ONGOING TRAINING IN INSTITUTIONAL HEALTH CARE AND HUMAN RIGHTS BE MANDATORY FOR ALL HEALTH PROFESSIONALS WORKING IN PUBLIC FACILITIES.

TRAINING BE DEVELOPED FOR NON-MEDICAL PRISON STAFF, SANDF MEMBERS AND POLICE, TO FACILITATE A MUTUAL UNDERSTANDING OF THE DUTIES AND OBLIGATIONS OF HEALTH PROFESSIONALS WORKING IN THOSE ENVIRONMENTS. THIS WILL SUPPORT PROFESSIONAL AND ETHICAL HEALTH PRACTICES.

STANDARDS AND NORMS THAT UPHOLD HUMAN RIGHTS BE DEVELOPED FOR INSTITUTIONAL HEALTH CARE. THESE NEED TO BE PUT INTO OPERATION VIA REGULAR INDEPENDENT AUDITS.

THE DEPARTMENT OF HEALTH ASSUME DE JURE AND DE FACTO CONTROL OF PRISON AND DETAINEE HEALTH CARE, MILITARY HEALTH CARE, STATE MORTUARIES AND FORENSIC SERVICES. (THOSE RESPONSIBLE FOR FORENSIC SERVICES SHOULD NOT ALSO BE RESPONSIBLE FOR PROVIDING HEALTH CARE TO PRISONERS AND DETAINEES, AS IS PRESENTLY THE CASE.) IN OTHER WORDS, HEALTH PROFESSIONALS WORKING IN THESE ENVIRONMENTS MUST BE EMPLOYED BY, REPORT TO AND BE PROFESSIONALLY ACCOUNTABLE TO THE DEPARTMENT OF HEALTH.