“I saw this tiny notice on the School of Economics notice board. Morris Kebble was looking for an economist to do an evaluation of different TB interventions. I had never heard of health economics. But I was fascinated by the idea of applying economic thinking and methods to health.”

A tiny notice: the humble beginning of an illustrious and impactful career for one Diane McIntyre. Along the way she’s added South African Research Chair in ‘Health and Wealth’ and Professor in the School of Public Health and Family Medicine and Executive Director of the International Health Economics Association (iHEA) to her name.

Thirty years later, on the cusp of retirement, Professor Di McIntyre shows no signs of withering fervour. Her spark when talking about ideas and challenging concepts is still as bright as when she arrived to study her BCom at UCT in the 1980s.

“I am a deep thinker and love wrestling with problems. I initially wanted to study medicine but for various reasons was talked out of it into studying a BCom because I loved maths and figures,” she says thinking back to her undergraduate years.

A holiday job at an accounting firm convinced her accounting was not her forte leading to an honours in economics and later a Masters on the economic evaluation of tuberculosis interventions. This prepared her for another fortuitous vacancy, a teaching post in the then Department of Community Health in 1988. The only non-medical post in the Department, it was a tense start particularly since health economics did not exist as a discipline in South Africa at the time.

““Who is this economist who knows nothing about health and nothing about medicine and wants to come in and see if our services are cost effective?” they said. It was a relatively unknown field and thus a lonely existence. I practically had to teach myself health economics,” she adds.

Contrasted with the tumultuous student years, academia was quiet, calm and peaceful. Prof McIntyre settled into teaching, supervising student projects, conducting household surveys, gradually developing ideas into research and set up the Health Economics Unit (HEU) in 1990.

After publishing extensively, starting the HEU and teaching, Prof McIntyre was frustrated at still being a lecturer. At the time the ad hominem process was not clear-cut. One day she walked into the HOD’s office and asked, “What do I have to do?” He said, “You’ve got to play the game.” “Tell me the rules of the game and I’ll decide if I want to play or not!” retorted Prof McIntyre whose zeal has served her well in the academy and as an impassioned universal healthcare advocate.

The rules would later change to include service and policy work as part of one’s career advancement. It is in this area that Prof McIntyre has made a significant and far reaching impact on the South African health system as a health economist. It is also where she would learn another set of rules on how to play a game that is at once rewarding and diminishing.

“There are times when policy work feels like “wow this is really meaningful and exciting!” that you can make a difference and other times it’s incredibly depressing because it doesn’t necessarily turn out as expected,” she explains.

Prof McIntyre has sat on various committees including serving on the Health Care Finance Advisory Committee to the Department of Health of the Government of National Unity, the Minister of Health’s Committee of Inquiry into a National Health Insurance for South Africa and the Medical Schemes Council. She also chaired the Minister of Health’s Medicine Pricing Committee from its establishment in 2003 until 2008 and served on the Ministerial Advisory Committee on National Health Insurance.

There have been many successes. Like when her time in the Healthcare Financing Committee of 1994 led to the introduction of free primary health services. She has also provided extensive input in the construction of the National Health Insurance plan, which she is now critical of, given the latest developments.

“I’m trying to write the magnum opus now that lays out the international evidence and any empirical evidence that we’ve got from South Africa to say there is a very clear evidence base for continuing with the initial route. I don’t see it as my job to challenge what is being put forward now in terms of unpacking the arguments against it. If those who are behind this sudden policy shift really believe that it’s going to take us to a universal health system then the onus is on them to demonstrate to everyone how it will,” she says.

So retirement, what next?

A life in rural Eastern Cape, living simply with rainwater tanks, solar geysers, little gas cookers, catching fish and growing vegetables says Prof McIntyre. She plans to embrace it with both arms knowing there’s an incredible group of health economists who will continue with teaching, researching and mentorship at the HEU.

The HEU has trained a significant number of African health economists and Prof McIntyre hopes to see the number continue to grow to improve capacity in the region.

As she retreats to a lush life by the water and crisp air in the Eastern Cape, Prof McIntyre beams with enthusiasm for herself and the future of the Unit she started twenty-seven years ago. “I am fortunate to retire early and incredibly proud of our team. My colleagues know I am just a phone call away and will be supporting them from afar.”