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2019/07/282019/07/02 04:02 PM
President Cyril Ramaphosa says the strategy to revise the National Health Insurance (NHI) detailed plan of implementation is at an advanced stage. He said the plan includes accelerating quality of care initiatives in public facilities, building human resource capacity, establishment of the NHI Fund structure, and costing the administration of the NHI Fund.

Presenting the State of the Nation Address (SoNA) to a joint sitting of Parliament recently, President Ramaphosa said government will attend to the health of the nation to improve the quality of life of South Africans, reduce poverty in all its dimensions, and strengthen the country’s economy. “We must attend to the capacity of our hospitals and clinics. An 80-year-old grandmother cannot spend an entire day in a queue waiting for her medication. An ill patient cannot be turned away because there is a shortage of doctors and nurses… A woman in labour cannot have her unborn child’s life put in danger because the ambulance has taken too long to come,” President Ramaphosa said. As part of the work that must be urgently done to improve the quality of the health system, the President announced that government is finalising the Presidential Health Summit Compact, which draws on expert insights, and will mobilise the capabilities of all key stakeholders to address the crisis in the State’s clinics and hospitals. Meanwhile, President Ramaphosa has raised concerns about increase in HIV infection rates, particularly among young women, and the relatively low numbers of men testing for HIV and starting treatment. He said government will intensify its work to implement the 90-90-90 strategy to end HIV as a public health threat, which includes increasing the number of people on treatment by at least another two million by December 2020.
  
2019/07/28
2019/07/02 04:04 PM
More than 25 years into the democratic dispensation, South Africa is still failing to provide a comprehensive healthcare package to all its people. In the Eastern Cape, the implementation of access to quality healthcare is inhibited by; inter alia, poor or no infrastructure. Where the government has attempted to bridge the gap between.com munities and primary health care facilities through the distribution of mobile clinics, these mobile clinics are not reaching the communities they are supposed to serve and members of the population, who live more than 5kms from a hospital or clinic, still do not have access to primary health care services. Healthcare is an affirmed right.

Section 27 of the Constitution guarantees this right and places an obligation on the Government to take legislative and other measures to progressively realise this right within its available resources. The Eastern Cape Department of Health ECDoH , in the year of the 6th administration, must ensure that this right is realised. This must be done by exercising sound financial administration, through a clear outline of their strategic plans and through a continued analysis of any failures to achieve their strategic plans, more so if they lead to service delivery failure. Lack of accountability and public engagement are examples of poor transparency.

The ECDoH received an appropriation of R 23.7 billion for the 2018 19 financial year. The department's budget allocation was adjusted in the amount of R 24.0 billion with a further projected estimate of R 24.5 billion. In the 2017 18 financial year and in the departments third quarter, the department had spent an amount of R 5.9 billion. By the end of the fourth quarter, the department had failed to utilise the entirety of its allocated budget.

The Department is recorded as having spent R 6.1 billion in the third quarter of the 2018 19 financial year, 2% more than it spent in the third quarter of 2017 18. It is unlikely that the department will spend the entirety of its revised estimated budget by the end of the fourth quarter according to its spending patterns. This may result in further underspending by the department, which may result in the inability of the department to spend its budget effectively, efficiently or appropriately. In the Eastern Cape Provincial Development Plan, the Premier, outlined critical health system challenges. These include a dysfunctional health system, socioeconomic conditions, limited financial resources and poor management, dilapidated health infrastructure along with the rural conditions of the province and inaccessibility in some areas, which leads to difficulty in providing healthcare services, poor infrastructure and dispersed settlements.

It is concerning that four years after the Provincial development plan was introduced, many of the challenges faced by the health system have not changed. Primary healthcare is the closest link to the community and as such, the best avenue to respond to the healthcare needs of the community in preventing further ill health. The Eastern Cape has the second lowest primary healthcare expenditure with Limpopo province having the lowest. To improve primary health care to overcome the challenges outlined in the Provincial development plan, there needs to be an improvement in the equity and efficiency of resources. During the 2017 18 financial year, the Eastern Cape Department of Health reported that the Emergency Medical Services programme had spent R 1 million, 99.9% of its budget for emergency transportation but failed to reach their target to respond to emergencies under 40 minutes in rural areas, the areas that need them the most. In planning and budgeting for the EMS programme, it is imperative that the ECDoH to take into consideration factors such as population migration, the number of children born, and the standard for emergency medical service ambulances outlined in the 2017 Emergency medical service regulation.

The Province needs an adequate number of EMS ambulances and staff to ensure that no one is denied EMS services. During his 2019 State of the Nation address, the President informed the nation that the NHI detailed plan of implementation is in a stage of advanced revision. During this time, it is incumbent on the ECDoH to create platforms to disseminate information surrounding the NHI Bill and what it will mean and to what extent it will affect the citizens in the province. We acknowledge that the ECDoH, as part of the 6th administration, come into office to inherit a state of healthcare in crisis and that they bear a heavy duty of creating institutional frameworks to address the current state of healthcare in South Africa in hopes of making it more equitable to all. In doing so, the department must endeavour to be transparent in its planning and use of public funds.

Tlamelo Mothudi is a health researcher at the Public Service Accountability Monitor PSAM Public Service Accountability Monitor.
  
2019/07/272019/07/02 03:44 PM
National Education, Health and Allied Workers' Union (Nehawu) convened its policy conference on Wednesday. The aim of the conference is for the union to decide on its approach to the government’s plans and President Cyril Ramaphosa's State of the Nation Address (Sona).

To discuss the conference, Ray White on the Xolani Gwala Show chats to union spokesperson Khaya Xaba. He says the union is happy with Ramaphosa's announcement of the implementation of the National Health Insurance (NHI).

We are happy that he spoke on the urgent implementation of the NHI as we have been advocating it for the past 20 years.
— Khaya Xaba, Spokesperson – Nehawu
  
2019/07/272019/07/02 03:47 PM
National Health Insurance (NHI) will happen, and the legislation governing its implementation and funding will go to Parliament soon, said the newly appointed health minister, Dr Zweli Mkhize. “Equally importantly, making progress towards universal health coverage requires transformation of the health system and reconfiguration of institutions for pooling of funds and purchasing of services to achieve social solidarity, efficiency, effectiveness and income and risk cross-subsidisation. In this regard we will be moving speedily to ensure that NHI Bill is tabled in Parliament," he said in a debate on the State of the Nation Address.

Yet, despite these promises of universal health coverage, the public health sector is plagued almost daily with reports of drug stock outs, staff shortages and lack of funds and security. “The NHI Fund requires strong governance mechanisms and improved accountability for the use of allocated funds. These provisions have been included within the structural design of the NHI Fund and they are reflected within the NHI Bill,” he added. “The unresolved issues of unaffordable private healthcare and poor levels of service delivery in the public sector have impacted negatively on our national healthcare system resulting in our inability to ensure that all South Africans have access to quality healthcare based on need and not on their ability to pay," Mkhize said. South Africa spends almost 8.6% of the Gross Domestic Product (GDP) on health care, which is comparable to other middle-income countries with 4.1% of the GDP spent on the uninsured population. Private medical schemes cover approximately 16% of the population, with most of the principal members of these schemes working in the formal sector.

An estimated 4.4% is spent on 16% of the population covered by medical schemes and who in the main access their health care services in a costly private sector. In this regard, a smaller percentage of the population pay-out-of-pocket to use the private health sector. Dr Mkhize said out-of-pocket services are rendered in both the public and private healthcare sectors - estimated at 0.6% of GDP or 8% of total health expenditure - which remains a burden to many poor households.

“This Government is determined to end these inequalities and bring quality healthcare to all as demonstrated by the establishment of the War Room in the Presidency. The president has been a champion of universal health coverage through the National Health Insurance,” he said. The implementation of the NHI is aimed at moving South Africa closer towards universal health coverage, wherein all citizens irrespective of their socio-economic status will be covered to receive quality healthcare services based on their health needs. Nonetheless, lack of staff, ARV and other drug stock

“It has to be supported by a quality health system. National Health Insurance is therefore a health financing system that is designed to pool funds and to use these pooled funds to actively purchase health services for the population based on the principles of equity and social solidarity. These pooled funds will provide for universal access to quality, affordable health care services for all South Africans irrespective of their socioeconomic status and I repeat, not on their ability to pay,” he said.

Plan to deal with queues at healthcare facilities

Mkhize said, meanwhile, that government’s analysis has shown that the majority of patients who visit public healthcare facilities do so only to collect chronic medication. “We will reduce the long waiting times in the public healthcare sector by improving the efficiency of the system such that those patients that are stable chronic patients who only visit a facility to collect their medicines can collect these medications from a point close to their home.
He also said that the stock visibility system has been implemented to monitor and address medicine availability. “The system will be strengthened by ensuring that district pharmacists, district managers and provincial pharmaceutical services monitor the availability closely and respond urgently when there is the non-availability of medicines,” he said
  
2019/07/262019/07/02 03:29 PM
Extract

SA’s longest-serving leader of the opposition, Sir De Villiers Graaff, had a handy solution to the numerous crises faced by his United Party (UP). “When in doubt, Div would appoint a committee,” one of his confidantes once told me. That worked until it didn’t and the UP dissolved itself, appropriately perhaps, on a Johannesburg ice rink way back in 1977.

There was something of the Sir De Villiers Graaff approach in the most recent state of the nation speech of President Cyril Ramaphosa, under scrutiny this week in parliament. While I was watching Ramaphosa last Thursday, and before my wife took the remote and insisted we watch real dystopian fiction in the form of the latest episode of The Handmaid’s Tale, I counted no fewer than nine commissions, panels, committees, summits and councils announced, or reannounced, by the president. I was advised last week, by one of his aides, that Thursday’s speech “would undergo eight or even nine redrafts, before he is satisfied”. A pity then that none of the nine committees was axed in redrafting, or no-one thought to insert the file heading for which Winston Churchill achieved fame during wartime, namely “Action This Day”.

Instead, for every one of the challenges, or crises, confronting the country there is a bureaucratic solution: of the biggest disaster to the sovereign balance sheet and the basic duty of the state, namely the looted, ailing and corrupted Eskom, there is both an accelerated bailout and the “Eskom Sustainability Task Team and Technical Review Committee”. On the rest of the ailing to bankrupt state-owned companies, no suggestion of cutting back, privatising or downsizing. Instead, brace for change with the “Presidential SOE Council”, which did merit mention in the speech. On the unaffordable National Health Insurance roll-out, given the national debt of R3.16-trillion and rising, there is no figure, just the jaw-dropping “Presidential Health Summit Compact”. For the 45,035 rapes recorded in SA in 2017/2018 (40% of whose victims were children) and overall 60,000 acts of domestic violence reported, there is a “Gender-Based Violence and Femicide Council” coupled with a “National Strategic Plan to eliminate this scourge”.

Nine million people unemployed? We have a National Wage Commission to cover the lucky ones in work. As for the Cape gang lands, there has been no suggestion of devolving police authority to the province as requested by premier Alan Winde. But there is a “National Anti-Gang Strategy” coupled with a “Revised National Drug Master Plan”. Eighty percent of 10-year-olds can’t read for meaning at our schools. Time then for the screws to be placed on incompetent and underperforming teachers? Not mentioned. But there is a “National Reading Coalition” to assist, the president advised. One of the speech’s mercies, however, was that the president did not reference or revive the Moral Regeneration Commission. Readers of a certain vintage might recall that circa 2002 it was headed by deputy president Jacob Zuma. He enthusiastically gushed in his “message of support” following its “second workshop” that it had addressed the heart of moral certitude: “Questions of right and wrong, good and evil, questions of ethical behaviour and moral values, are as pertinent for national survival as they were in the days of the Greek philosophers….”  That worked out well, but presumably this was before an infamous and more modern Indian family from Saxonwold came calling.

Overarching all these committees, commissions, plans, strategies, task teams, compacts, technical reviews and councils is the Big Daddy of them all, the National Development Plan (NDP). This was dusted off on Thursday night as well as the uber document to guide us towards 2-million new youth jobs, high growth and doubtless the smart cities, bullet trains and robotic medicine that came in at the speech’s tail end. Actually, I am sure a committee here or there might inch us further forward, but the touching faith placed in corporatist solutions and intergovernmental committees to national problems on the scale confronting us could be naively misplaced at best. At worst, to quote the under-fire but likely next prime minister of Britain, Boris Johnson, it is a case of “if we kick the can we kick the bucket”. But what Ramaphosa did on Thursday was to absent himself from what he promised to do at the outset of the address: to announce “difficult choices that may not please everyone”. Nor indeed did he do anything but dangle in the air his previous comment at his inauguration of “the defining moment” confronting the nation. Tough choices? Defining moments? Action This Day? No word or elaboration in the speech. Maybe Ace Magashule binned them. There was also no acknowledgment of the numerous policy mistakes and wrong directions undertaken by the party he leads. Or that many of its shibboleths need to be junked if the nation is to survive. There will be a spectrum auction and a “world-class visa regime”, but these were both promised in 2018 and have yet to see the light of day.

In precise terms, Ramaphosa wrote in the Financial Times (October 23 2018): “We have implemented a review of the visa regime to attract more tourists and skilled workers.” Now, eight months later, it remains unsighted. On the Eskom financial crisis, even the hyped February announcement of splitting the utility into three separate units, much to the consternation of the unions, received no acknowledgment or reference in the June speech. Has it been dropped? Shelved? Kicked down the road? We are no wiser, except that several more multiples of billions will be thrown at the cash guzzler. Or will the February announcement of a “restructuring officer” now “soon to be appointed” be lumbered with the task of splitting up the behemoth? In the meantime, since the February speech, Eskom is currently leaderless, its CEO having retired, literally, hurt. But if Ramaphosa were to revisit his own (since he was vice-chair of the planning commission that drafted it) NDP, he might be reminded of a defining paragraph in its diagnostic overview that he chose not to share with parliament or the nation last Thursday. It reads that successful countries have what is called a “future orientation”. This is not about bullet trains or smart cities or sandcastles in the air, but rather, as the NDP more modestly reminds us, the menu consists of “policy bias to take decisions that lead to long-term benefits, as opposed to short-run solutions that could have negative effects later on”.

Rampahosa’s speech was, however, pretty precise in relitigating the past. It commenced with the 106th anniversary of the dispossessing Native Lands Act. But then in terms of restoration of dignity via the plethora of plans for new housing and land to overcome spatial apartheid and the dire need for improved infrastructure, Ramaphosa reconjured the much-announced (its provenance is in the Zuma heyday of 2012), not-yet-sighted Infrastructure Fund and “implementation team”. But how are all these grand plans, expensive roll-outs and exorbitant bailouts to be funded? Absent of “quantitative easing” (or printing money), which is not compatible with the president’s commendable recommit to the constitutional mandate and independence of the Reserve Bank, the sums simply don’t add up. The simple maths and current facts of our national situation are very straightforward and utterly daunting, and also went unmentioned last Thursday: 35% of our current budget is consumed by paying public servants’ wages, the interest on debt consumes R163bn every year, and the personal taxpayer base is now largely dependent on an ever-shrinking (and emigrating) 500,000 individuals. There is, in a word, no more money. And little in the speech will reassure the remaining credit rating agency, Moody’s Investors Service, to mark our debt sovereign grade and not pull the plug in November, which will see our interest bill hit the stratosphere.

The growth Ramaphosa promised, the investment the country desperately needs and the consumer confidence required won’t come out of a committee or a panel or a strategy document. And it certainly can’t come from appeasing Magashule and his gang.  You can’t meet the exigencies of the moment by kicking the can down the road. It will only happen when the president takes the country into his confidence and actually commits to the “difficult choices that may not please everyone”. His please-everyone attempt last week avoided that task entirely. And so it satisfied no-one."
  
2019/07/262019/07/02 03:39 PM
Health Minister Dr Zweli Mkhize says universal health coverage is essential and the National Health Insurance (NHI) will happen. Participating in a debate on the State of the Nation Address on Tuesday, he said the NHI Bill will soon be sent to Parliament and that the days of debating whether it will be implemented or not are over.

“Equally importantly, making progress towards universal health coverage requires transformation of the health system and reconfiguration of institutions for pooling of funds and purchasing of services to achieve social solidarity, efficiency, effectiveness and income and risk cross-subsidisation. “In this regard we will be moving speedily to ensure that NHI Bill is tabled in Parliament. “The NHI Fund requires strong governance mechanisms and improved accountability for the use of allocated funds. These provisions have been included within the structural design of the NHI Fund and they are reflected within the NHI Bill,” he said. South Africa spends almost 8.6% of the Gross Domestic Product (GDP) on health care, which is comparable to other middle-income countries with 4.1% of the GDP spent on the uninsured population.

Private medical schemes cover approximately 16% of the population, with most of the principal members of these schemes working in the formal sector. An estimated 4.4% is spent on 16% of the population covered by medical schemes and who in the main access their health care services in a costly private sector. In this regard, a smaller percentage of the population pay out of pocket to use the private health sector. Dr Mkhize said ‘out of pocket’ services are rendered in both the public and private healthcare sectors - estimated at 0.6% of GDP or 8% of total health expenditure - which remains a burden to many poor households. “The unresolved issues of unaffordable private health care and poor levels of service delivery in the public sector have impacted negatively on our national health care system resulting in our inability to ensure that all South Africans have access to quality health care based on need and not on their ability to pay.

“This Government is determined to end these inequalities and bring quality health care to all as demonstrated by the establishment of the War Room in the Presidency. The President has been a champion of universal health coverage through the National Health Insurance,” he said. The implementation of the NHI is aimed at moving South Africa closer towards universal health coverage, wherein all citizens irrespective of their socio-economic status will be covered to receive quality health care services based on their health needs. “It has to be supported by a quality health system. National Health Insurance is therefore a health financing system that is designed to pool funds and to use these pooled funds to actively purchase health services for the population based on the principles of equity and social solidarity. These pooled funds will provide for universal access to quality, affordable health care services for all South Africans irrespective of their socioeconomic status and I repeat, not on their ability to pay,” he said.

Plan to deal with queues at healthcare facilities

Dr Mkhize said, meanwhile, that government’s analysis has shown that the majority of patients who visit public healthcare facilities do so only to collect chronic medication. “We will reduce the long waiting times in the public health care sector by improving the efficiency of the system such that those patients that are stable chronic patients who only visit a facility to collect their medicines can collect these medications from a point close to their home. He also said that the stock visibility system has been implemented to monitor and address medicine availability.

“The system will be strengthened by ensuring that district pharmacists, district managers and provincial pharmaceutical services monitor the availability closely and respond urgently when there is the non-availability of medicines,” he said.
  
2019/07/262019/07/02 03:43 PM
The private sector can learn a lot from its public counterparts, but still needs to support the public sector as it meets its challenges. Addressing KZNDHC Conference delegates in Durban on Saturday, Discovery Health CEO Dr Jonny Broomberg stressed that it was now time to stop pointing fingers and move beyond the tendency to concentrate on reforms and the NHI when dealing with public private sector healthcare issues.

It was time to deal with the more practical issues such as private public structures and what was best for the health system at large in this regard, he added: “The team-based model is the right model if done properly and the model all should aspire to in the delivery of health care. It is, after all, better to work with colleagues than work alone as most GPs do,” he suggested. A major private sector problem, he stressed in support of this contention, was that it was deeply fragmented, intimating that this was where it should look at the public sector in terms of collaboration. “Good news is that there are some moves in this direction where we have larger groups, for example, providing primary care with GPs being joined by physios, dieticians etc. to provide a ‘one-stop shop’, so to speak.”

In hospitals, he noted, there were also multidisciplinary teams such as oncologists, radiologists and psychiatrists working together. It was unfortunate, however, that many private doctors were still “stuck in their comfort zones” when it came, for example, to the idea of working in hospitals, Broomberg added in the ensuing debate. On this, he said, an innovative mind-set was now required when asking “how can we do things differently?”
  
2019/07/26
2019/07/02 03:43 PM
President  Cyril Ramaphosa is today expected to reply to the debate on the State of the Nation Address Sona, after he came under fire from opposition parties. The DA, EFF, IFP, ACDP and UDM blasted Ramaphosa for lack of substance in his address last Thursday.

EFF leader Julius Malema accused Ramaphosa of dumping ANC Nasrec resolutions to expropriate land without compensation and nationalise the South African Reserve Bank SARB. But ANC MP Seiso Mohai, who is the chief whip of the National Council of Provinces, defended Ramaphosa. He said the EFF were not the spokespersons of the ANC. "The ANC has not assigned anyone to be its spokesperson.

No one is a guardian to its conference resolutions," said Mohai. He added that the election of Ramaphosa in last month's poll was an affirmation of the support he had in the country. But Malema also urged Ramaphosa to come clean on the people who donated funds to his CR17 election campaign. Malema accused Ramaphosa of backtracking on ANC resolutions. "Last week you retreated on the expropriation of land without. Compensation and the nationalisation of the SARB," said Malema. DA leader Mmusi Maimane said the country was in the throes of a health care crisis. He said state owned enterprises needed major reforms, and that the National Health Insurance NHI would not work and would cost the country billions. But Health Minister Zweli Mkhize denied this and said there was no turning back on the NHI.

ACDP leader Rev Kenneth Meshoe said he supported Ramaphosa in his defence of the mandate and independence of the SARB. UDM chief whip Nqabayomzi Kwankwa said Ramaphosa's Sona was not a comprehensive plan to turn around the country.
  
2019/07/252019/07/02 03:14 PM
Democratic Alliance (DA) leader Mmusi Maimane called President Cyril Ramaphosa's latest State of The Nation Address fanciful with lofty dreams, but unimaginative in terms of how Ramaphosa seeks to realise his vision. Maimane was speaking at the National Assembly in a joint sitting to debate the State of The Nation Address. Ramaphosa’s address, last week Thursday, highlighted seven principles and five goals for the next decade to improve South Africa’s socio-economic prospects.

Maimane said Ramaphosa’s allusions to a bullet train, skyscrapers and new age cities in South Africa were life affirming aspirations, but the country's reality was too unequal for any of it to be attainable. "It cannot be a South Africa for some and not a South Africa for all. The stats released last month paint a dire picture. It is a picture of unemployment of 32% and a picture of an economy that has contracted," said Maimane.

Maimane did not pass up the opportunity to speak against the imbroglio of the South African Reserve Bank, where African National Congress (ANC) officials flirted with policy uncertainty by claiming that the governing party agreed to expand the central bank’s mandate. "We need a bold plan, the right plan, the right budget and the right people. We don’t need to debate about the mandate of the Reserve Bank. It is already in the Constitution. We need to get down to the work of doing what we were elected to do," Maimane said.  Maimane said government’s responses to the fourth industrial revolution was too late to make a significant impact in buffering South Africans from the labour market disruptions to come. "Honourable members, giving school children smart tablets is not the fourth industrial resolution, it is the third industrial revolution. We should be preparing our children for jobs that don’t yet exist. We should be equipping children for coding, digital design and programming," he said. Maimane said it was the responsibility of government and Parliament to “rethink policies that did not work in the last decade” and make tough decisions, instead of comforting themselves by dreaming. "These are tough decisions. That’s why it hasn’t happened. So, instead, we talk about dreams, faster horses and, as some on Twitter would say, Wakanda. Our nation is in trouble, but we can change it by building a resilient nation with well-equipped people," he said.

Wakanda refers to a fantastical African country made famous by the movie, Black Panther.  In response to Ramaphosa's seven principles, Maimane proposed seven reforms, namely: reform state-owned entities, introduce charter schools, ditch National Health Insurance, change labour law, reduce the size of Cabinet, extend property ownership and ensure a professional police service under provincial government authority.
  
2019/07/252019/07/02 03:20 PM
Last week’s State of the Nation gave me a lot of hope. I know these were just words from President Cyril Ramaphosa, but like I said before, I believe his heart is in the right place and that he genuinely wants to build a better country.

I suspect that one of his motives is business. Like I’ve said before, Ramaphosa is a businessman, so he would have done the projections for running a country well. And it doesn’t take an MBA to understand that a country where most citizens are doing well, is good for business, because they will spend that money on products and services that you own. I know there have been many criticisms of Ramaphosa’s third Sona, but I reckon he was on the right track with most of it. For example, the National Health Insurance is something that I have encouraged on this page, since it first became clear that it may become a reality.

It is going to irritate many South Africans, and there will be growing pains that will frustrate the rest of us, but in the end - if done properly - I see a system where we all have access to superior medical care. This is something that we all deserve and which is long overdue. Ramphosa’s goals with regard to job creation, social cohesion and safer communities are all things that resonate with me strongly and I want to help him achieve these things. I think it is all our duty to help with every aspect of his goals, or at least the ones we agree with.

We have become a nation of complacent complainers, who leave too much of government’s duties up to government alone. But like the president said, we have many severe challenges, of which a stagnating economy is chief among them. Now while that sounds like a massive task that no individual can have an impact on, the truth is we can have an effect as a collective. However, the big challenge which I believe required a lot more attention from the president, is our battle against crime. As I pointed out previously, our challenges cannot be seen in isolation. So of course the slowing economy, resulting unemployment - especially among our youth - and infrastructure problems all play a huge role and must be tackled together to address crime. It’s the thing that I believe gets most South Africans down and discouraged. I believe that most of us will be able to live with most of the challenges we are facing as a nation, if only we could do so without the fear of terrible harm coming to us and our families. While the issues the president plans to address are important, I believe much more attention should be paid to the critical ones that result in the crime that traumatises us as a nation.

And this is where the disconnect between us and our leaders come into play. Because, for as long as ministers and MPs continue to live in secure homes, with electric fences and bodyguards paid for by us, the taxpayer, they will never fully understand the need for this. Crime will become priority for them only if and when they are threatened by it on a daily basis. Ramaphosa wants to halve the country’s violent crime rate, but our crime rate is dozens of times above what any of us would like it to be.

So half is just not enough. He will need to aim a whole lot higher than that.
  
2019/07/252019/07/02 03:22 PM
"Come clear" on who funded your campaign to become ANC president, EFF leader Julius Malema challenged President Cyril Ramaphosa during Tuesday's debate on the State of the Nation Address (SONA). Malema told a joint sitting of Parliament on Tuesday that there was no chance of winning the fight against corruption if the president was involved in allegations of money laundering.

"We want the president to come clear, to explain and take the country into confidence, as to who are the people who have donated money in the CR17 campaign and what do they stand to benefit," Malema said. "We need the names, not leaked documents, Mr President. You ought to call all these trustees [of his 2017 campaign] and say to them they must give you a report of who donated money and what are the expectations of those people." Malema said they do not intend to remove the president unless he was found to be a constitutional delinquent, in which case they would call for impeachment proceedings.

We want you, Mr President, where a mistake was committed, to take full responsibility and announce which practical steps you are going to take in correcting those mistakes.

"Please help South Africa, by taking it into your confidence. Make sure that you lead by example."DA leader Mmusi Maimane also broached the subject of the Bosasa payment to Ramaphosa's campaign and the resulting Public Protector's investigation. "Mr President, you should lead by example and stop delaying and frustrating the Public Protector’s investigation in your Bosasa dealings," Maimane said. "Let the Public Protector do her work, and once the report is finalised, appear before a parliamentary ad hoc committee, so that the matter can be dealt with in an open and transparent manner."

Maimane's 7 reforms

This was included in seven reforms proposed by Maimane "that will enable us to become the modern, inclusive country we all dream of". This elicited groans from the ANC benches. Maimane cited Eskom, charter schools and a healthcare fix-up as key prioroties the president should address. Eskom should immediately be split into two entities and municipalities should be allowed to buy electricity directly from independent power suppliers, he said. He also proposed charter schools, which are schools where the private and public sectors are in partnership.

"Not only will this clip the wings of the powerful and destructive union Sadtu, it will also offer parents real choice. We can't have our children bundled into taxis and sent far from home just to receive a decent education," Maimane said. Maimane said the government should forget about its National Health Insurance plan. He said the DA had a range of solutions "that will make quality healthcare available to all South Africans without destroying our national budget".  He also proposed that labour laws be relaxed, tax incentives for people who created jobs, and a re-look of the national minimum wage.  He said the state should extend property ownership to millions of dispossessed South Africans and devolve policing powers to provinces.

'He is a big dreamer and a big doer'

The general slant of opposition MPs' speeches was that Ramaphosa's SONA was without an action plan to create the country he envisaged and did not deal with the realities ordinary South Africans faced. Minister in the Presidency Jackson Mthembu defended Ramaphosa's speech, saying that South Africa was fortunate to have a visionary leader in Ramaphosa. "He is a big dreamer and a big doer at the same time," Mthembu said. He said Ramaphosa had confirmed that the National Development Plan (NDP) was the "lodestar" in the creation of a South African developmental state.  "While progress was slow, particularly on the economic side, we confirm our intention to achieve our NDP targets to address the challenges of inequality, poverty and unemployment and economic growth," Mthembu said.
Mthembu criticised Maimane's speech, accusing him of forgetting that parties were no longer on the election campaign trail. He said Ramaphosa's plan "for the continued implementation of this vision was eloquently and succinctly articulated”.
  
2019/07/252019/07/02 03:25 PM
Zweli Mkhize emphasised that the NHI programme will be implemented speedily, despite objections by various stakeholders, including the DA. The government will ensure that the National Health Insurance (NHI) bill is tabled in parliament soon, health minister Zweli Mkhize said on Tuesday.

The proposed legislation will have to be considered by both the National Assembly and the National Council of Provinces, and go through public consultation before it can be implemented. It will have far-reaching health reforms aimed at achieving the government’s ambition of providing universal health coverage. Its main aim is to launch an NHI Fund that will purchase health services on behalf of patients from public and private sector providers, which will be free at the point of care. A key aspect of the bill is the future role it envisages for medical schemes, which currently provide coverage to about 8.9-million people.

Various stakeholders have warned that the roll-out of the NHI will not succeed if the poor management of public healthcare facilities persists, and the shortage of doctors and other health professionals is not addressed. SA has one of the lowest doctor-to-patient ratios in the world, and the country’s medical schools are producing just more than 1,000 doctors a year, which is not enough. “Earlier in 2019, the Hospital Association of SA (Hasa), which represents the private hospital sector, warned that NHI could lead to the loss of up to 132,000 jobs.” During the debate on the state of the nation address on Tuesday, Mkhize emphasised  that the contested NHI programme will be implemented, despite the objections by various stakeholders.  “We will be moving speedily to ensure the NHI Bill is tabled in parliament,” said Mkhize. “The NHI Fund requires strong governance mechanisms and improved accountability for the use of allocated funds. These provisions have been included within the structural design of the NHI Fund and they are reflected within the NHI.”

Two-tiered system
Mkhize said that despite the government’s post-1994 democratic breakthrough and the multiple efforts aimed at improving access to healthcare services, especially for the vulnerable, the health system has stubbornly remained two-tiered, fragmented and inequitable, consisting of the public  and private health sectors.

SA spends almost 8.6% of GDP on healthcare, which is comparable to other middle-income countries, with 4.1% of the GDP spent on the uninsured population, who receive care in the overburdened public sector, Mkhize said. Private medical schemes cover approximately 16% of the population, with most of the principal members of these schemes working in the formal sector.  “A smaller percentage of the population pay out of pocket to use the private health sector. In addition, ‘out of pocket’ services are rendered in both the public and private healthcare sectors [estimated at 0.6% of GDP or 8% of total health expenditure], which remain a burden to many poor households,” said Mkhize.

He added that the unresolved issues of unaffordable private healthcare and poor levels of service delivery in the public sector have impacted negatively on SA’s national healthcare system resulting in “our inability to ensure that all South Africans have access to quality healthcare based on need and not on their ability to pay. “This government is determined to end these inequalities and bring quality healthcare to all, as demonstrated by the establishment of the war room in the presidency. The president has been a champion of universal health coverage through the NHI,” said Mkhize. “The implementation of the NHI is aimed at moving SA closer towards universal health coverage, wherein all citizens, irrespective of their socio-economic status, will be covered to receive quality healthcare services based on their health needs,” said Mkhize.

DA MP and health spokesperson Siviwe Gwarube said NHI, as it stands, premises its entire existence on the need to level the field of access.“It does not seek to improve the existing health facilities and level of care. NHI, in its current form will nationalise healthcare. We cannot allow a piece of legislation that has neither been costed nor effectively planned for destroy the little that we have,” said Gwarube. “The DA will oppose this bill until it places the patient at the centre of its conception.”
  
2019/07/242019/07/02 02:46 PM
The World Health Organisation (WHO) in South Africa is looking for health system experts in South Africa to help it with providing support to government in its endeavour to move to Universal Health Coverage (UHC) through the implementation of its National Health Insurance (NHI) plan. According to the WHO, the idea is to develop a CV database of local health system experts with high-level expertise on core health systems functions and issues that the organisation could hire on a need basis to assist it in providing technical assistance to the South African government to accelerate progress towards UHC.

The experts will work at varying levels of seniority to contribute to the development of technical documents, evidence generation and knowledge brokering across a number of technical areas and issues. They will work with WHO Health Systems and Services (HSS) Cluster to help provide high levels of technical and tailored evidence to inform health system decision making process in the following key areas:

Health Governance, policies and regulations; (Setting the health system wide polices, norms and standards, strategic partnerships, systems design, regulations, accountability, public health and health in all policies) Health economics and financing (economics of health, health financing instruments and mechanisms, investment in health, value for money and sustainability, contracting and provider payment mechanisms, defining and costing benefit packages) Health workforce and labour market (HRH skill mix, forecasting and planning, retention, mobility, workforce migration and performance management) Health information systems, health research and evidence (Metadata and data standards, Monitoring and Evaluation framework, Medical coding systems, Electronic health records, hospital and routine information systems, design of health surveys and operational research)
Pharmaceuticals and medical products including pricing policy, accessibility, affordability and availability of essential medicines and services, TRIPS and IPR issues, Quality of care and service delivery (integrated people centred health services, standard treatment guidelines and referral pathways, clinical governance, patient safety and healthcare quality, community engagement) Digital health and innovations (Information Communication Technology (ICT) systems for health information and service delivery; health information enterprise architecture, health innovation strategies; scaling up and rolling out the transferability of policy options)

For more information and to apply, click on the link below:

https://www.pnet.co.za/5/index.cfm?event=offerView.dspOfferInline&offerId=2979815&click=no&rs=1&previewid=8C47A03CCF7EE013A8D3FD05CC0BE3F8
  
2019/07/242019/07/02 02:48 PM
Indirect references to recently well-publicised events such as the Mamelodi Hospital incident and the Alexander shut-down in one of his first, if not first public appearance since his appointment as Minister of Health earlier this month, Dr Zweli Mkhize has given some indication that he is under no illusion about the tasks ahead in his newfound position.

The real problem at the moment, Mkhize told KZN Doctor Healthcare Coalition (KZNDHC) annual conference banquet guests at the weekend, was an economic situation under strain exacerbated by inequality. Citing the Alexander shutdown debacle as an example – “people living in absolute squalor only a kilometre away from the richest square kilometre of real estate on the continent” – people, he said, just look at this and say “wow, something has to be done”.

Same, he added, applied to the country’s healthcare services: ““Having a successful private
sector with a failing public sector hasn’t and doesn’t work. For one to work, the other has to make a contribution one way or the other.

“There has to be collaboration, co-ordination and integration between the private and public
health sectors to improve the lives of all South Africans,’ he stressed, reiterating the theme of this year’s KZNDHC Conference.

Among the main challenges facing the country’s healthcare services was that people still expected a lot more than what the country had to offer. Until the economy improved this
would continue to be a problem “for our kids growing up” and on how to cope with the increasing demands on health services.

“National Health Insurance (NHI) is fundamental to the problem of inequality and without achieving this, we won’t be addressing the inequalities.

“The debate for and against NHI has gone. Concentration must now be on implementation,
starting with what can be done in terms of existing resources,” Mkhize continued, alluding in particular to the unequal relationship between the public and private sectors.

“In the public sector there are a lot of things that have to be fixed and we need to
figure out how this has to be done. Our biggest problem is staff shortages. How, in the same system, can we find additional resources to match staffing requirements to meet service needs?”

At this point he referred to his recent visit to Mamelodi Hospital which he found to be “totally over-run” with an over-burdened staff complement: “I could only sympathise with
the staff.”

Issues like these had to be dealt with, but at departmental level, he pointed out, this was
difficult due to strained resources and having to compete in this regard with other necessities being faced by the country at large: “How do we here, therefore, find a solution together to deal with these issues?” Mkhize asked.

“There has to be way to enable our systems, both private and public, to co-operate,
co-ordinate, and be integrated somehow to get to a point where we all invest in the same system. We are, after all, dealing with the same population, be they public or private, so somewhere down the line,” the minister urged his predominantly private sector doctor audience, ”we have to talk more.

“Our doors are open. Let’s keep talking!”
  
2019/07/242019/07/02 02:53 PM
Delivering the State of the Nation Address in parliament, president Ramaphosa called for a new social compact in South Africa. Durable partnerships needed to be forged between government, business, labour, communities and civil society.

Spelling out the responsibilities of each partner, the president declared that government must create an enabling environment and use public resources wisely. Business needs to keep the country’s national strategic objectives in mind when taking decisions, labour has to advance the interests of workers while promoting business sustainability and job creation, and civil society is tasked with holding government to account while participating to achieve common goals.

The president announced that the sixth administration will focus on seven priorities:

• Economic transformation and job creation
• Education, skills and health
• Consolidating the social wage through reliable and quality basic services
• Spatial integration, human settlements and local government
• Social cohesion and safe communities
• A capable, ethical and developmental state
• A better Africa and World

He confirmed that all government’s “programmes and policies across all departments and agencies will be directed in pursuit of these overarching tasks. The National Development Plan will also be restored “to its place at the centre of our national effort, to make it alive, to make it part of the lived experience of the South African people”. Over the next ten years, progress needs to be made in tackling poverty, inequality and unemployment so that no person in South Africa will go hungry, the economy will grow at a faster rate than population growth, two million young people will be employed, every ten-year old will be able to read for meaning and violent crime will be halved.

In the health sector, the president announced that the Presidential Health Summit Compact, designed to address the crisis in clinics and hospitals, was being finalised. Steps were also being taken to prepare for the implementation of National Health Insurance (NHI). “We are far advanced in revising the NHI detailed plan of implementation, including accelerating quality of care initiatives in public facilities, building human resource capacity, establishment of the NHI Fund structure, and costing the administration of the NHI Fund,” he said. The president also indicated that government will intensify its work to implement the 90-90-90 strategy to end HIV as a public health threat, including increasing the number of people on treatment by at least another 2 million by December 2020. As regards Eskom, the president declared that the power utility’s financial position remained a matter of grave concern.

He revealed that Eskom currently has sufficient financing to meet its obligations until the end of October 2019. A default by Eskom on its loans will cause a cross-default on remaining debt negatively impacting on the fiscus. As a response, the president announced that a Special Appropriation Bill will be tabled in parliament on an urgent basis to “allocate a significant portion of the R230 billion fiscal support that Eskom will require over the next 10 years in the early years”.

The finance minister will provide further details on the proposed legislation in due course. Other developments at Eskom include the appointment of a new CEO and a Chief Restructuring Officer tasked with repositioning Eskom financially with careful attention to the mix between revenue, debt and cost structure of the company. The president also confirmed that the communications minister will, within the next month, issue the policy direction to ICASA to kick-start the spectrum licensing process. “This process will include measures to promote competition, transformation, inclusive growth of the sector and universal access.” In terms of the National Minimum Wage, the president revealed that the National Minimum Wage Commission is expected to conclude research on the impact of the minimum wage on employment, poverty, inequality and wage differentials by the end of September 2019.

To drive expansion in the productive sectors, the president indicated that master plans drawn up with business and labour will be implemented in sectors such as clothing and textiles, gas, chemicals and plastics, renewables, and steel and metals fabrication. Government also wants to double international tourist arrivals to 21 million by 2030 by renewing the country’s brand, introducing a world-class visa regime and focusing on Chinese and Indian markets and air arrivals from Africa. In the realm of land reform, the president confirmed that the report of the Presidential Advisory Panel on Land Reform and Agriculture had been received and will be tabled before cabinet for consideration.

In the short-term, government will speed up efforts to identify and release public land suitable for smart, urban settlements and farming and funding for emerging farmers will be prioritized.
  
2019/07/242019/07/02 03:04 PM
Cyril Ramaphosa’s first state of the nation address as elected president of the country struck a welcome balance between realism about the depth of the current crises and optimism about how this can change under his administration. He did not mince his words on the problems in governance, the economy and social relations.

It is good that the president made the economy the first of his seven priorities, noting that it is a “concern rising above all others”. We know that our problems are vast unemployment, poverty and inequality. The president also acknowledged that economic renewal must take into account the changing nature of work and must be attuned to needs of the global climate crisis. While some in the SA Reserve Bank and Treasury have presented the post-apartheid period as one of great success in keeping international investors and rating agencies largely placated, the true test is in the eating. And if we look at the conditions that the majority of South Africans live under, we see the dismal performance for what it is, and speculating about a new city in no way replaces fixing the ones we have. It is a disgrace that our townships are in such a bad way. How is it possible that after 25 years we still have these economic deserts where people are forced to protest for basic services?

Part of it is due to the Jacob Zuma years. But much more fundamentally the economy has not grown the way we would have hoped in 1994. The development of corrupt patronage networks and the ability for state capture to become so toxic and pervasive is as closely linked to the inability of policy to adequately transform the economy as it is to the simple insertion of “bad people” in government. Several economists have been arguing for a shift in macroeconomic perspectives away from old orthodoxies and in line with international trends. The speech hints at a shift in government thinking, although it might have been more bold. The performance of the economy means we cannot continue with a rigid adherence to fiscal discipline of the kind we have been pursuing. We need to restructure and reprioritise spending in a way that stimulates the economy. The speech says positive things in this direction but bolder moves and clearer targets are needed. There is no doubt that there are areas where spending can and should be cut but fiscal policy should not be used in a blunt way. One example is with public-sector employment. SA has a relatively low ratio of public-sector employees but a high ratio of spending on public-sector employment to GDP. The reason for this is that public-sector employment remains top heavy with an excess of highly paid administrative and managerial staff while nurses, teachers and police suffer from stagnant wages and poor administrative support. A policy that freezes hiring in the public sector will not address this and has significant knock-on effects in education, health and safety not to mention the impact on local economies where people spend their salaries.

The president has rightly acknowledged that price stability is not enough by itself to ensure economic prosperity. He rightly stressed the importance of regular meetings between the Bank and government to ensure employment and growth are included in the Bank’s strategic thinking. Ramaphosa is clearly listening to the growing view that the Bank can do more to stimulate the economy.

The debate about the Bank and economic policy is generating unnecessary tension. In a mature democracy debates should not be the source of instability or threats regarding investment. There is room for a serious discussion on these matters without name-calling and personalities. Indeed, why can other countries pursue certain policies without being chastised? Why can the US Federal Reserve have an extended mandate but not us? Why can they debate it but we can’t? Why can’t we be flexible?

The anxieties about a credit-ratings agency downgrade are real and government must pursue policies that account for this. However, this concern should not stop conversation. The president has said that the government will provide a portion of the R230bn needed at Eskom in the coming decade. The utility is essential to the performance of the economy. And it will need serious investment to recover from its current woes. This is actually an indirect stimulus for the economy. Many of the measures referred to by the president require fiscal loosening. The social wage is one of the seven priority areas highlighted. Within this, specific commitment around housing, the National Health Insurance (NHI) and improving public safety will all require more funding and better use of funds should they be realised. Similarly, the focus on youth unemployment is correct. Yet this too will require public investment to resolve and it is positive that the president has committed to use the expanded public works programme and other vehicles. It is imperative that policy priorities and promises are not in contrast with the prescriptions of Treasury. Good policies will only take us so far without the resources to realise them. Elsewhere in his speech, the president notes: “We have the opportunity to be at the forefront of green growth, of low-carbon industrialisation, of pioneering new technologies and of taking quantum leaps towards the economy of the future. We must increase the contribution of renewable and clean energy to our national energy mix and explore the potential of the hydrogen economy.”

Such a position must be at the forefront of the plans for Eskom’s future. If we are to take climate change seriously then we must put forward plans to decarbonise the economy. These plans also have the potential to allow for job creation and vast improvements in human wellbeing. SA must take international calls for a Green New Deal seriously. The importance of capital inflows to meet our balance of payments required needs is understood. However, foreign direct investment should not be presented as the primary solution for our problems and cannot be used to plaster over deeper structural issues. The concentration in the economy, for example, is concerning. Concentration patterns have changed but have remained. The president noted industries — including car, agro-processing and others — but did not mention concentration explicitly.

The president calls for a revitalisation of our productive sectors. This is welcome. But that depends on the right character of investment. Post-apartheid SA has typically been characterised by high profits and low fixed investment especially in productive sectors of the economy like manufacturing. It is imperative that we pay attention to the nature of the investment that is announced. Public investment is key. And it is good that R100bn is set aside for infrastructure, but this can only be the beginning. One of the most serious challenges in effecting the above is the competency and legitimacy of the state which have both been severely undermined in the decade of Zuma rule. The severity of state malfunctions at all levels of government pose a serious challenge to those advocating for the increased role of the state in the economy. These challenges cannot be ignored but they should not be an excuse to leave fixing the country to “the market”. We need both state and market. We need a total revamp of the state system based on performance and standards. In line with checks and balances and strengthening of accountability systems. More than any other aspect, this is where bold leadership by Ramaphosa and vigilance by civil society groups is needed. We need a whole arsenal of measures to stimulate the economy. This requires measured boldness. The key now is in the detail of policy and in implementation.

• Prof Ben Turok is the director of the Institute for African Alternatives.
  
2019/07/12
2019/07/15 11:12 AM
Health minister Zweli Mkhize will on Friday unpack the details of the approved National Health Insurance (NHI) Bill, which is aimed at providing universal health coverage for South Africans Jackson Mthembu, minister in the presidency for planning, monitoring & evaluation, announced on Thursday that the cabinet had finally approved the controversial bill, but did not provide any details on it. Mkhize was set to brief the media on the bill ahead of his budget vote address in parliament on Friday morning.

The DA labelled the cabinet's approval "premature, irresponsible and simply disastrous". The cabinet approved the bill for release for public consultation over three months from June 2018 to September 2018. He said the input from that process has now been incorporated in the latest version of the bill. The bill was mired in controversy towards the end of 2018, after a leaked Treasury letter exposed an alleged attempt by President Cyril Ramaphosa's adviser, Olive Shisana, to make sweeping changes to its draft. A revised version was rejected by the cabinet in early December and then reconsidered in January. The approved bill will now be subjected to another "rigorous" parliamentary process, Mthembu said.

The proposed legislation will have to be considered by the National Assembly and the National Council of Provinces, and go through public consultation before implementation. Its main aim is to launch an NHI fund that will purchase health services on behalf of patients from public and private sector providers, which will be free at the point of care. "Once the bill has been passed, the existing draft implementation plan will be amended accordingly to give effect to the transitional arrangement of rolling out NHI in phases," said Mthembu. According to the minister, the transition period after the bill is passed will allow for the repeal of certain pieces of legislation to facilitate "alignment and coherence". A key aspect of the bill is the future role it envisages for medical schemes, which now provide coverage for about 8.9 million people. Various stakeholders have warned that the roll out of NHI will not succeed if the poor management of public health care facilities persists and if the shortage of doctors and other health professionals is not addressed. Siviwe Gwarube, the DA's spokesperson on health, said the party was aware that neither Mkhize nor his predecessor, Aaron Motsoaeledi, engaged on the bill with provinces, which are responsible for providing health services.

"The matter has not been discussed at the National Health Council, and provincial departments have not been engaged about the additional responsibilities that the implementation of the NHI in its current form will require from them," Gwarube said. According to her, the bill in its current form has not been costed nor has its feasibility been tested. "All that we know is that the previous minister, Dr Aaron Motsoaledi, admitted that the R259bn price tag for NHI was an estimate. We are also aware that the majority of NHI pilot projects have been a spectacular failure," Gwarube said. She said the DA would oppose the bill in its current form.
  
2019/07/122019/07/15 11:14 AM
Central healthcare clinical and administrative capacity lacking and provinces would be affected adversely. There have been mounting calls recently for central academic hospitals to be moved into the national governance sphere, allowing the national health department to administer and run these institutions.

Even Gauteng premier David Makhura supported the idea in his state of the province address, indicating that Charlotte Maxeke Johannesburg Hospital, Chris Hani Baragwanath Hospital, Steve Biko Hospital, and George Mukhari Hospital should be run by the national government.

Would the department of health run these facilities any better than they are now? It runs no health-care facilities in SA. This is not its function so there is a complete lack of skills, experience, and knowledge of administering hospitals in the department. It would have to create and staff an internal division to manage this function. Such a step would require the appointment of competent, experienced personnel capable of performing this function. This would create a whole new grouping of high-level, salaried positions in the department. Once again, the government would add to the health-care administration, as opposed to adding health-care professionals who deliver services to the system. Alternatively, you will find staff might be co-opted from provinces, meaning the same people who mismanage the hospitals will still be running them.

The second consideration is whether the department budget will be increased by the requisite R30bn now being spent by provinces on running these hospitals. At present, the department’s budget is about R40bn, so this would require a 75% increase in budget year on year to fully fund such hospitals at current rates. Treasury would also concurrently have to reduce the provincial proportional budgetary allocation by this amount. So provinces would not have additional resources available to run primary health-care better, as Makhura has proposed. The final consideration is the various support functions for these Central Hospitals that lie within the provinces. The entire logistics- and supply chain function is a provincial competence, or incompetence, which would have to be duplicated at the national level to supply these hospitals with all the necessary equipment and consumables. If the supply chain is not duplicated, the hospitals will still be dependent on an outsourced agreement with the provinces’ supply chain, which is failing them at present.

 Once again, one has to question whether the department has the requisite skills and knowledge of supply chain within its staff, or whether this function would have to be created along with the additional administrative spend of duplicating a provincial function. With the smaller amount of consumables and drugs used by a group of 10 hospitals, pharmaceutical companies, and consumable suppliers will also not be willing to tender at the same low prices the provinces are able to acquire through bulk buying at a provincial level. A supply chain for such a small grouping of hospitals will be highly unlikely to create any logistical economies of scale. It would add an additional layer of administrative costs to the running of these hospitals.

The proposed nationalising of these hospitals is unlikely to improve efficiency, patient care or the financial position of the department. The positive effects on primary health-care delivery will also not materialise in the provinces, as removing hospitals will coincide with removing funding. In government, funding follows function. Generally, it is also unlikely that such a move to the national sphere will lead to reductions in administrative staff at provincial health departments, as unions will simply not stand for that. The levels of inefficiency would just increase further by such a step, with less work for the same amounts of provincial healthcare administrators.

In SA, we have a distinct lack of practical solutions for the problems we are encountering. The continued ideological approach to problem-solving, such as proposing nationalisation of provincial hospitals, or the nationalisation of all health care through National Health Insurance, needs to be shelved and a pragmatic approach needs to start rearing its unpopular head.

• Dr Serfontein is a member of the Free Market Foundation health policy unit.
  
2019/07/122019/07/15 11:18 AM
The National Health Insurance Bill was approved by the cabinet on Thursday, taking SA a step closer to a major health policy change that could spell disaster if industry warnings are not heeded. The department of health said Minister Zweli Mkhize would announce more details on Friday. NHI was described by the previous health department as providing free high-quality health for all.

The bill, released in July 2018, proposes a single state-run medical fund reporting to the minister of health, but health industry stakeholders say a new fund would not fix fundamental problems in hospitals and clinics. The move to legislate NHI comes after the finance minister in his February budget cut the NHI conditional grant and diverted NHI money to fill frozen posts for nurses and doctors in state hospitals. It is not known if the version soon to be tabled in parliament takes into account the many comments submitted by health experts, social activists, doctors, hospital groups and medical aids. The initial NHI bill, which was released for comment in June 2018, proposed:

• A single state-run medical fund reporting to the minister of health;
• That certain pieces of legislation be repealed to enable the NHI law to work;
• A shift in power from provincial departments, who now get the lion’s share of the health budget, to national departments;
• A cap on what health workers can charge;
• That medical aids can only offer coverage for “complementary procedures” not offered by the government; and
• No clarity on how it would be paid for.

The NHI bill last year caused tension after President Cyril Ramaphosa appointed Dr Olive Shishana to run an NHI war room, under the presidency’s roof – and away from the health department’s offices. This spilled over into a rift between the treasury and the health department. Business Day reported in November that a leaked treasury letter was critical of the health department’s draft of the NHI bill, saying changes made did not have the finance minister’s approval. The treasury also complained in its letter that public comments seemed to be ignored in the new draft. It was also concerned that the bill side-lined medical aids, allowing them only to cover services not offered by the NHI. The bill was described as “unnecessary” and “premature”.

Responding to the news that the cabinet approved the bill on Thursday, University of KwaZulu-Natal pharmacist and health analyst Andy Gray said: “The tabling of the bill has been widely anticipated, but repeatedly delayed. The approval by the cabinet will be interpreted as showing that consensus has been reached between the health department, or at least the ‘war room’ in the presidency, and the treasury, even though the draft bill was almost silent on the sources of funding for NHI. “But as always, the devil is in the detail, and the governance of the funding will be closely watched.” Natalie Zimmerman, CEO of the SA Society of Anaesthesiologists, urged caution.

“We [anaesthesiologists] absolutely support universal healthcare, we recognise that there are many failings within the current structure and systems, but hope that measures to address these are reasonable, practical, solution finding, rather than system breaking, and financially sustainable.” Johan Serfontein of Healthman consultancy, who works with doctors, said the bill would spell disaster for people needing medical care if it did not take the public comments into account. “If the draft bill wasn’t radically changed, the implementation could lead to the collapse of the entire South African health system.”

The DA said it was still not clear how the project would be financed as questions in parliament to the health minister last week went unanswered.
  
2019/07/122019/07/15 11:21 AM
Here’s what is happening in and affecting South Africa today:
• The EFF is escalating its offensive against Public Enterprises minister Pravin Gordhan, attempting to disrupt the minister’s speech and ‘physically threatening’ him during his department’s budget vote, and joining the Public Protector in defending against his bid to have her findings against him interdicted and reviewed. Gordhan has been pushing for reform in government and seeking to root out corruption. In his speech, he said that those involved in corrupt activities – like stealing money from VBS Bank – should own up to it. [ENCA, TimesLive, IOL]

• After being on the ice for over a year, energy minister Gwede Mantashe is bringing back talk of a nuclear energy build for South Africa, which he says the country should consider for around 2045. Nuclear energy was championed by former president Jacob Zuma, who tried to push through plans to build several new nuclear power plants. However, the plans were shelved when President Cyril Ramaphosa took charge, saying it was too expensive. [Reuters]

• “We well and truly cannot go on like this,” Finance Minister Tito Mboweni told parliament. He was presenting Treasury’s budget vote, which includes promises of more bailouts and financial support for struggling state-owned companies – however, he added that time was running out. Mboweni said that while public companies in sectors like aviation and broadcasting were failing, private competitors were thriving. “We cannot allow this to continue,” he said. [Business Day]

• Cabinet has approved National Health Insurance, but economists are trying to do the numbers on the cost of the system, and it does not look good. According to Dr Thabi Leoka, an economist at Argon Asset Management, if South Africa’s economic growth stays under 2% per annum, the cost of NHI will astronomical – over R130 billion a year. Government has given no indication where the money for the scheme will come from, with taxpayers already milked dry. [702]

• South Africa’s rand strengthened on Thursday after the chairman of the Federal Reserve set the stage for a US interest rate cut later this month, weakening the dollar and boosting risk appetite worldwide. On Friday the rand was at R13.94 to the dollar, R17.48 to the pound and R15.71 to the dollar.
  
2019/07/122019/07/15 11:23 AM
A National Health Insurance (NHI) Bill incorporating input on a draft released in June 2018 for comment is ready to be tabled in the National Assembly and ‘subjected to another rigorous parliamentary process’.

Approved by Cabinet on Wednesday, the Bill provides for the establishment of an NHI fund reporting to the Minister of Health. According to a media statement on the outcome of Wednesday’s Cabinet meeting, the fund will operate as an autonomous public institution to be administered in keeping with the requirements of the 1999 Public Finance Management Act for Schedule 3A national entities. In this regard, among other things the Act deals with banking, cash management, and investment, annual budgets and audited financial statements. In his most recent State of the Nation Address President Cyril Ramaphosa said the process of revising a ‘detailed plan’ for the Bill’s implementation is ‘far advanced’. It includes ‘accelerating quality-of-care initiatives in public facilities’, ‘building human resource capacity’, establishing an ‘NHI fund structure’ and ‘costing’ its administration. Given the poor state of the public health sector, this could take decades to accomplish; it will require attitude change and vast sums of money. Yet according to yesterday’s post-Cabinet meeting statement, once the parliamentary process is complete the plan will be amended to give effect to the Bill’s transitional arrangements for ‘rolling out the NHI in phases’ – tending to create an expectation of imminent improvements to the quality of healthcare for ordinary South Africans.

Addressing delegates at the presidential health summit last October, Deputy President David Mabuza alluded to the ‘challenges’ associated with financial resources management across the public sector – emphasising the importance of ‘value for money in purchasing health services’. How the government deals with this and widespread concerns about the fund’s primary source of revenue (Business Day) will determine whether NHI succeeds or becomes yet another unfulfilled promise and costly mistake.
  
2019/07/12
2019/07/15 11:24 AM
Health Minister Dr Zweli Mkhize says the department will deal with staff shortages for frontline services in the year ahead.  The Minister led a debate on the department’s budget vote on Friday morning.  “The shortage of frontline service delivery staff needs to be eliminated once and for all. We have identified the shortage of staff, which requires urgent attention. Of the 4 143 required medical officer positions, we will fill 2 680 in this financial year,” Mkhize said.

This intervention, said the Minister, should be implemented simultaneously with the preliminary steps to introduce the National Health Insurance (NHI).  Some of the nurse, allied health professions and community health worker positions will also be filled within the same period. “We are undertaking to absorb all the qualifying 2 625 medical interns, and 6 786 community service health professionals, including an anticipated 700 additional graduates from the Nelson Mandela Fidel Castro collaboration programme on training medical students in Cuba.  “The joint team of National Department of Health and National Treasury has met to reprioritise the budget and identify vacant posts to be converted into professional service delivery posts,” Mkhize said.

Implementation of the NHI

After Cabinet approved the NHI Bill for tabling in Parliament for public consultation, the structure of the National Department of Health will be reorganised to support the implementation of the NHI.   “The NHI Implementation Unit will be established while the legislative processes are underway.  “This unit will form the embryo of the National Health Insurance Fund. Capacity building for staff that will be in this unit will be undertaken,” said the Minister.

In the implementation of the NHI, the department has developed the Health Patient Registration System. The system will be the backbone of an electronic health patient record.  “We have already registered 42.6 million users on the system and all South Africans will be registered by the end of this financial year. “We support the Department of Home Affairs in the registration of babies in our hospitals, as they will then be registered automatically on the NHI patient register.  “NHI will require a digital health platform that will support the operations of the NHI Fund and work has already commenced in this regard,” said Mkhize.   The department has identified over 30 managers at various levels of the health system, who will receive training within the next four weeks -- supported by international development partners. These managers will learn about how NHI is implemented from different parts of the world to ensure the sustainability of implementation.
 
Mobile app to monitor drug stock-outs

Mkhize announced the development of a mobile App linked to a call centre that will allow instant reporting by patients or civil society whenever vital medication is unavailable at clinics and hospitals. “This information will enable authorities at the provincial and national level to immediately intervene,” he said.   He said where there are global shortages of medicines; the department will work tirelessly to timeously identify alternative global suppliers or therapeutic alternatives. “We are also exploring the procurement of available software for prescription and delivery of medication to centres closest to patients. “Patients would not need to go to hospitals for the sole purpose of collecting medicines. We will partner with NGOs to take advantage of IT systems that have already been piloted in the country.

“In this way, we want to ensure that the entire health system can guarantee the security of supply of medicine and timely delivery of chronic medication in areas including townships, informal settlements, and rural areas, as has already been demonstrated in Alexander, Diepsloot, Bara and Ndofaya malls,” he said.
  
2019/07/122019/07/15 11:25 AM
Doctors, nurses, dentists, and hospitals will treat everyone when National Health Insurance (NHI) is rolled out, selecting them on the basis of how sick they are, rather than on their ability to pay, says health minister Dr Zweli Mkhize.

On Friday morning, Mkhize gave parliament more details on how NHI would work. Cabinet approved the NHI bill on Thursday, moving it to parliament for debate. In its draft form in 2018, the bill suggested NHI would be a single government-run medical fund, financing health services for rich and poor, and reporting to the minister of health.

It is not clear what changes have been made to the bill by the government since last year. Mkhize said on Friday that under NHI, healthcare would be the same for everyone, private and public, saying health workers "will be available to provide services equally”. “Currently, poor people often get second-rate healthcare, while wealthier people are able to afford good treatment. The power lies in our hands ... NHI is a way of providing good healthcare to all our people. “Experts and companies have questioned how NHI would be funded. Estimates of the annual cost have ranged between R259bn and R350bn. Mkhize did not explain where the money would come from but said NHI would be the answer to current funds shortages in the health system. "In the long-term, the investment in NHI will create a funding mechanism that will permanently resolve to underfund. “Mkhize said at present there was insufficient funding allocated for the health system. "The current baseline [of funding] is below the expected level of funding, considering the population size, disease burden and the expected quality of services required."

"We are engaging National Treasury to explore various modalities to adequately fund health services. “He admitted that the R19bn allocated for the next three years for dilapidated and decaying infrastructure was "grossly inadequate”. Babies would be registered on the NHI computer system when they were born, and also registered at Home Affairs, the minister said.

The health department was working with Treasury to find funds to ensure vacant doctors and nurses posts were filled, he said. He also committed to increasing the use of community health workers by the government. These people provide nursing support services by visiting patients at home to track why they missed appointments to fetch medicines or find sick people who need a referral to a clinic.

He said 30 managers at various levels of the health system would travel overseas to receive NHI training within the next four weeks.
  
2019/07/122019/07/15 11:26 AM
The National Health Insurance Bill has been approved by cabinet and sent to parliament for discussion, bringing it one step closer to becoming law.

Here is what you need to know.

The final draft of NHI Bill has not yet been tabled in parliament or made public, but the Health Minister Zweli Mkhize revealed some details in his speech to parliament on Friday.

1. NHI will share all the money available for healthcare among ALL people, suggesting medical aid premiums will be added to the single-government run fund.
Mkhize: "NHI is a way of providing good healthcare for all by sharing the money available for healthcare among all our people. The health benefits that you received will depend on how sick you are and not on how wealthy you are."

2. Services will be for everyone, suggesting hospitals will not be divided into public and private facilities.
Mkhize: "Hospitals, clinics, doctors, specialists, dentists, nurses, and all other health workers will also be available to provide services equally."

3. The health department wants more money from the Treasury if NHI is to work.
Mkhize said the funding shortfall for health department must be corrected "without further delay". 

4. The health department has admitted there is a severe shortage of staff with more than 4,100 vacant doctors posts in hospitals - that must be resolved before NHI.
Mkhize said there are 4,143 medical officers, (doctors) 3,932 nurses posts that are unfilled He said there were plans to fill 2,689 doctors posts and 2,371 nurses posts.
He also said there were too many people working as administrators in provincial and national health rather than on the frontline.

5. There is an app for that.
The health minister said: "There is an app being developed for patients to report when medicines are out of stock at their clinic or hospitals.

6. Money for medicines must not be for salaries.
Mkhize said budgets for medicines must be ring-fenced, so it doesn’t go to paying salaries. This has happened. A study published in the Health System Review stated that health department staff costs between 2006 and 2015 exceeded inflation by 38%. In the end, by February health departments had accumulated R14bn in debt to suppliers because money for drugs and consumables like gloves and syringes had been shifted to pay for salaries.

7. The Health Department wants to fix dilapidated hospitals for NHI to work.
A team between national treasury and health has been established to find "creative financing" in order to fix old hospitals and clinic and deliver new ones within 5 to 7 years
Mkhize said the money that had been allocated over the medium term to fix aging hospitals and clinics was "grossly inadequate”.
  
2019/07/122019/07/15 11:29 AM
The Department of Health has already enrolled more than 42 million South Africans in the Health Patient Registration System.

Presenting his departmental budget on Friday, Minister of Health Dr Zweli Mkhize said that this system was developed for the implementation of the National Health Insurance (NHI) and will act as a ‘backbone of an electronic health patient record’. “We have already registered 42.6 million users on the system and all South Africans will be registered by the end of this financial year,” he said. “We support the Department of Home Affairs in the registration of babies in our hospitals, as they will then be registered automatically on the NHI patient register. “NHI will require a digital health platform that will support the operations of the NHI Fund and work has already commenced in this regard,” said Mkhize.

He added that the department has identified over 30 managers at various levels of the health system, who will receive training within the next four weeks – supported by international development partners. These managers will learn about how NHI is implemented from different parts of the world to ensure the sustainability of implementation.

Updated bill

While Mkhize reiterated that an updated NHI bill had been approved by the cabinet, there was little information on how South Africa’s universal healthcare would be funded or when the bill would be tabled in parliament.

Mkhize said that while there have been some concerns about the readiness of our system to implement the NHI, his department would address issues as and when they appeared. “I believe that too much discussion, analysis, and diagnosis has been done and it is time for us to jump into implementation,” he said. “If we continue analysing the problem we will never end up tackling the problems.” Presenting the outcome of the cabinet meeting on Thursday (11 July), a minister in the Presidency Jackson Mthembu said that the bill will be rolled out in phases once it has been passed. “In 2018, cabinet approved that the bill is released for public consultation over a three-month period, from June to September 2018,” Mthembu said. “The inputs received from this process have been incorporated into this latest version, which will be subjected to another rigorous parliamentary process,” Mthembu said that the NHI will provide for universal quality healthcare services to all South Africans, irrespective of their socio-economic background.

He added that the new system will be based on values of justice, fairness, and social solidarity. “Once the Bill has been passed, the existing draft implementation plan will be amended accordingly to give effect to the transitional arrangement of rolling out the NHI in phases,” he said. “The transition period will also allow for the repeal of certain pieces of legislation to enable alignment and coherence.”
  
2019/07/122019/07/15 11:32 AM
Opposition parties have questioned the financial sustainability of the National Health Insurance (NHI). On Friday, Members of Parliament (MPs) debated the nation’s health budget tabled by Minister Zweli Mkhize.

As expected, the budget speech centred around universal healthcare and improved health conditions for South Africans. Mkhize’s budget vote came a day after Cabinet announced that it had approved the National Health Insurance Bill, which would give effect to universal healthcare. Mkhize said under the NHI, the decision on which treatment a patient gets would be based on how sick they were rather than how much money they had. But the Democratic Alliance’s Siviwe Gwarube questioned the wisdom of introducing NHI under the current conditions in the country.

“The legislation will see the nationalisation of healthcare, the creation of a state-owned enterprise, which will be the perfect breeding ground for mass corruption and slow delivery of care.”

Economic Freedom Fighters (EFF) MP Dr Sophie Thembekwayo said it would be a pointless exercise if there’s no proper infrastructure.
  
2019/07/122019/07/15 11:35 AM
Zweli Mkhize’s address at the department budget vote of R51bn focused on fixing the healthcare system and its ‘dilapidated’ infrastructure. Health minister Zweli Mkhize and his team presented the skeleton of the National Health Insurance (NHI) Bill on Friday morning but did not flesh out the details, including what the costing and economic impact would be.

The long-expected draft law, approved by the cabinet on Wednesday, is aimed at giving effect to an ANC resolution to create a universal healthcare system that will replace the current broken public medical service. The bill will be tabled before parliament, but it is not clear when the legislative process, that includes public hearings, will be completed and the final draft submitted to the president to be enacted into law.

Mkhize told the media on a briefing before his budget vote address that the NHI will be implemented incrementally. Mkhize’s address at the department budget vote of R51bn focused on fixing the healthcare system and its infrastructure so there will be a base able to implement the NHI fund.  This included addressing staff shortages and re-organizing management. “It will be impossible to convince the public about the virtues of the NHI if it is built over a dilapidated and decaying infrastructure,” Mkhize said.

He said an amount of R19bn has been set aside for the three-year, medium-term expenditure framework period to refurbish, maintain and build four hospitals and 34 clinics at R6bn; 85 hospitals and 120 clinics at R5.2bn; and maintain 485 clinics at a cost of R8.9bn.“While this is a significant amount, it is grossly inadequate. The department has done an audit of all facilities and has costed the entire programme of infrastructure build,” Mkhize said. He said a team of experts in finance, health, and infrastructure from both the National Treasury and department of health has been established to seek creative financing mechanisms and alternative models of delivering of health infrastructure.  “They have been given a clear directive to accelerate the refurbishment of all old hospitals and clinics and deliver new ones within five to seven years,” Mkhize said.

He said this would form the basis on which the NHI will operate. “Preliminary indications are that this is feasible. Based on the developed plan, I will engage provinces and other stakeholders on this matter.”
  
2019/07/112019/07/15 11:09 AM
Minister in the presidency Jackson Mthembu has said heads must roll following the auditor general's (AG) dismal findings on the state of municipalities in the country. Addressing journalists after a cabinet meeting on Thursday‚ Mthembu said the government wanted to see action taken against habitual offenders in municipalities. “We can’t just continue condemning and condemning‚ we should have an action plan,” he said.

Last month‚ AG Kimi Makwetu said audit outcomes were deteriorating in municipalities; of the 257 municipalities‚ only 18 received clean audits. Mthembu said municipal officials implicated in wrongdoing would have to pay back the money‚ as the AG has been empowered in law to undertake this function. “Cabinet said heads must roll for those who continue to spend fruitlessly‚ spend wastefully and spend irregularly.”  Local government minister Nkosazana Dlamini-Zuma has been tasked by the cabinet to work with municipalities to turn things around and is expected to update it periodically. “The cabinet has said that the national minister working with relevant municipalities must find a way of curbing these maladministration tendencies in our system of local government‚,” Mthembu said.

E-tolls taking a toll

Meanwhile‚ the cabinet has given transport minister Fikile Mbalula‚ finance minister Tito Mboweni and Gauteng premier David Makhura a month to come up with a plan to deal with e-tolls in Gauteng. “We are confident that these ministers will act as directed by the president to come back in August on the e-tolling system in Gauteng and say what we should do‚,” Mthembu said.

The trio has been involved in a public spat over the matter‚ with Mboweni saying e-tolls are here to stay. Makhura has insisted that the user-pay projects on the province’s highways are overburdening consumers. Mthembu further announced that the cabinet has approved the National Health Insurance (NHI) Bill to go to parliament to be rubber-stamped. He said health minister Zweli Mkhize would share further details on the bill in the coming days.

The NHI is expected to provide far-reaching health reforms so that the government can provide healthcare for all. Despite the persisting controversy around the bill‚ the government is certain it will be passed in parliament and later be signed into law
  
2019/07/11
2019/07/15 11:12 AM
National health insurance (NHI) is one step closer to becoming a reality after Cabinet approved the NHI Bill of 2018, ready to be tabled and debated in Parliament, Minister in the Presidency Jackson Mthembu announced.

"In 2018, Cabinet approved that the Bill be released for public consultation over a three-month period, from June to September 2018.”The inputs received from this process have been incorporated into this latest version, which will be subjected to another rigorous parliamentary process," Mthembu said, addressing the media on the outcomes of Wednesday's Cabinet briefing. Mthembu said the Bill will give effect to the National Development Plan to provide for universal quality healthcare services to all South Africans, irrespective of their socio-economic backgrounds.

"It will address the current health system that serves only 16% of South Africans whilst excluding the overwhelming majority. “The Bill provides for the establishment of an NHI Fund as a public entity reporting to the Minister of Health, to be governed by the Public Finance Management Act. Mthembu said once the Bill has been passed, the existing draft implementation plan will be amended accordingly to give effect to the transitional arrangement of rolling out the NHI in phases, including the repeal or aligning existing legislation. He added that Minister of Health Zweli Mkhize would hold a separate media briefing to unpack the bill. Former health minister Dr Aaron Motsoaledi said last year that the transition was expected to take approximately 15 years in three phases. Phase two began in 2017 and will end in 2022. In theory, the system should finally be ready by 2026, he said at the time. Last week, the DA indicated that the Bill would not go through Parliament "uncontested". After Mkhize told the Portfolio Committee on Health that the NHI Bill was on its way to becoming a reality, DA MP and spokesperson on health Siviwe Gwarube said in a statement released after the meeting that a report on the feasibility of the NHI pilot projects had never been made public.

"The road to universal healthcare is not limited to this problematic piece of legislation. More concerningly is the establishment of yet another state-owned-enterprise which will open up the public purse to looting by the politically-connected few." She said the DA had long held the view that universal healthcare was possible, but that the NHI, as proposed by the ANC government, was too expensive and not feasible.

"The ANC forcing through the NHI will not go uncontested, the DA will fight this and propose a credible plan that will ensure that every South African has access to proper and quality public healthcare," Gwarube said.
  
2019/07/102019/07/15 11:07 AM
Jackson Mthembu says the inputs received from the 2018 consultation process have been included in the latest version of the Bill. Cabinet has approved the National Health Insurance (NHI) Bill for tabling in Parliament, Minister in the Presidency Jackson Mthembu said on Thursday.

Briefing journalists on the outcomes of the fortnightly cabinet meeting on Wednesday, Mthembu said the inputs received from the 2018 three-month consultation process have been included in the latest version of the Bill. “The NHI Bill provides for the establishment of the NHI Fund as a public entity reporting to the minister of health. It will be established as an autonomous schedule 3A under the Public Finance Management Act, 1999 (Act 1 of 1999),” said Mthembu.

“Once the Bill has been passed, the existing draft implementation plan will be amended accordingly to give effect to the transitional arrangement of rolling out the NHI in phases. The transition period will also allow for the repeal of certain pieces of legislation to enable alignment and coherence.”

Mthembu said Health Minister Zweli Mkhize would unpack the contents of the Bill at a later stage.
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