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2018/12/07
2018/12/10 04:19 PM
MEDBRIEF AFRICA

It is back to the drawing board for the Department of Health on the National Health Insurance (NHI) Bill after Cabinet decided to send it back to the department for more work. The Bill was presented to Cabinet yesterday, but statements on its website indicate that it was not approved during yesterday’s session with various other draft legislation destined for Parliamentary approval.  Presidential spokesperson, Khusela Diko confirmed to MedBrief Africa last night that the Bill was presented to Cabinet but that it was not approved and will only be finalised early next year.

According to a report by Health-e News government sources have confirmed that a special Cabinet meeting will now be held at the end of January next year to discuss the Bill and decide on the way forward.

The decision by Cabinet to refer the Bill back comes amidst fierce criticism from stakeholders in the healthcare sector and civil society warning that rushing the legislation through in its current form could lead to a total collapse of the healthcare system. However, in a strongly worded statement last week, Health Minister Aaron Motsoaledi slammed critics of the Bill and media reports that a team led by presidential advisor Dr Olive Shisana made changes to the document initially approved by the then Minister of Finance, Nhlanhla Nene and the Health Minister for presentation to Cabinet.

This was confirmed in a letter written by the deputy director-general of Treasury, Ismail Momoniat to Shisana and leaked to the media last month. It was also revealed that the Director-general of Health, Precious Matsoso was side lined in the process and not provided with a copy of the revised Bill as it made its way to Cabinet. A version of the Bill which contains the changes referred to in the letter to Shisana is dated 5 October indicating that the Department of Health couldn’t possibly consider the hundreds of comments on the draft Bill released in June this year as the deadline for submissions was only the 21st of September.

The delay of the Bill comes only a few days after the Health Market Inquiry into the private sector announced that it had postponed the release of its final report and recommendations to the end of March next year to provide it with enough time to seriously consider all input it had received from stakeholders on the provisional report. It was expected that the Department of Health would consider the final recommendations of the HMI report for inclusion in the NHI Bill.
  
2018/12/07
2018/12/10 04:20 PM
BUSINESS DAY
Thursday’s statement makes it clear the cabinet has not given the bill the green light, but it is unclear what its concerns are.

The cabinet has rejected the fiercely contested National Health Insurance (NHI) Bill, sending it back to the health department for further work, it emerged on Thursday.

The bill paves the way for far-reaching health reforms aimed at achieving the ANC-led government’s ambition of providing universal health coverage. Its main aim is to establish 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 cover to about 8.9-million people.

The bill has been mired in controversy in recent weeks, after a leaked Treasury letter laid bare conflict between its officials and presidential adviser Olive Shisana after she reversed aspects of the bill previously agreed to by the ministers of health and finance. The Treasury raised a host of concerns, ranging from the sharply diminished role of medical schemes laid out in the revised version of the bill to a lack of consultation about far-reaching proposed changes to the role of provincial health departments.

Shisana heads the NHI "war room" in the presidency, which took control of the NHI process in August.

Shortly after the Treasury letter was leaked in mid-November, health director-general Precious Matsoso went public with her concerns, saying she had been completely side lined in the process of revising the bill after the public comment period close, despite being the department’s accounting officer. The bill was redrafted by Shisana and two people selected by health minister Aaron Motsoaledi — his adviser, Aquina Thulare, and deputy director-general Anban Pillay.

Without directly alluding to it, a statement issued on behalf of the cabinet on Thursday made it clear that it had not approved the bill for submission to parliament at its latest meeting on Wednesday. It was not on the list of bills and policies approved for public comment, nor was it on the list of draft legislation that had been given the green light to enter the parliamentary process.

Presidential spokesperson Khusela Diko confirmed the bill came before cabinet on December 5 and had not been approved. "It will be finalised in the New Year," she said.

She declined to elaborate on the cabinet’s concerns about the bill, saying she was unable to comment on the processes.

Attempts to obtain comment from acting cabinet spokesperson Phumla Williams were unsuccessful on Thursday.

Motsoaledi’s spokesperson, Popo Maja, declined to comment on the cabinet’s deliberations or the status of the NHI Bill, as did finance minister Tito Mboweni’s spokesman, Jabulani Sikhakhane.

Motsoaledi had previously defended the government’s approach to crafting the bill, saying that there had been nothing irregular in the manner in which it was being processed.
  
2018/12/07
2018/12/10 04:35 PM
IOL
A new procedure that can drastically improve the lives of leg amputees was recently performed for the first time in South Africa.

The procedure involves a revolutionary new type of prosthesis that does away with traditional suction sockets by directly attaching an amputee’s prosthetic limb to their skeleton.

Professor Nando Ferreira from Stellenbosch University’s Division of Orthopaedics, who was the lead surgeon, collaborated with the Institute for Orthopaedics and Rheumatology at Mediclinic Winelands, prosthetist Eugene Rossouw, and associate professor Munjed al Muderis of the Osseointegration Group of Australia, to perform South Africa’s first osseointegration prosthesis implant on November 5.

The recipient was a 28-year-old woman who suffered a traumatic above-knee amputation in 2009. Since then, she has struggled with her socket prosthesis, which interferes with her occupation and daily life.

The patient has progressed well, and her first prosthesis fitment was done two weeks after the surgery.

She has begun a 12-week rehabilitation protocol that involves progressive weight bearing while using two crutches for six weeks, followed by another six weeks using one crutch.

The procedure was originally developed in Australia by Al Muderis, the Australian surgeon who pioneered osseointegration and developed the Osseointegration Group of Australia Osseointegration Prosthetic Limb (OGAP-OPL) prosthesis, the surgical technique, and the rehabilitation protocol over the last decade.

About 750 surgeries have been performed, mostly in Australia.

“The OGAP-OPL is a revolutionary prosthesis that does away with traditional suction sockets by attaching an amputee’s prosthetic limb to the skeleton. This affords amputees unique advantages and can drastically transform their quality of life,” Ferreira said.

Amputees frequently suffer problems with traditional suction sockets, including skin irritation, poor fit due to sweating and volume changes of the stump throughout the day, discomfort while sitting, and the time it takes to attach and remove a prosthesis.

These socket-related problems are eliminated with an osseointegration prosthesis.

Recipients also have a better perception of the body’s position and movement and can feel the surface they are walking on, allowing them to walk with more confidence.

The osseointegration prosthesis restores the normal anatomical alignment of the thigh bone, which significantly reduces common gait deviations in above-knee amputees.

However, the procedure is not without complications, most significantly infection around the implant and fractures of the remaining bone.

“Candidates are carefully screened for suitability and currently only individuals suffering severe socket problems that significantly interfere with work and daily life are considered for this procedure,” Ferreira said.

“The unique design, materials and manufacturing process of the OGAP-OPL allows bone to grow into the surface of the implant.”
  
2018/12/06
2018/12/10 04:20 PM
HEALTH-E NEWS
A special Cabinet meeting will be held on 30 January with the NHI, which lays the groundwork for a single health system, the only item on the agenda.

The Bill was presented to Cabinet on Thursday, where state law advisers assured members that the Bill did not contravene the Constitution.

The Cabinet statement made no mention of the NHI, leading to speculation that the Bill had been rejected.

However, two well-placed sources confirmed to Health-e that, as the Cabinet agenda was full, Cabinet members had decided to defer the Bill to a special Cabinet meeting on 30 January. The NHI, which lays the groundwork for the establishment of a single health system, will be the only item on the agenda at this meeting.

The Department of Health declined to comment on the process, with spokesperson Popo Maja saying it was a Cabinet matter.

The NHI Bill sparked controversy recently when the Director General of Health, Precious Matsoso, said she had neither seen the final draft nor signed off on it before it had been referred to a Cabinet sub-committee last week.

However, Matsoso confirmed this week that she had since received a copy of the Bill, and confirmed that the NHI process was being driven by a “war room” located in the Presidency convened by Dr Olive Shisana.

Health Department Deputy Director General Anban Pillay has been seconded to the Presidency to assist Shisana.

The NHI proposes a radical shake-up of the country’s health system based on compulsory contributions from all working people towards an NHI Fund. The fund will then disburse funds to health institutions – public and private – that meet certain basic criteria and are accredited as service providers by the Office of Health Standards Authority. All citizens will then be able to get health care from any accredited facility based on their needs.

It is unclear whether private medical aids will continue to exist as most working people will be unable to afford to pay contributions to both the NHI Fund and private schemes.

At the recent Presidential Health Summit called to discuss the NHI, a number of civil society organisations called on government to fix the ailing health service before introducing the NHI.

However, Health Minister Aaron Motsoaledi has condemned them as being against universal healthcare.
  
2018/12/06
2018/12/10 04:21 PM
DAILY MAVERICK
The opinion piece by Busani Ngcaweni is misplaced, inaccurate and at best wishful thinking.

In an opinion piece, Busani Ngcaweni contends that the National Health Insurance (NHI) is a cure-all to all South Africa’s health needs while the reality is that the public healthcare system is on life support.

While the goals of providing universal healthcare are important it is clear that the ANC government lacks the political will and capacity to deliver it. Plans by the Minister of Health, Dr Aaron Motsoaledi, to push ahead with the National Health Insurance are an act of desperation and form part of the ANC’s electioneering tactics. It is a decision doomed to failure from the outset.

The NHI proposal has never been properly costed with Motsoaledi admitting that he had no idea how much it would cost or where the money would come from. Meanwhile, NHI pilot projects have failed abysmally wherever they have been trialled.

What Ngcaweni fails to mention is the backdoor dealings of Motsoaledi following the introduction of the NHI Bill. It was reported that Motsoaledi had made substantive changes to the Bill and presented a new version to Cabinet without consulting with National Treasury or senior members of his own department. Instead, reports suggest that the changes are the brainchild of Motsoaledi and presidential adviser Dr Olive Shisana.

The Minister made substantive changes to the existing Bill that effectively kill the private healthcare system. This includes restricting medical aid or other private health insurance schemes to providing only complementary cover, effectively making NHI the only game in town. The effect of this is nothing short of nationalising the private healthcare industry by making the State the sole purchaser of healthcare services. The Minister did not take any input from the public seriously, as the proposed changes are substantive, and the public and other stakeholders have not had an opportunity to raise their concerns.

The proposed creation of a single National Health Insurance Fund is little more than the creation of another enormous state-owned entity (SOE). This is greatly concerning considering the government’s dismal performance in managing SOEs, endemic corruption and its equally dismal performance in providing healthcare. Much like government’s failed management of Eskom, South Africa will surely be heading towards a healthcare “blackout” if NHI is fully implemented.

The Minister is completely out of touch with the crisis in the South African public health system, and this was highlighted by his denial of the ongoing health crisis.

DA visits to hospitals and clinics around the country have exposed medicinal shortages, equipment shortages and a severe shortage of beds. In most hospitals visited, infrastructure is collapsing and lack of maintenance in facilities is painfully obvious. Doctors are leaving the public health sector in droves. They cannot work under the present conditions with lack of resources, very long hours due to lack of effective personnel and maladministration at every level. While the Western Cape has 33 specialists per 100,000 residents, Limpopo only has 1.3 specialists per 100,000. The MEC of Health in Limpopo stated: “If people are one day sick and require a specialist, they will wish they were born in the Western Cape.”

The current and revised NHI Bill fails to address the real crisis in the health sector.

First, it cannot be implemented due to failure in the current health sectors which cannot deliver effective healthcare to the majority of South Africans.

Second, the Minister himself cannot tell us what the costs of implementing the Bill will be and advises that it will take up to 15 years to effectively implement. The provinces cannot manage current budgets and have all declared they are under-financed.

Third, the NHI pilot projects have failed abysmally already. If a pilot project is unsuccessful, there is no chance that it will be successful nationally. Lastly, the NHI aims to put a cap on the amount of private health insurance providers and medical aids. This creates a risk of monopoly in the industry, price fixing and collusion.

There is however hope for quality universal healthcare.

After extensive consultation with both academia and the industry, the DA’s offer, titled Our Health Plan – to uplift the health sector and introduce a practical and sustainable health plan – is far more effective. It can be rolled out and put into effect within five to eight years, takes into account the needs of all South Africans and, where put into practice, has proved itself.

Furthermore, Our Health Plan will provide quality healthcare which is affordable and can be implemented using our current health budget. This would mean that medical aid contributions would no longer be tax deductible. The additional revenue would go to reducing the costs of medical aid.

Where the Our Health Plan is implemented in the Western Cape, the province has shown that it can deliver better healthcare than in any other provinces, a fact recognised by the MEC of health in Limpopo. Mortality rates are lower – half of any other province, it has attracted the highest number of South African doctors and has the highest number of specialists per capita. Hospitals and clinics are better maintained and have far better resources.

The Minister aims to rob Peter to pay Paul. The current health system has collapsed and is in the severe financial crisis. It can be fixed but will require proper leadership, less corruption and better management and appropriate use of budgets.

The DA health plan is the only alternative to resuscitate a broken system.

Lindy Wilson DA Deputy Shadow Minister of Health.
  
2018/12/06
2018/12/10 04:21 PM
BUSINESS DAY
Thursday’s statement makes it clear cabinet has not given the bill the green light, but it is unclear what its concerns are.

Mystery surrounded the status of the National Health Insurance (NHI) Bill on Thursday, after the government issued a post-cabinet statement silent on the hotly contested draft legislation. The bill paves the way for a suite of far-reaching reforms aimed at achieving the ANC-led government’s ambition of providing universal health coverage. It proposes establishing 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 cover to about 8.9-million people. Last week presidential spokesperson Khusela Diko said the bill had been due to be tabled before the cabinet on December 5. While Thursday’s statement makes it clear that the cabinet has not given the bill the green light, it is unclear what its concerns were and what action it may have subsequently demanded of either the health department or the presidency.

The statement contains a list of bills and policies that have been approved for public comment, as well as legislation approved for submission to parliament. The presidency has established an NHI “war room” led by presidential adviser Olive Shisana. Working closely with two people selected by health minister Aaron Motsoaledi, she has led the process of revising the NHI Bill, which was released for public comment in June. The submission period closed on 21 September.

Motsoaledi’s spokesperson, Popo Maja, declined to comment on the cabinet’s deliberations, or the status of the NHI Bill. Acting cabinet spokesperson Phumla Williams and presidential spokesperson

Khusela Diko was not immediately available for comment.
  
2018/12/06
2018/12/10 04:36 PM
NETWERK24
’n Opwindende nuwe prosedure wat die lewe van mense met onderste ledemaat-amputasies drasties kan verbeter, is onlangs vir die eerste keer in Suid-Afrika uitgevoer.

’n Professor aan die Universiteit Stellenbosch (US), in samewerking met die Instituut vir Ortopedie en Rumatologie (IOR) by die Mediclinic Winelands, die prostetikus Eugene Rossouw, en medeprofessor Munjed Al Muderis van die Osseo-integrasiegroep van Australië, het op 5 November vanjaar Suid-Afrika se eerste osseo-integrasie-prostese-inplanting uitgevoer.

Die US se fakulteit geneeskunde en gesondheidswetenskappe (FGGW) sê in ’n verklaring die prosedure is oorspronklik in Australië deur Al Muderis ontwikkel, en behels die chirurgiese inplanting van die Osseo-integrasiegroep van Australië se osseo-integrasie- prostetiese ledemaat (OGAP-OPL).

“Die OGAP-OPL is ’n revolusionêre nuwe soort prostese wat wegdoen met die tradisionele prostetiese vassuig-sok deur die prostetiese ledemaat direk aan die persoon se skelet te heg. Dit bied unieke voordele wat die lewensgehalte van mense met amputasies drasties kan verbeter,” sê prof. Nando Ferreira van die US se afdeling vir ortopedie aan die FGGW.

Ferreira is die chirurg wat die prosedure gelei het.

Mense met amputasies ervaar gereeld probleme met die tradisionele sok-prostese, insluitende velirritasie, probleme met hoe dit pas weens byvoorbeeld sweet en veranderinge in die volume van die stompie deur die loop van die dag, ongemak wanneer hulle sit, en die tyd wat dit neem om die prostese aan te sit en af te haal.

“Kandidate word versigtig gekeur vir geskiktheid en tans word slegs individue vir die operasie oorweeg wat ernstige sok-probleme ervaar wat groot inbreuk maak op hul werk en daaglikse lewe.” prof. Nando Ferreira

Probleme wat verband hou met sok-prostese is iets van die verlede met ’n osseo-integrasie-prostese aangesien dié prostetiese ledemaat direk aan die skelet geheg word. Ontvangers het ook beter propriosepsie (persepsie van die ledemaat se posisie en beweging) en kan die loop-oppervlak voel, wat hulle toelaat om met meer selfvertroue te loop.

Die osseo-integrasie-prostese herstel ook die normale anatomiese lynrigting van die dybeen (femoraal) (sien beeld hierby), wat algemene loop-afwykings verminder in mense met amputasies bo die knie. Die prosedure is egter nie sonder komplikasies nie.

Infeksie rondom die inplanting en frakture in die oorblywende been is die mees beduidende komplikasies wat ná osseo-integrasie kan voorkom. “Kandidate word versigtig gekeur vir geskiktheid en tans word slegs individue vir die operasie oorweeg wat ernstige sok-probleme ervaar wat groot inbreuk maak op hul werk en daaglikse lewe,” sê Ferreira. Die ontvanger van Suid-Afrika se eerste osseo-integrasie-prostese-inplanting is ’n 28-jarige vrou wat in 2009 ’n traumatiese amputasie bo haar knie gehad het. Sedertdien sukkel sy met haar sok-prostese, wat inbreuk maak op haar werk en alledaagse aktiwiteite. (Die pasiënt verkies om anoniem te bly.)

Só werk dit:
“Die OGAP-OPL se unieke ontwerp, materiaal en vervaardigingsproses laat toe dat daar been binne-in die oppervlak van die inplantasie groei en so “integreer” die prostese met die skelet.

’n Spesiaal ontwerpte stut wat dan deur ’n opening in die stompie steek, wat chirurgies gemaak is, vorm ’n koppelingspunt vir die eksterne komponente van die prostetiese ledemaat,” verduidelik Ferreira.

Al Muderis is die Australiese chirurg wat die baanbrekerswerk oor osseo-integrasie gedoen het en oor die afgelope dekade die OGAP-OPL-prostese ontwikkel het, asook die chirurgiese tegniek en die rehabilitasie-protokol.

Tot nou is die prosedure al ongeveer 750 keer uitgevoer, meestal in Australië.

“Prof. Al Muderis se entoesiasme om die lewe van mense met amputasies te verander, is sigbaar in sy onvermoeide werk en gewilligheid om ander chirurge op te lei in sy tegniek,” sê Ferreira.

Prof. Al Muderis se entoesiasme om die lewe van mense met amputasies te verander, is sigbaar in sy onvermoeide werk en gewilligheid om ander chirurge op te lei in sy tegniek. prof. Nando Ferreira Ferreira het na Sydney, Australië, gereis saam met die egpaar Eugene (prostetikus) en Fransien (fisioterapeut) Rossouw, om opleiding van Al Muderis te ontvang in die chirurgiese prosedure, prostetiese passing en rehabilitasie. Hierdie span is tans die enigste groep wat gesertifiseer is om die OGAP-OPL-prosedure in Suid-Afrika uit te voer.

Vir die chirurgie op die plaaslike pasiënt is Ferreira bygestaan deur dr. Gerhard Pienaar, ’n ortopediese chirurg van die Instituut vir Ortopedie en Rumatologie aan die Mediclinic Winelands, en Al Muderis, wat van Australië gereis het om toesig te hou oor die operasie. Die pasiënt sterk goed aan en het haar eerste prostese-passing twee weke gelede gehad. Sy het begin met die 12 week lange rehabilitasie-protokol wat progressiewe gewigslading vir ses weke met twee krukke behels, gevolg deur ses weke van bystand-mobilisasie met een kruk.

Die span is van plan om hierdie prosedure aan nog pasiënte te bied, in die openbare, sowel as die private gesondheidsektor, en hoop dat dit ’n goed aanvaarde opsie sal word vir Suid-Afrikaners met amputasies, volgens die verklaring.
  
2018/12/06
2018/12/10 04:36 PM
BIZCOMMUNITY
In a first for South Africa, a 28-year-old patient with a previous trans-femoral amputation has received a successful osseointegration prosthetic limb implant.

The surgery was performed by Professor Nando Ferreira, an orthopaedic surgeon at Stellenbosch University, as the lead surgeon. He was assisted by Dr Gerhard Pienaar, an orthopaedic surgeon at Mediclinic Stellenbosch. They were joined by Dr Munjed Al Muderis, an orthopaedic surgeon from Sydney, Australia, who has pioneered the technique and the device itself. Ferreira travelled to Sydney in 2018 to learn the procedure, and he is currently the only surgeon in South Africa who is certified to use the implant

Addresses limitations of traditional prosthesis

“This is a revolutionary technology,” says Muderis. “It changes the whole philosophy of how to treat and manage someone with an amputated limb. Before we would use a bucket prosthesis that encases the residual limb. With this procedure, we can directly attach the prosthetic limb to the skeleton. This reorganises the muscles and nerves to operate the limb.”

This procedure addresses a number of limitations of the traditional prosthesis approach, says Muderis. “The vast majority of amputee patients will at some stage have trouble fitting a bucket or socket prosthesis. They will struggle with skin issues, as the contact can cause friction, heat and chafing, and over time lead to blisters and infections, as well as mobility and fit. The human body changes as time goes by, and a bucket prosthesis that fitted perfectly in the morning will often not suffice by the afternoon or evening, as the residual limb swells in response to weather and pressure conditions.”

He says an osseointegration prosthetic limb implant can also help amputee patients regain their sense of confidence. “With a socket prosthesis, there is a lack of feedback from the ground. So when you walk, you walk as if you are on a hovermat. They do not feel the ground. So they will need to look at the floor all the time as they move, and are unable to walk in dark rooms. With this technology, they get 100% feedback from the ground.”

It also addresses a number of long-term issues. “In a traditional socket prosthesis, both the femur and hip joint are not loaded naturally, which results in degeneration and atrophy of the bone and can lead to osteoporosis," says Muderis.

Modelled on anatomy

The osseointegration prosthetic limb is modelled on the anatomy of the human body. “This prosthetic implant takes the load back to the femur and the hip joint when walking. This allows for direct contact to the ground, which provides greater stability and more control, and minimises energy exerted.”

During the procedure, surgeons refashion the muscles around the implant, says Muderis, using a technique known as myodesis. They will then implant the device into the bone, which over time will allow the bone to grow into the implant. This has the effect of allowing the muscles around the bone to operate the limb.

Only 750 cases of this surgery have been performed globally in the past 10 years. This procedure is still seen as revolutionary and only performed on a relatively regular basis in Sydney, Australia. Other centres in England, the Netherlands and Sweden are performing these procedures, albeit in limited numbers.
  
2018/12/06
2018/12/10 04:38 PM
BUSINESS REPORT
It is a fascinating time for healthcare globally. Shifting demographics, cost pressures, policy changes, consumer ism, and rapid advances in technology will change the face of healthcare as we know it.

South Africa has its own unique challenges and opportunities. The triple threats of poverty, inequality and unemployment mean many citizens are simply unable to access quality healthcare.

The introduction of National Health Insurance NHI in South Africa aims to address this issue, presenting real opportunities for public private partnerships and innovation.

Shifting global demographics and the demand for healthcare:
People are living longer, many with chronic conditions. We also see population growth, particularly in developing markets such as Africa expected to grow by 2.4 billion by 2050. Populations are becoming increasingly unhealthy, driven by sedentary life styles, high personal stress levels, and poor dietary habits.

The result is an increasing disease burden on health systems. In South Africa alone, 50 people die every day due to diabetes, while an additional 35 lives are lost daily due to respiratory diseases.

At Life Healthcare we are seeing increasingly complex cases, both in terms of diagnoses and treatment. We recognise that our patients require quality care, not only in acute facilities, but across the entire continuum of care.

For this reason, in addition to maintaining the highest quality of care in our hospitals, we are also focusing on building our non-acute offering from primary care services to mental health, rehabilitative care and diagnostic services.

Rising cost pressures:
Healthcare costs are rising globally, jeopardising affordability of healthcare for many. Most healthcare systems are looking at ways to cut costs, and improve disease prevention in society.

At Life Healthcare we pride ourselves on our operational efficiency. We continually work hard to ensure that we remain an effective, productive healthcare provider, without ever compromising on our commitment to quality patient care.

We are also strengthening our offering across the continuum of care to empower patients to take ownership of their health, and to support prevention as well as cure.

Changes in policy and regulatory environments:
Globally the healthcare regulatory environment is complex and evolving. In South Africa, the NHL Medical Schemes Amendments Bills, and outcomes of the Health Market Inquiry will change the healthcare landscape fundamentally.

The goal of universal health care will require strong partnerships between public and private players. If we look for creative solutions and leverage the best from the public and private sector, we have an opportunity to significantly improve healthcare access and affordability in the country.

While we at Life Healthcare appreciate the challenges of execution, we are excited to help deliver on new healthcare models to benefit population segments we don't currently serve.

Consumer centricity:
As people become accustomed to personalised, digital offerings in retail and banking, they will expect similar experiences when it comes to their healthcare. Connectivity and access to information mean healthcare consumers are becoming more knowledgeable and better able to compare quality and outcomes across clinicians and medical service providers.

Patients also demand convenience. In Europe, for example, home based care is gaining traction, while personalised care, walk in services and virtual queueing are also becoming popular.

Evaluation and measurement of patient experience has fast become international best practice and assists in ensuring patient centred care remains a priority for healthcare service providers globally. At Life Healthcare, we are commit ted to clinical excellence and patient centricity.

To this end, in South Africa we publish our patient experience scores in real time, giving insight into the hospital stay and the level of service.

Technology and healthcare access:
The World Health Organisation WHO predicts rapid advancements in technology will drive better quality of healthcare and enable greater access to services by providing more diverse treatment models while lowering costs.

Similarly, the 2018 Philips Future Healthcare Index FHI finds that technology and digital innovation, artificial intelligence, and connected care will be important enablers of healthcare access and ground-breaking treatments, despite the impact of rising costs on affordability.

At Life Healthcare we believe in the potential of technology to transform healthcare. We continuously seek ways to source cutting edge technology to improve patient quality, patient experience and efficiency.

One area already benefiting from technological advancements, and which will continue to grow is diagnostic imaging. Making use of smarter technology means healthcare providers can enhance the patient experience by lowering the risk of diagnostic errors while speeding up the provision of better, more affordable treatment.

We have seen the growing impact of diagnostics within integrated care and Life Healthcare has invested in these capabilities by acquiring the leading European provider of complex molecular and diagnostic imaging services, Alliance Medical Group, to strengthen our offering in this field and provide the best experience to patients across the whole continuum of care. Furthermore, advancements in surgical technology are making a positive impact on surgical outcomes for both the patient and the surgeon.

Life Healthcare's investment into robotics aligns to our strategy to invest in appropriate and proven technologies to remain technologically relevant and drive clinical quality and improved outcomes for our patients. Robotic assisted surgery, for example, allows minimally invasive procedures which reduces the need for blood transfusion and benefits patient outcomes in term of less postoperative pain, reduced risk of wound infection, as well as a shorter hospital stay and faster recovery. To this end, Life Healthcare has invested in a robotic assisted surgical system which will allow us to offer this technology at Life Kingsbury Hospital.

Setting up for future growth:
As healthcare providers, we must develop innovative healthcare models, while continuing to focus on efficiency, quality and patient centricity. We must also build strong partner ships to improve healthcare access and affordability. Despite its challenges, the future of healthcare in South Africa can be bright.

Dr Shrey Viranna is the chief executive of the Life Healthcare Group.
  
2018/12/05
2018/12/10 04:22 PM
BUSINESS DAY
A total 3,535 nurses qualified in 2018, of whom 3,470 have already been placed, MPs told.

Virtually all SA’s newly qualified nurses have been placed in public sector posts for 2019, a senior health department official assured MPs on Wednesday.

In contrast to the last-minute scramble to find positions for new nurses in previous years, the process of placing nurses who qualified in 2018 has gone smoothly, according to the department’s chief operating officer, Gail Andrews.

A total of 3,535 nurses qualified in 2018, of whom 3,470 had already been placed, she told parliament’s portfolio committee on health. SA nurses have been given priority, and the handful of nurses who have not been offered posts in the public sector are foreigners who are studying in SA, she said.

All 248 bursary holders from Limpopo have been placed in posts in the province, she said. Bursary holders are required to work for a period in the province that funded their studies.

The department’s chief nursing officer, Nonhlanha Makhanya, briefed MPs on ongoing reforms to nursing qualifications, and the rationalisation of nursing colleges.

Nursing colleges fall under the jurisdiction of provincial health departments, which determine their five-year enrolment plans based on their needs and the available resources.

Following several years of reorganisation, each province now has a single nursing college with satellite campuses, and the nursing schools previously located in hospitals are being converted into clinical training units or sub-campuses, she said. The South African Military Health Services also runs a nursing college.

From 2020, a new three-year diploma in general nursing will be offered by nursing colleges. This will be the entry-level nursing qualification, and students can obtain advanced diplomas in skills such as midwifery or oncology. Studies that lead to qualifying as an enrolled nurse or staff nurse will not be offered after 2019.

Makhanya said general nurses will be more highly skilled than enrolled and staff nurses, and will not require supervision from more senior nursing staff.

In line with legislative requirements, health minister Aaron Motsoaledi has formally requested the higher education and training minister to declare the nursing colleges as public higher education colleges, she said.  All the provinces except Northern Cape have already submitted their programmes for accreditation with the Council for Higher Education, she said.

Makhanya said universities are also revising their nursing curriculums to meet the requirements of the new nursing qualifications.
  
2018/12/03
2018/12/10 04:32 PM
DAILY MAVERICK
On the eve of a quarter century of freedom and democracy, South Africa is engaged in yet another project of transformation that will bring us closer to the fulfilment of our constitutional objective to create a caring, inclusive and more equal society.

Cabinet is shortly expected to consider the National Health Insurance (NHI) Bill, which sets out to create, as Health Minister Aaron Motsoaledi has said, a funding system for healthcare that will guarantee that every individual living in South Africa has access to a free and good quality healthcare at the time of need.

At the core of this initiative is to ensure the widest possible pooling of resources – financial resources to pay for healthcare, and the effective and efficient use of available human and other resources to provide quality healthcare to all.

In pursuing this policy initiative, South Africa is by no means out on a limb. Indeed, South Africa is seeking to align itself with global best practice as experienced in a number of developed and developing economies. The country seeks to answer the call of the World Health Organisation (WHO), which asserts that good health is essential for sustained economic and social development and poverty reduction. The WHO maintains that access to much-needed health services is crucial for maintaining and improving health, and propounds that people need to be protected from being pushed into poverty because of the cost of healthcare.

The WHO defines universal health coverage as ensuring that all people have access to much-needed health services (including prevention, promotion, treatment, rehabilitation and palliative care) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship. Universal health coverage has therefore become a major goal for health reform in many countries and a priority objective of the WHO.

For South Africa, the development and adoption of the NHI is an intervention that aims to end the inequality that is adversely affecting households and workplaces when people are denied certain levels and categories of healthcare, including access to certain technologies, purely because they cannot afford them.

Stories abound of patients being turned away from some health facilities because they cannot afford upfront payments running into tens of thousands of rand or of those critically injured being asked if they have medical aid before paramedics can decide where to take them for treatment. This is a sad violation of a basic human right to access medical treatment that our nation needs to deal with.

The status quo within the medical schemes industry and private healthcare system in general requires a complete overhaul in terms of pooling, purchasing and provisioning of care.

As demonstrated by the Council for Medical Schemes’ (CMS) annual reports and other publications, and to a large extent the Health Market Inquiry Provisional Findings over the past years, medical schemes’ membership growth has stagnated and has recently been declining. The medical schemes have either been amalgamating or liquidating.

Some schemes within this industry are also troubled by bad-risk profiles, and this often leads to increases in claims ratio and inevitably affects premium increases. All this occurs within the context of increased rates of supply-induced demand, excessive profiteering by third parties like administrators, dumping on the state (when beneficiaries run out of benefits), nomination of public healthcare facilities to provide healthcare without having service-level agreements with some medical schemes or the capacity to bill the medical scheme.

This industry is also plagued with issues related to fraud, waste and abuse across the entire healthcare value chain.

At an individual level, members are also experiencing increased rates of out-of-pocket payments and unaffordable premium increases are among other phenomena that leave millions of South Africans not just vulnerable to market forces but to worsening health status and mortality as well.

This has been demonstrated by a recent outcry from some medical schemes members like Zelda la Grange who have used social media to vent their frustration:

• “… I pay R5,000+ per month, and I was told last month that my chronic allowance is depleted, and I must now pay the last two months out-of-pocket. I haven’t been to the Dr once this year. The NHI starts looking attractive…”
• “… A family of 5, I pay R12,000 per month and my kids haven’t seen a doctor in the last 3 months, but our Medical Savings Account is depleted …”
• “… NHI has always been attractive. I pay R6,700 per month. Few months ago, I had to spend 3 days in a hospital and the medical scheme told me to pay R9,000…”
• “… I pay R4,000 with no dependants, I was told by my doctor that I need glasses and my medical scheme asked me to pay R800 over and above R4,000… Never thought I’d see the day when I say it, but NHI is looking attractive…”
• “… Utterly disgraceful, besides paying R12,000 every month, I must pay an extra R2,000 per month for chronic medicine… I ended up paying an additional R20,000 or so…”

Some of these principal members reduce the number of dependants covered, whilst others exit medical schemes due to different affordability challenges. Once these members exit the medical schemes environment, their financial protection against catastrophic healthcare costs diminishes and they now become beneficiaries of the public healthcare system.

All these issues occur within the context of excessive risk pool fragmentation (through multiple schemes and benefit options) and differences within medical schemes in respect of benefit option entitlements (or richness) and limited financial protection for the covered lives, especially the old and sick.

This is the segment of the population that tends to require more protection against catastrophic healthcare costs.

In response to this volatile environment, some medical schemes use benefit design to recruit the young and healthy population whilst the old and sick members will experience entry barriers such as paying late joiner penalties.

It is therefore understood that underwriting is meant to protect the schemes against adverse selection; one needs not forget that it can be viewed as discriminatory as well, especially for the segment of the population that enters the labour market late in their lives due to unemployment.

Unless addressed efficiently through effective implementation of the NHI, where there will be a single pool offering one benefit package being accessed by different types of risk profiles, risk pool fragmentation will continue being a barrier preventing progressive achievement of universal coverage in South Africa.

It is within this background that the WHO recommends that health-financing reforms should consider policy options to encourage risk-pool consolidation, otherwise, implementing other measures (such as increasing the level of prepayment funding) without paying proper attention to changes in risk pooling can result in increased fragmentation, and compromised equity and efficiency goals.

The legislative provisions included within the published NHI Bill should therefore be read in context alongside the NHI Green Paper and NHI White Paper and Policy Document.

Since the publication of the NHI Green Paper in 2012, changes in the current pooling, financing and purchasing mechanisms within the national health system were mooted.

Paragraph 395 of the NHI White Paper states that “… the role that medical schemes will play within NHI must be considered within the current context of the existing two-tiered health system. The establishment of NHI will ensure that the State optimally uses available resources to benefit the national population, including post-retirement entitlements. This requires government’s strategic and decisive intervention to eliminate fragmentation in funding pools which has been shown to adversely impact the performance of the current health system…”

Paragraph 399 further states that “in line with international experience, individuals and households will have the opportunity to purchase voluntary private medical scheme membership to complement this universal entitlement if they choose to. Private health insurance coverage, such as that offered by medical schemes, can play various roles within South Africa’s universal health coverage system… Once NHI is fully implemented, medical schemes will offer complementary cover to fill gaps in the universal entitlements offered by the state…”

These provisions seek to optimise utilisation of available resources, including financial and human resources, and to ensure that people do not insure against the same healthcare costs twice.

It is therefore important to ensure that services provided by medical schemes are rolled out in tandem with the NHI Fund to secure value for money, address current pooling inefficiencies and eliminate duplicative cover or double-dipping.

The recently published Medical Schemes Amendment Bill envisions how the role of medical schemes in our national health system will change and outlines a new interplay between the NHI Fund and the CMS.

This re-organisation of the health system is designed to address long-standing shortcomings within the health system in the areas of human resources, financial management, procurement and supply chain management, and the maintenance of infrastructure and equipment.

This effort to level a critical playing field in our society should be welcomed by all South Africans who respect our Constitution and wish to be part of a healthy, productive and more equal South Africa. DM

Busani Ngcaweni is head of policy in the Presidency, writing in his personal capacity.
  
2018/12/02
2018/12/10 04:32 PM
CITY PRESS
It is a relationship marred by distrust and allegations of a lack of transparency but it's going to take two to tango and both the private and public healthcare sectors working together to achieve "one of the most pressing global priorities" universal healthcare coverage.

But if the latest report by the World Innovation Summit for Health Wish on the Role of Private Providers in Delivering Universal Health Coverage is anything to go by, private providers are not too keen for the changes this might entail.

The report was released at a recent Wish Summit held in Doha, Qatar. About 2 000 healthcare experts, innovators, entrepreneurs, policymakers and ministers from more than 100 countries attended the summit.

According to Sir David Nicholson from the Institute of Global Health Innovation, one of the authors of the report, for private providers universal healthcare coverage represents both an "opportunity and a threat".

"The opportunity comes from the chance to access a large number of patients under public contracts, often through new national health insurance schemes, such as those being rolled out by India, Indonesia, Kenya, South Africa and Egypt, among other countries.

"The threat comes from the shift in future spending trends for healthcare. In the coming decades public players will take an increasingly dominant position in low and middle income countries implementing universal health coverage," the report said.

In a survey for the report to find out whether established private providers were preparing to take up the opportunities for new business and service delivery models that could be offered, the responses showed that most were not.

The survey showed that, although they have an essential role to play in the realisation of universal healthcare coverage, it seems private healthcare providers are not keen on changing some of the ways they do business.

The researchers, chaired by Nicholson, surveyed 20 of the biggest private provider chains operating across 40 low to middle income countries representing the operators of more than 500 hospitals and 7 000 clinics or lab facilities.

"Only a quarter of providers expressed a clear intention to shift their business and service delivery models towards publicly financed universal care services. A quarter expressed a clear intention not to do this," the report noted.

The remaining half either expressed a desire to work with governments without significantly changing their mix of patients and reach of services, or planned to broaden their delivery model but without public partnerships.

"Government is not willing to pay the costs of world class medical care and we do not want to compromise quality," a private provider said.

"Doctors are in short supply and, even with salary incentives, it's hard to get them to move to areas in which the government would like us to work," another said.

Governments had negative perceptions about the private sector. "The private collects data to make money related decisions. They do little with that data to improve services," a public player said.

Another said: "Supplier induced demand is rife.

"The private sector has benefited from national health insurance participation as their occupancy rate has improved. But, at the same time, we see worrying rates of hospitalisation."

The report proposed setting up a global network of "investors for health" dedicated to developing "universal health coverage ready" approaches; a mediation service to improve the quality of dialogue between public and private sector organisations in countries that aspire to have universal healthcare coverage; and a sector collaboration charter to assess the readiness of both sectors to work together to achieve universal health coverage in countries that want it.
  
2018/12/01
2018/12/10 04:33 PM
MEDBRIEF AFRICA
The Health Market Inquiry’s (HMI) final report and recommendations on the private healthcare sector have been delayed to 31 March next year. Confirming the postponement of the report that was scheduled to be released today, Competition Commission spokesperson Lydia Molefe told MedBrief
Africa that the formal notice of the extended deadline will be published in the Government Gazette today.

According to the HMI Panel, the postponement will allow the inquiry sufficient time to review the 64 submissions received from stakeholders on its provisional findings and recommendations with the seriousness they deserve.

Senior healthcare consultant at HealthMan, Dr Johann Serfontein says although the delay is disappointing, it is not unexpected.

“It does provide insight that the various submissions made by stakeholders following the interim report are being robustly engaged with by the HMI. This is an important engagement step, which cannot be rushed through in any project of this nature,” Serfontein said.

He however expressed concern that a similar robust consideration of stakeholder submissions is not being applied to submissions on the NHI. According to him, procedural issues, such as apparent non-consideration of stakeholder comments are likely to be raised in court at a later stage, as is currently happening in the land expropriation without compensation process.

It was hoped that the HIMI’s final report would be taken into account in the National Health Insurance (NHI) Bill that is expected to be presented to Cabinet next week.  However, this doesn’t seem to have happened with Health Minister Aaron Motsoaledi this week slamming media reports that changes were made to the version of the NHI Bill agreed on by him and former Finance Minister Nhlanhla Nene by a team led by presidential health advisor, Dr Olive Shisana.  He was reacting to statements civil societies, including the Treatment Action Campaign and SECTION27, that the hundreds of submissions on the draft Bill released in June this year were not taken into consideration and that he was adamant to rush it through Parliament before next year’s general elections.

Referring to a letter from Treasury to the Presidency that was leaked to the media earlier this month, expressing serious concerns about the alleged changes to the Bill, Motsoaledi blamed the criticism on “the enemies of the NHI that will do everything possible to cast serious aspersions on the credibility of the NHI process to stop it from becoming a reality”.

Section 27 deputy director Umunyana Rugege told Business Day that although they welcome the HMI’s decision to delay the report to ensure extensive consideration of stakeholders’ submissions, there was a need to conclude the deliberations of the panel as expeditiously as possible in light of the speed of the processing of the NHI Bill.

“As we have argued before, the two processes are linked and should influence each other in the interests of advancing access to healthcare in South Africa” she told Business Day.
  
2018/11/30
2018/12/05 09:23 AM
BUSINESS DAY
It is unsurprising that the latest National Health Insurance Bill is being rushed through the legislative process without adequate thought. The rush has little to do with meeting the healthcare needs of South Africans. Rather, the aim is to help the ANC win votes in the 2019 election through the false promise of free, quality healthcare for all.

The public submissions on the bill have generally been ignored. Even important points made by the Treasury were thrown into the rubbish bin, it seems.

The people in the government now arguing about the NHI Bill are united in supporting a particularly dangerous idea: that medical aid schemes should be confined to covering health services "complementary" to those offered by the NHI.

Since the NHI is intended to include a vast range of health services, there will be few "complementary" services that medical schemes can cover. Most medical schemes will thus cease to exist when this restriction takes effect.

But medical schemes are the main source of funding for SA’s excellent private healthcare system. Private healthcare will thus also largely come to an end under NHI. This will deprive South Africans of choice and force most to use the dysfunctional public healthcare system.

The government should aim at expanding access to private care. This can be done in various ways, including tax-funded health vouchers, permitting low-cost medical schemes, and making greater use of public-private partnerships.

In seeking to provide all South Africans with decent healthcare, the government should treat the private sector as an ally rather than an adversary.

Marius Roodt: Head of campaigns, Institute of Race Relations
  
2018/11/30
2018/12/10 04:34 PM
BUSINESS DAY
It is unsurprising that the latest National Health Insurance Bill is being rushed through the legislative process without adequate thought. The rush has little to do with meeting the healthcare needs of South Africans. Rather, the aim is to help the ANC win votes in the 2019 election through the false promise of free, quality healthcare for all.

The public submissions on the bill have generally been ignored. Even important points made by the Treasury were thrown into the rubbish bin, it seems.

The people in the government now arguing about the NHI Bill are united in supporting a particularly dangerous idea: that medical aid schemes should be confined to covering health services "complementary" to those offered by the NHI.

Since the NHI is intended to include a vast range of health services, there will be few "complementary" services that medical schemes can cover. Most medical schemes will thus cease to exist when this restriction takes effect.

But medical schemes are the main source of funding for SA’s excellent private healthcare system. Private healthcare will thus also largely come to an end under NHI. This will deprive South Africans of choice and force most to use the dysfunctional public healthcare system.

The government should aim at expanding access to private care. This can be done in various ways, including tax-funded health vouchers, permitting low-cost medical schemes, and making greater use of public-private partnerships.

In seeking to provide all South Africans with decent healthcare, the government should treat the private sector as an ally rather than an adversary.

Marius Roodt: Head of campaigns, Institute of Race Relations

  
2018/11/30
2018/12/10 04:34 PM
BUSINESS DAY
The Competition Commission's long running health market inquiry has delayed publishing its final report until March 29 2019, saying it needs more time to consider the extensive sub missions it has received from stakeholders since it published its interim findings in July.

It had hoped to publish its final report on Friday. The inquiry began in January 2014 and set out to investigate the barriers to effective competition in the private health care market and why annual health care inflation consistently out strips consumer price inflation by several percentage points.

The original deadline for the release of its final report was November 2015, but it has been repeatedly postponed partly due to legal challenges, but also because it has been at pains to show it is taking heed of concerns raised by stakeholders at every step of the way.

The inquiry has been conducted by a five member panel chaired by retired justice Sandile Ngcobo. The delay in the release of the final report will allow the inquiry sufficient time to review sub missions "with the seriousness they deserve", said panel member Sharon Form, professor of public health at the University of the Witwatersrand.

By September 7 the inquiry had received 47 written submissions from stakeholders in response to its provisional report Formal notice of the latest deadline extension, to March 29, is expected to be published in the Government Gazette on Fri day, said Fonn. Section 27 deputy director Umunyana Rugege said it is not surprising that the inquiry needs more time to consider comments, given the volume of sub missions it had received.

"This is a crucial process for the country and due consideration of all stakeholders comments is welcomed.

However, there have been many delays in the process since 2014 and we note the need to conclude the deliberations of the panel as expeditiously as possible in light of the speed of the processing of the NHI (National Health Insurance Bill).

As we have argued before, the two processes are linked and should influence each other in the interests of advancing access to health care in SA," she said.

The provisional report found a lack of competition in the medical scheme market and evidence of over servicing by providers and concluded that the private hospital sector is so highly concentrated it inhibits effective competition. It recommended interventions aimed at increasing.com petition, improving consumer protection and ensuring greater efficiency in the market.
  
2018/11/30
2018/12/10 04:35 PM
SAKE24
Daar is geen ongerymdhede in die proses van die wetsontwerp oor nasionale gesondheidsversekering (NGV) nie, se dr. Aaron Motsoaledi, minister van gesondheid.

Hy verwerp mediaberigte waarin bewerings van onreelmatighede uitgespreek is in 'n verklaring en meen dit is 'n poging om die geloofwaardigheid van die proses te "beswadder" en die openbare mening daaroor te verander.

Dit kom na berigte oor 'n brief van die nasionale tesourie aan dr. Olive Shisana, raadgewer van die president oor NGV, waarin kom mer uitgespreek is oor veranderinge aan die wetsontwerp wat nou op pad is na die kabinet.

Motsoaledi sit in sy verklaring die feite rakende die konsultasie proses uiteen:

Kommentaar is van belanghebbendes en van die publiek gekry. Dit is deur sy departement hersien en vir die hersiening van die NGV wetsontwerp oorweeg.

Verdere konsultasie met belang hebbendes is gedoen. Dit sluit in 'n beraadslagende vergadering waar op pres. Cyril Ramaphosa op 24 Augustus met meer as 300 partye geskakel het. Op die vergadering het Ramaphosa aangekondig hy sal die NGV proses as staatshoof lei.

Die media het vrae gehad waarop Motsoaledi se hy het Ramaphosa persoonlik gevra om die proses te lei omdat dit 'n "seismiese gebeur tenis" is wat die leiding van die staatshoof benodig.

"Daarom is daar niks sinisters vir die presidensie om in die NGV proses betrokke te wees nie. Dit is ontwerp om so te wees," sê hy. Motsoaledi se die NGV is 'n "vlagskipprogram van die staat wat ontwerp is om te verseker dat ons ons grondwetlike mandaat van ge sondheid kan lewer as 'n reg van elkeen in die land".

Sedert die Verenigde Nasies VN die beginsel van universele gesond heidsdekking aanvaar het as een van die 17 doelwitte vir volhoubare ontwikkeling, het "staatshoofde in die meeste groot demokratiese lan e die verantwoordelikheid aan vaar om dit te bereik".

Die NGV is Suid-Afrika se uni versele gesondheidsdekking. "Dit sal agterlosig wees van ons presidensie om afsydig te staan teenoor so 'n groot poging."

Na die beraadslagende vergade ring het Motsoaledi met burgerlike organisasies, akademiese instel lings, dekane van fakulteite van ge sondheidswetenskap, tradisionele leiers, vakbonde en professionele mediese verenigings gepraat.

Daar was wye konsultasie tussen die nasionale tesourie en die departement van gesondheid wat deur die presidensie gefasiliteer is.

"Soms was dit deur briefwisseling. Dus was daar niks onbetaamliks aan die brief wat die tesourie oor die kwessie geskryf het nie.

"Die soort gesprekke sal voort gaan tussen staatsdepartemente in die wetgewende en die beleidma kende proses." Hy ontken dat "enige wetgewing oortree is of dat daar enige onwet tigheid of onreelmatigheid" in die wyse is waarop die wetgewingspro ses tussen die departement, sy amp tenare, die tesourie, die presidensie en die res van die regering plaas vind.

Motsoaledi glo dit is sinister dat die brief aan die media uitgelek is. Hy se dit is deur gewetenlose amptenare gedoen wat voorgee hulle het iets "boos" in die gesprek tussen staatsdepartemente blootgele.
  
2018/11/29
2018/12/05 09:24 AM
BUSINESS DAY
The Competition Commission’s long-running health market inquiry has delayed publishing its final report until March 29 2019, saying it needs more time to consider the extensive submissions it has received from stakeholders since it published its interim findings in July.

It had hoped to publish its final report on Friday.

The inquiry began in January 2014 and set out to investigate the barriers to effective competition in the private healthcare market and why annual healthcare inflation consistently outstrips consumer price inflation by several percentage points.

The original deadline for the release of its final report was November 2015, but it has been repeatedly postponed — partly due to legal challenges, but also because it has been at pains to show it is taking heed of concerns raised by stakeholders at every step of the way.

The inquiry has been conducted by a five-member panel chaired by retired justice Sandile Ngcobo.

The delay in the release of the final report will allow the inquiry sufficient time to review submissions “with the seriousness they deserve”, said panel member Sharon Fonn, professor of public health at the University of the Witwatersrand.

The inquiry received 47 written submissions from stakeholders in response to its provisional report by September 7, the deadline it set for responses. It granted a further 17 stakeholders an extension to this deadline, which along with requests for access to the underlying data and information it had considered in compiling its provisional report, meant that it pushed out the deadline for its long-awaited deadline by two months until November 30.

Formal notice of the latest deadline extension, to March 29, is expected to be published in the Government Gazette on Friday, said Fonn.

Section 27 deputy director Umunyana Rugege said it is unsurprising that the inquiry needs more time to consider comments, given the breadth and volume of submissions it had received.

“This is a crucial process for the country and due consideration of all stakeholders comments is welcomed. However, there have been many delays in the process since 2014 and we note the need to conclude the deliberations of the panel as expeditiously as possible in light of the speed of the processing of the NHI [National Health Insurance] Bill. As we have argued before, the two processes are linked and should influence each other in the interests of advancing access to healthcare in South Africa” she said.

The provisional report found a lack of competition in the medical scheme market and evidence of over servicing by providers and concluded that the private hospital sector is so highly concentrated it inhibits effective competition.

It recommended interventions aimed at increasing competition, improving consumer protection and ensuring greater efficiency in the market.
  
2018/11/29
2018/12/05 09:25 AM
POLITY
Solidarity’s Occupational Guild for Health Practitioners today expressed their dissatisfaction with the irresponsible way the National Health Insurance Bill (NHI) is dealt with. This followed the Health Department’s attempt to get the proposed bill approved without proper public participation and consultation.

According to Morné Malan, senior researcher at the Solidarity Research Institute (SRI), the Health Department’s conduct indicates that this department is increasingly willing to push through harmful policies despite their negative impact on the fiscus and the health of South African citizens.

“Minister Motsoaledi reacts to criticism as if he believes he is at war with organisations that try to promote and protect citizens’ rights. Perhaps he should ask himself what is giving rise to this perception. The department has been acting in bad faith ever since the bill was released in June. They are cryptic about finances, practical matters, the nature and extent of the NHI fund, the impact on health practitioners and more. They clearly also do not pay attention to comments or suggestions to improve the current system. Furthermore, the estimated costs of the NHI are not yet known, but it will be an enormous amount,” Malan explained.

Solidarity emphasised its opposition to the NHI Bill and the nationalisation of health care by effectively expropriating the resources of private health care. “We refuse to accept the narrative that the department seeks to make South Africa a healthier country because this bill in particular has several shortcomings that will have countless conceivable – and probable – negative consequences – economically and especially with regard to the health of South Africans. When governments act in this way, they must be treated as ideologists or megalomaniacs, or both,” Malan said. 

In addition, Solidarity rejects the efforts of the department to classify the debate regarding the NHI as a struggle between different classes. “This issue is not about rich versus poor. It has to do with being sick versus being healthy. At present, our public health care is so sick, it is almost terminal, and no-one will benefit by transferring all health care to these bureaucrats. It will merely nationalise the service that has led to the Esidimeni tragedy and the countless public hospitals already falling apart, until nobody can escape the government’s incompetence any longer,” Malan emphasised. 

  
2018/11/29
2018/12/05 09:48 AM
CAPE TIMES
Health Minister Aaron Motsoaledi has slammed reports that he is "pushing" the National Health Insurance Bill NHI through Cabinet without proper consultation and public participation, saying that enemies of NHI will do everything possible to halt the bill.

This comes after reports emerged at the weekend suggesting that Treasury officials and President Cyril Ramaphosa's adviser, Olive Shisana, were at each other’s' throats over a number of changes introduced after the public comment period on the bill had closed.

The original draft bill was released on June 21, with a three month comment period that closed on September 21.

The bill intends to pave the way for a central fund that will purchase services on behalf of patients.

It will also realise the government's ambitions of providing universal health coverage. The Health Ministry's spokesperson, however, slammed the reports, saying there was no deviation from protocol, or irregularities, in the conclusion of the bill.

The department's Popo Maja said: "We have no doubt that enemies of NHI will do everything possible to try to stop NHI from becoming a reality, failing which they will try to cast doubt and aspersions on the integrity of the process. "We wish to reassure the nation that no law is being breached nor any illegality or irregularity committed in the manner in which the legislative process towards realisation of NHI is being conducted between the Department of Health, its officials, the Treasury, the Presidency and the rest of government," said Maja.

It is also claimed that Motsoaledi is trying to push the bill through Cabinet without consulting with Treasury and health Department officials.

Last week, Health director-general Precious Matsoso claimed that she was side-lined, and not involved in revising the bill after certain changes were made to it despite being the department’s accounting officer.

The minister, however, said no one had the sole power to decide on the bill, saying that various stakeholder are involved at all stages of negotiating the bill.

“It is unfortunate that some anti-NHI individuals or entities have decided to personalise, isolate and attack some hard-working and dedicated presidential support staff, particularly Professor Olive Shisana, employed to help drive government priorities in the social sector, health included,” said Maja.

However, the DA has called on the Portfolio Committee on Health and the Standing Committee on Finance to convene a joint meeting to discuss NHI in the wake of the reports.

DA MP Lindy Wilson said: “The revised national Health Insurance Draft Bill should be made public and the public participation process should be immediately reopened.

“The dodgy revised bill would put the needs of South Africans on the backburner yet again, and the DA will not allow this to happen.”
  
2018/11/29
2018/12/05 09:49 AM
BUSINESS DAY
President Cyril Ramaphosa's ambitions of getting a blueprint for fixing SA’s health system in the next two weeks have hit a stumbling block.

The Presidency has delayed the signing of this "health.com pact" until the end of January, spokesperson Khusela Diko confirmed. Healthcare professionals had complained that the deadline was unworkable.

The commitment to crafting this plan emerged from a two day health summit convened by the president in late October, which drew 600 delegates from the public and private healthcare sector as well as labour and civil society organisations.

The gathering was cast as a high level meeting to thrash out ideas for tackling the crisis confronting SA's public health system, which is grappling with corruption, staff shortages, and stock outs of even basic medicines such as contraceptives.

However, there is growing disquiet and suspicion that the government is seeking to spin the event to create the impression that participants endorsed its National Health Insurance (NHI) plans.

NHI is its flagship policy for achieving universal health coverage, and its first piece of enabling legislation is due to be tabled in cabinet next week.

Health minister Aaron Motsoaledi told Radio 702 earlier in November that the summit had given NHI the green light.

"Everybody endorsed NHI and said it must go ahead," he said at the time.

Fazel Randera, a member of the Progressive Health Forum, said focus should be rather spent on multiple crises facing the health service, rather than the NHI.

"At the end of the summit we were given a slide session summary of what had come back from the various commissions.

"One read that there should be one health service for one country and that NHI was no longer a debate.

"Now there was no discussion on those particular points," said Randera, who is a member of the summit task team chaired by presidential adviser Olive Shisana.

A power point presentation entitled "Way forward health summit", provided to Business Day after the summit, said participants were "committed to one country one health system", and that universal healthcare coverage" is not negotiable and NHI is a means to get there".

The SA Medical Association Sama was so concerned about the December 10 deadline that it convened a meeting of more than 60 associations representing healthcare professionals a fortnight ago, at which they resolved to seek a four month extension.

Sama chairperson Angelique Coetzee said the deadline had been unrealistic as the views of more than 100 healthcare associations and societies needed to be canvassed.

The health system had to be fixed before implementing NHI, she said. Separately, Motsoaledi issued a statement on Wednesday defending the government's handling of the NHI Bill, which has been mired in controversy after a leaked Treasury letter revealed it was butting heads with Shisana over a host of measures she and her team had changed after the public comment period closed in September.

Motsoaledi said he rejected "with contempt" reports of alleged irregularities in the manner in which the legislation was being processed.
  
2018/11/29
2018/12/05 09:50 AM
SOLIDARITY
Movement says dept. has been acting in bad faith ever since the bill was released in June.

Solidarity’s Occupational Guild for Health Practitioners today expressed their dissatisfaction with the irresponsible way the National Health Insurance Bill (NHI) is dealt with. This followed the Health Department’s attempt to get the proposed bill approved without proper public participation and consultation.

According to Morné Malan, senior researcher at the Solidarity Research Institute (SRI), the Health Department’s conduct indicates that this department is increasingly willing to push through harmful policies despite their negative impact on the fiscus and the health of South African citizens.

“Minister Motsoaledi reacts to criticism as if he believes he is at war with organisations that try to promote and protect citizens’ rights. Perhaps he should ask himself what is giving rise to this perception. The department has been acting in bad faith ever since the bill was released in June. They are cryptic about finances, practical matters, the nature and extent of the NHI fund, the impact on health practitioners and more. They clearly also do not pay attention to comments or suggestions to improve the current system. Furthermore, the estimated costs of the NHI are not yet known, but it will be an enormous amount,” Malan explained.

Solidarity emphasised its opposition to the NHI Bill and the nationalisation of health care by effectively expropriating the resources of private health care. “We refuse to accept the narrative that the department seeks to make South Africa a healthier country because this bill in particular has several shortcomings that will have countless conceivable – and probable – negative consequences – economically and especially with regard to the health of South Africans. When governments act in this way, they must be treated as ideologists or megalomaniacs, or both,” Malan said. 

In addition, Solidarity rejects the efforts of the department to classify the debate regarding the NHI as a struggle between different classes. “This issue is not about rich versus poor. It has to do with being sick versus being healthy. At present, our public health care is so sick, it is almost terminal, and no-one will benefit by transferring all health care to these bureaucrats. It will merely nationalise the service that has led to the Esidimeni tragedy and the countless public hospitals already falling apart, until nobody can escape the government’s incompetence any longer,” Malan emphasised. 

Issued by Morné Malan, Senior Researcher, Solidarity Research Institute, 29 November 2018

  
2018/11/28
2018/12/05 09:50 AM
BUSINESS DAY
The hotly contested bill paves the way for the establishment of a central fund that will purchase services on behalf of patients.

The DA plans to seek legal advice on the National Health Insurance (NHI) Bill, which is due to be tabled before the cabinet on December 5. The hotly contested bill paves the way for the establishment of a central fund that will purchase services on behalf of patients, and is a vital step towards the government’s ambitions of providing universal health coverage.

The bill is now mired in controversy, after it emerged in early November that Treasury officials were butting heads with the president’s adviser, Olive Shisana, over a host of measures she and her team had introduced or changed after the public comment period on the bill had closed.

The Treasury also raised concerns over the extent to which public submissions were considered. The extent to which the Treasury’s concerns have been addressed is not clear at this stage, as cabinet documents are classified and rarely leaked.

The controversy was heightened last week after health director-general Precious Matsoso revealed that she had been side-lined and had played no role in revising the bill after it had been released for public comment in June, despite being the department's accounting officer. 

“If the ANC government continues to push through the NHI Bill without proper public participation and consultation, the DA will seek legal advice regarding the highly irregular process followed in revising the NHI Bill,” DA deputy health spokesperson Lindy Wilson said.

“The minister’s backdoor dealings subsequent to the closure of public comment period, effectively mutes any input from the public, as the proposed changes are substantive, and the public and other stakeholders have not had an opportunity to raise their concern.”  Wilson said the revised NHI Bill should be made public, and the public participation process reopened. 
  
2018/11/28
2018/12/05 09:51 AM
BUSINESS DAY
The health minister has rejected recent media articles alleging irregularities in the way the bill is being processed.

Health Minister Aaron Motsoaledi has defended the government’s approach to crafting the contentious National Health Insurance (NHI) Bill, which is to be tabled in the cabinet next week.

The bill is a vital step in achieving the government’s ambitions of providing universal health coverage, as it paves the way for a central fund that will be used to purchase services on behalf of patients. The government has promised that NHI services will be free at the point of delivery, but exactly what benefits will be covered and how they will be funded has yet to be spelt out.

The bill is now mired in controversy, after a leaked Treasury letter revealed that its officials were butting heads with the president’s adviser, Olive Shisana, over a host of measures she and her team had changed after the public comment period on the bill closed on September 21.

Political tension over the bill rose last week after health director-general Precious Matsoso disclosed that she had been side-lined and had not had sight of the bill since it was released for public comment in June, despite being the department's accounting officer. At the time, Shisana confirmed that Matsoso had not been involved, saying Motsoaledi had assigned that task to deputy director-general Anban Pillay and his adviser, Aquina Thulare.

In a three-page statement released by his spokesperson, Popo Maja, on Wednesday afternoon, Motsoaledi said he rejected “with contempt” recent media articles alleging irregularities in the manner in which the NHI Bill was being processed by the government.

He said there was nothing sinister in the presidency’s involvement in the NHI process. There had been extensive consultation between Treasury and his department, facilitated by the presidency, he said.

“Sometimes these consultations took place through exchange of letters. There was hence nothing untoward with the letter written by the National Treasury on this matter. What is sinister, however, is the leaking of such letters to the media by some unscrupulous officials pretending that they uncovered some hidden evil lurking in governmental departmental exchanges,” he said in the statement.

He did not offer an explanation for why the director-general had not been included in revising the NHI bill.

Motsoaledi said the presidency had the right to “facilitate, direct and unblock obstacles in the process of legislation and policy making.

“We have no doubt that the enemies of NHI will do everything possible to try to stop NHI from becoming a reality, failing which, they will try to cast doubt and aspersions on the integrity of the process. We wish to assure the nation that no law is being breached nor any illegality or irregularity committed in the manner in which the legislative process towards realisation of NHI is being conducted between the department of health, its officials, the Treasury, the presidency and the rest of government,” he said.
  
2018/11/28
2018/12/05 09:52 AM
CAPE TALK
Health Minister Aaron Motsoaledi has fired back at critics who have protested over the speed at which the National Health Insurance (NHI) Bill is being processed.

In a statement issued on Wednesday, the ministry said there are those who have sought to cast aspersions on the integrity of the process.

This follows reports about apparent breaches in protocol in the development of the latest version of the Bill, which was submitted to Cabinet’s social development sub-committee.

Motsoaledi joined Karima Brown on her show to respond to this and other questions related to the bill.

“It puzzles me. It is true that there were robust discussions between health and treasury. Even on Monday afternoon, I had a meeting with the finance minister and presidency. We meet quite often.” — Aaron Motsoaledi, health minister

“This is a flagship government programme which has been commissioned by the ruling party as far as 2007.” — Aaron Motsoaledi, health minister

“It is written, it has been developed over a long time.” — Aaron Motsoaledi, health minister

“It is not something that is going to be left to chance, it is a huge thing. A seismic shift.” — Aaron Motsoaledi, health minister

Click here to listen to the full conversation.
  
2018/11/28
2018/12/05 09:55 AM
MED BRIEF AFRICA
The Ministry of Health has just issued a strongly worded statement in reaction to recent media reports claiming that, for one, presidential adviser, Prof Olive Shisana, and the Minister of Health, Dr Aaron Motsoaledi, appeared to have side-lined senior Department of Health and Treasury officials in preparing a new version of the National Health Insurance (NHI) Bill now due for submission to Cabinet next week.

At issue has been primarily the nature and manner of coverage of the content of a four-page letter from Treasury to the Presidency leaked to the media in mid-November. Main point raised by the media from the letter contents was the allegation that various provisions in the NHI Bill, previously agreed upon between government departments, had been changed without consultation, or agreed-upon changes were not implemented. It was also alleged in the letter reports that comments from the public had not been taken into account.

“Clearly this is meant to cast serious aspersions on the credibility of the process and in the instance try to delegitimise it in the mind of the public,” the statement notes

“We have no doubt,” it adds later, “that enemies of NHI will do everything possible to try to stop NHI from becoming a reality, failing which, they will try to cast doubt and aspersions on the integrity of the process.”

The statement continues as follows (with minimal editing in the interest of reading time and space):

Here are the facts (on the NHI Bill process):

Comments were received from a variety of stakeholders and citizens. As is normal practice the Department of Health reviewed the comments and considered theme in revising the NHI Bill. In addition to public comments, further stakeholder consultations took place. This included a consultative meeting in which the President himself engaged with over 300 participants at the CSIR on 24th of August.

 It is at this consultative meeting that the President announced that he is going to lead the NHI process as Head of State. The media did raise questions about this. The Minister of Health explained that, he personally requested the President to lead this process because ushering in NHI is a huge seismic event which will need the guidance of the Head of State.

 Hence there is nothing sinister at all for The Presidency to get involved in this NHI process. It is designed to be so. The President is the Head of State and hence, The Presidency has a legal right and authority to oversee government work – all government work including legislation.

After that consultative meeting (referred to above), the Minister went around the country addressing civil society organisations, academic institutions, deans of health science faculties, traditional leaders, labour unions and professional medical associations about the NHI Bill, the medical scheme amendment Bill and the report of former Chief Justice, Sandile Ngcobo’s Public market inquiry into the cost of private healthcare.

There has been extensive consultation between National Treasury and the Department of Health, which as planned were facilitated by the Presidency.

 Sometimes, these consultations took place through exchange of letters. There was hence nothing untoward with the letter written by National Treasury on these matters. This type of exchange will continue to happen unhindered as is normal practice between government departments in legislative and policy making process.

What is sinister, however, is the leaking of such letters to the media by some unscrupulous officials and then pretending that they uncovered some hidden evil lurking in government departmental exchanges.

 The types of discussions within interdepartmental coordinating structures like NHI War Rooms and Department of Health and National Treasury Technical Task Teams are always robust to ensure rigor and coherences and will always be welcome in government.

The responsibility of the Presidency is to bring departments together so that various perspectives are taken into account before policy recommendations are taken to Cabinet.

As the Ministry of Health, we will always welcome, support and appreciate the role played by the Presidency in ushering in a new era of NHI.

Through the work of the War Room, the Department of Health and National Treasury have been able to address the concerns and jointly plan the way forward.  The same applies to submissions made by other government departments.

 Furthermore, we note media commentary about documents submitted to Cabinet. We wish to state that Cabinet is not a secret organisation. It is a legitimate structure empowered by law to conduct the affairs of the state and by the same laws, its documents are classified. As such contents may not be released until authorised by Cabinet itself.

We wish to restate once again that the Presidency has a right to facilitate, direct and unblock obstacles in the process of Legislation and policy making.

We have no doubt that enemies of NHI will do everything possible to try to stop NHI from becoming a reality, failing which, they will try to cast doubt and aspersions on the integrity of the process.

We wish to reassure the nation that no law is being breached nor any illegality or irregularity committed in the manner in which the legislative process towards realisation of NHI is being conducted between the Department of Health, its officials, the Treasury, The Presidency and the rest of government.

It is unfortunate that some anti-NHI individuals or entities have decided to personalise, isolate and attack some hard working and dedicated Presidential support staff, particularly Prof. Olive Shisana, employed to help drive government priorities in the social sector, health included.

NHI is bigger than individuals. It is the ultimate expression of social justice, fairness and as the former Director-General of the World Health Organisation stated, it is an equaliser between the rich and the poor. We are hence not surprised by the type and calibre of people who are working around the clock to undermine NHI. Equalising between the rich and the poor is a revolution that will automatically scare those who flourish under conditions of inequality. It is expected that they will club together in a desperate bid to stop this inevitable revolution whose time has arrived.

There is no single individual, be it an advisor, a Director-General or a Minister who has the sole monopoly or right to determine the fate of NHI. That is the sole preserve of Cabinet and ultimately the citizens of this country through the Parliamentary process.

The allegation that we ignored calls to extend the period of public participation beyond three months, is pure mischief. This issue was raised at the consultative seminar held on the 24th of August 2018 and the Minister of Health explained to the meeting why it will be undesirable to grant any extension. Furthermore, he explained that whatever outstanding issue that could not be raised through public participation within that period of 3 months will still be achieved when Parliament conducts public hearings throughout the length and breadth of our country. Such public hearings are still coming.

South Africa has been driving the introduction of NHI since 2009. Since that period, there has been individuals and or organisations that always made it their duty to find one reason or the other to argue that we are not ready for it. We believe these individuals will go on forever and will stop at nothing for decades to come to continue that line of argument. At no stage will they ever declare we are ready.

One of the reasons always put forward is that the public healthcare system needs to be fixed first. To musk their intentions we note that in recent days they have now added the fixing of the private healthcare as a prerequisite.

Fixing the quality of the public healthcare system and dealing with the exorbitant cost of private healthcare has always been our goal and is a strong recommendation by the National Development Plan of the country. Government fully endorsed this recommendation without any reservation. But this fixing of the system has never been mutually exclusive with the implementation of NHI, in fact they go hand in glove and reinforce each other. We shall never agree to be put in a no-man’s land of chicken and egg situation.

We are doing everything in our power to resolve the challenges of infrastructure, human resources and availability of health commodities.

Any individual or organisation who will use such challenges as a good reason to delay NHI smacks of dishonesty and hypocrisy because the plans to improve quality of healthcare have been unveiled at the consultative meeting of 24th August and consolidated and adopted at the Presidential health summit held end of October 2018.

We are calling on all stakeholders and social partners to join hands with us on this journey to usher in Universal Health Coverage where no one will be left behind.

Ministry of Health

SOURCE: Mr Popo Maja: Spokesperson. Ministry of Health.
  
2018/11/28
2018/12/05 10:09 AM
IOL
The Health Ministry has condemned those who have criticised the speed at which the National Health Insurance (NHI) Bill is being processed, claiming they want to “delegitimise” the process.
 
“We have no doubt that enemies of NHI will do everything possible to try to stop NHI from becoming a reality, failing which, they will try to cast doubt and aspersions on the integrity of the process,” according to the ministry statement issued this afternoon (28 November).

“We wish to reassure the nation that no law is being breached nor any illegality or irregularity committed in the manner in which the legislative process towards the realisation of the NHI is being conducted between the Department of Health, its officials, the Treasury, The Presidency and the rest of government.”

This follows a week of media reports about apparent breaches in protocol in the development of the latest version of the Bill, which was submitted to Cabinet’s social development sub-committee yesterday.

Last week, a letter written by acting Director General of Treasury, Ismail Momoniat, to NHI Presidential advisor Dr Olive Shisana was leaked to the media. In it, Momoniat said that Treasury could not support the latest version of the Bill as it had been “very substantively amended in October”, removing various agreements reached between the Ministers of Finance and Health.

After the publication of the leaked letter, Treasury said “we have reached agreement on most of the major issues,” and “we are confident that we will soon publish this important Bill for tabling in Parliament.”

However, on Monday, civil society organisations said that the three-month comment period on the Bill had been too short, and called on Cabinet to “send the NHI Bill back to the Department of Health and to require a proper and thorough consultation process and consideration of options available for improvement of access to and quality of health care services in the country”.

The Treatment Action Campaign (TAC), SECTION27, Rural Health Advocacy Project (RHAP), People’s Health Movement (PHM) and Lawyers for Human Rights (LHR) also said that the current Bill “risks damage to the functional elements of the health system – public and private” and that “government needs to focus on fixing the crises in private and public health rather than on hastily passing legislation that, in its current state, takes the country in the wrong direction”.

But the Ministry said that the Health Minister had already explained that “whatever outstanding issue that could not be raised through public participation within that period of three months will still be achieved when Parliament conducts public hearings throughout the length and breadth of our country. Such public hearings are still coming.”

It also explained that the Presidency was driving the NHI at the request of the health minister because “NHI is a huge seismic event which will need the guidance of the Head of State”.

“NHI is not just an ordinary government programme. It is a flagship programme of the state which is designed to ensure that we deliver on our constitutional mandate of Health as a right of all citizens regardless of their station in life,” said the Ministry.

“Ever since the United Nations adopted the concept of Universal Health Coverage (UHC) as one of the 17 world's sustainable development goals, in all major democracies of the world, Heads of State have taken over the responsibility of being the major advocates and drivers of the process towards the achievement of Universal Health Coverage which in our country is NHI.  It will be remiss for our Presidency to stay aloof from such a major world endeavour.” 
  
2018/11/27
2018/12/05 10:10 AM
MED BRIEF AFRICA
Civil societies have urgently called on government for proper consideration of public comments on the NHI Bill which is expected to be presented to Cabinet today (27 November).

In a joint statement the Treatment Action Campaign, SECTION27, Lawyers for Human Rights, the Rural Health Advocacy Project (RHAP) and the People’s Health Movement (PHM) express serious concerns that the Bill will be rushed through the legislative process following its hasty presentation to Cabinet.

They pointed out that several requests for an extension of the three-month comment period that started after the draft Bill’s release in June to allow for proper consultation were ignored as well as further requests by SECTION27 for transparency about the number and type of comments made ignored.

“Just two weeks after the final date for submissions (21 September 2018), a version of the Bill amended by presidential advisor Dr Olive Shisana without the knowledge of the Director General of Health and without consultation with the Minister of Finance was leaked, together with a letter from Treasury complaining about this change in direction. This version, prepared so soon after the submission deadline, cannot have taken into account the likely hundreds of submissions made by interested parties across the country. It was also, interestingly, prepared before the Presidential Health Summit of 19 and 20 October 2018, at which delegates made clear the need to focus on system improvement aimed at fixing the crisis in public health rather than on legislation.

“Now we understand that the Bill will be presented to Cabinet today for approval – the final step before it is presented to the legislature. The legislative development process has been removed from the office of the Director General, who bravely spoke out last week about being side-lined by the presidency and her subordinates. We also understand that the Bill has not been discussed in the National Health Council – the body established by section 23 of the National Health Act 61 of 2003 to advise the Minister of Health on policy and on proposed health legislation (before it is introduced to the legislature),” the organisations noted.

They accuse government of not taking into account the comments made over the past either between the Green and White Papers and the Bill or after the draft Bill was published for public comment.

“This makes a mockery of public consultation as required by the Constitution and opens the Bill up to future attack and delay on these grounds. Pro-poor civil society organisations and healthcare professionals have consistently argued that government needs to focus on fixing the crises in private and public health rather than on hastily passing legislation that, in its current state, takes the country in the wrong direction.”

They call on Cabinet to send the NHI Bill back to the Department of Health and to request a proper and thorough consultation process and consideration of options available for improvement of access to and quality of health care services in the country.
  
2018/11/27
2018/12/05 10:13 AM
BUSINESS DAY
Health director general Precious Matsoso broke ranks in truly remarkable fashion last week when she accused President Cyril Ramaphosa's adviser, Olive Shisana, of sidelining her in the development of the National Health Insurance (NHI) bill.

The director general is the department's accounting officer and will be tasked with defending the proposed legislation when it is introduced in parliament. Yet she says she played no role in revising its release for public comment in June, a statement confirmed by Shisana

For the director general to be left out in the cold in this manner is truly astonishing. And for her to lay bare the dysfunction in the government by further claiming Shisana has ridden roughshod over the public consultation process makes it even more so.

The bill is a key aspect of the government's ambitions for realising universal health coverage as it sets out the legal framework for establishing a central NHI fund that will purchase health services on behalf of patients from public and private sector providers. It is vital that the government gets it right, both in terms of the content and the public consultation process that informs the final draft presented to parliament. If the government gets either aspect wrong, it lays itself wide open to legal challenge. There were signs of trouble even before Matsoso spoke out.

A leaked letter sent from the Treasury to Shisana on November 9 exposed sharp division, with the Treasury complaining that Shisana had removed key aspects that it had previously fought to include.

According to the letter, she reintroduced several problems that the ministers of finance and health had resolved previously, including immediate relegation of medical schemes to a complementary role once the bill was enacted, thus limiting them to providing cover only for services not offered by the NHI.

The Treasury quite rightly warned that her approach would be perceived as a threat to the private sector, medical scheme members and tax payers. The result, it said, would leave the bill open to legal challenge.

The Treasury also warned that far reaching proposals to shift a host of functions from provincial health departments without consultation with the bud get council and provinces were in breach of the Intergovernmental Fiscal Relations Act and it raised concern about the insertion of an uncosted proposal to establish 300 contracting units that would purchase services for patients.

Shisana appears to have hastily bludgeoned together a revised bill, with the help of just two people, selected by health minister Aaron Motsoaledi, in order to get it into the cabinet process before the end of the year. Given that public submissions closed on September 21 and about 180 were received, it is unlikely that Shisana and her team could have reviewed them properly by early November, as by this stage the Treasury was writing to complain about her changes.

This is typical of the way the ANC government has handled the development of its NHI policy, which it has rushed at every iteration for the past decade to meet politically motivated deadlines, from policy conferences to looming elections. That perpetual hurry has served no one's interests but those of politicians.

Weak policies clearly place at risk the government's hopes of providing decent healthcare services that are free at the point of delivery to everyone. But there are other pitfalls.

The presidency's apparent lack of consultation jeopardises the government's fragile relationship with the private sector. The presidential health summit convened by Ramaphosa in late October sought to strike an inclusive and consultative tone, with his deputy, David Mabuza, telling delegates all sectors need to be involved to tackle the problems confronting SA's health system.

If Shisana and her team are not even consulting properly within the government, how can the private sector trust its views will be heard on anything at all?
  
2018/11/27
2018/12/05 10:59 AM
HEALTH-E NEWS
The Presidency and Health Minister Aaron Motsoaledi seem intent on pushing the National Health Insurance (NHI) Bill through Parliament before next year’s election despite major unanswered questions.

The revised NHI Bill was presented to Cabinet’s social cluster sub-committee today (27 November) before going to Cabinet, according to the health department.

However, the department failed to answer a number of other questions including why it was pushing the Bill through the legislative pipeline so fast – when even Health Director-General Precious Matsoso admitted last week that she had not seen the latest draft.

Civil society organisations have called on Cabinet to “send the NHI Bill back to the Department of Health and to require a proper and thorough consultation process and consideration of options available for improvement of access to and quality of health care services in the country”.

Professor Olive Shisana, the NHI advisor in the Presidency, is driving the NHI process and has allegedly changed a number of clauses, according to insiders.

The Bill has not been discussed in the National Health Council established by the National Health Act to advise the Minister of Health on policy and on proposed health legislation.

Acting Director General Ismail Momoniat wrote a letter to Shisana last week saying that Treasury could not support the latest version of the Bill as it had been “very substantively amended in October”, removing various agreements reached between the Ministers of Finance and Health.

Treasury was particularly concerned about amendments to the powers of provinces to deliver healthcare, inadequate costing of functions and the relegation of medical schemes to a complementary role which was “premature” and opened the Bill to legal challenges.

However, after the letter was leaked to the media, Treasury issued a statement describing it as “part of the vibrant and ongoing engagement to ensure policy coherence”.

“We have made substantial progress on key areas and have reached agreement on most of the major issues,” added Treasury. “Many of the issues raised by Treasury have been substantively addressed. We are confident that we will soon publish this important Bill for tabling in Parliament.”

But Treasury stressed that “the NHI must be adequately funded and successfully implemented while reducing the risks involved in the implementation of such a large and complex programme”.

Civil society organisations claim that the draft Bill was prepared even before a Presidential Summit that was supposedly called to consult various parties about the NHI.

“Public comments on the NHI over the past decade do not appear to have been taken into account, either between the Green and White Papers and the Bill or after the draft Bill was published for public comment,” according to a statement from Treatment Action Campaign (TAC), SECTION27, Rural Health Advocacy Project (RHAP), People’s Health Movement (PHM) and Lawyers for Human Rights (LHR).

“This makes a mockery of public consultation as required by the Constitution and opens the Bill up to future attack and delay on these grounds.”

The organisations also argue that the current Bill “risks damage to the functional elements of the health system – public and private” and that “government needs to focus on fixing the crises in private and public health rather than on hastily passing legislation that, in its current state, takes the country in the wrong direction”.

While the health department failed to respond to the civil society statement, last week Treasury said that “the implementation of the NHI and improvements in the quality of the health system go hand in hand and are therefore being addressed concurrently.”
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