Every year, governments, companies, and we miss deadlines. Usually, the consequences are manageable. A report is submitted late, a project is delayed, a meeting is rescheduled, an apology is offered, and perhaps there is some minor embarrassment, but life moves on.
In public health, the consequence is usually avoidable deaths. That may sound dramatic, but it reflects a fundamental difference between healthcare and almost every other sector of society.
Public health is a struggle against biology and nature, and they do not negotiate deadlines. Viruses do not wait because a pandemic preparedness plan has been delayed. A child’s brain does not postpone its development while a nutrition programme awaits funding. HIV does not delay progressing to AIDS because we put off going to see a doctor. Disease continues to keep time, irrespective of whether we do.
That is why timeliness matter so much in health. A condition that could have been prevented becomes one that requires treatment. A treatable illness becomes a chronic condition. A manageable outbreak becomes an epidemic. A workforce shortage that could have been anticipated becomes a national crisis.
Perhaps this explains one of South Africa’s greatest public health paradoxes. We are not short of policies. We are not short of strategies. We are not short of frameworks, plans, declarations or ambitious targets. Many of them are thoughtful, evidence-based and internationally respected. Yet plans do not improve health. Implementation does, and implementation is usually only effective if it happens on time.
Too often we celebrate the launch of an initiative as though the difficult work has already been done. The strategy is unveiled. The task team is established. The implementation plan is approved. The media statement is issued.
But public health is not measured by what we promise. It is measured by what we deliver before the opportunity to prevent harm has passed. That is why implementation should never be regarded as an administrative exercise. It is the point at which policy either becomes
better health, or another missed opportunity.
Public health does not fail because we don’t know what to do. It fails because we do not do what we already know – on time.
None of this should be interpreted as criticism of policies and politicians alone. One of the enduring lessons of public health is that health is produced by society, not by the health sector in isolation.
Policymakers are responsible for setting priorities, allocating resources and ensuring effective oversight.
Managers are responsible for turning policy into functioning systems, monitoring progress and correcting problems before they become crises.
Healthcare professionals are responsible for diagnosing early, following up on abnormal results, promoting prevention and speaking up when patients are placed at unnecessary risk.
Communities strengthen health by supporting vaccination, creating safer neighbourhoods, protecting vulnerable people and demanding accountability when promises are not honoured.
Individuals have responsibilities too. Attending screening appointments. Taking medication as prescribed. Seeking help early. Looking after their physical and mental health.
Every one of these responsibilities has a deadline, not a guideline. When deadlines are missed, they create a deadly cascade.
A delayed procurement becomes an empty pharmacy shelf, an empty shelf becomes interrupted treatment, interrupted treatment becomes a hospital admission, and a hospital admission becomes pressure on an already stretched health system.
The true measure of a health system is not whether it eventually responds, it is how quickly it responds while prevention is still possible. This is where health systems succeed or fail.
Public health has long recognised a deceptively simple principle: you need to ask the question, “Did we actually do what we said we would do, when we said we would do it, and to the standard we promised?”
Health systems do not fail because they lack plans. They fail because they lack the discipline to turn plans into timely action. That requires something many institutions still struggle to embrace. Implementation must be monitored continuously, not reviewed retrospectively. Warning signs should trigger action, not explanation.
Deadlines should trigger intervention before they become headlines.
When it comes to health, either our own or that of our community, we must always remember disease continues to keep its own time, and if left uninterrupted, it never misses a deadline. A missed deadline inevitably starts a countdown that will lead to unnecessary deaths somewhere down the line.
• Dr Wolvaardt is the founder of the Foundation for Professional Development and has recently stepped down as managing
director.
- Every year, governments, companies, and we miss deadlines.
- Usually, the consequences are manageable.
- A report is submitted late, a project is delayed, a meeting is rescheduled, an apology is offered, and perhaps there is some minor embarrassment, but life moves on.
- In public health, the consequence is usually avoidable deaths.
- That may sound dramatic, but it reflects a fundamental difference between healthcare and almost every other sector of society.
