Reforming Healthcare in SA – A Primary Care Perspective
“Every health system in the world has inefficiencies, and there are well documented ways of reducing these inefficiencies through better management, incentives and primary healthcare programmes. With the planned restructure of healthcare delivery in South Africa, the entry point into health for all will certainly be primary care delivery.”
This was the view of Professor Morgan Chetty, chairman of the Independent Physicians Association (IPA) Foundation of SA and the KwaZulu-Natal Managed Care Coalition Limited. He was one of the speakers at the Metropolitan Health Engage Forum, recently held in Johannesburg.
Representatives from various public and private sector bodies aired their views on how to make primary healthcare affordable and accessible to all. Achieving this goal would have knock-on effects for the whole healthcare industry and the ultimate realisation and affordability of the National Health Insurance (NHI).
The consensus was that the private sector has much to offer in support of Government's healthcare reform in South Africa. However, very little dialogue has taken place to determine the way forward.
Chetty, who spoke on how doctor networks could contribute to making primary healthcare accessible, affordable and sustainable, said that the current system’s rapidly advancing costs and uneven quality is simply unsustainable.
He said that the IPA or a doctor group movement is ideally positioned to deliver primary healthcare, providing a link between community healthcare and more specialised healthcare. This, he says, will reduce the disease burden, produce economic savings, assure greater equity and promote the sustainability of healthcare.
He stated that the success of implementing health services in an environment that will cater for millions of patients who have never had access to formalised healthcare will depend on “meaningful public-private partnerships, collaboration and interdependence among role-players and a collective culture based on lateral thinking and planning”. He concluded by saying that with the current uncertainties within the healthcare industry, it is important to apply an integrated approach. This, he believes, will lead to the escalation of NHI implementation.
Sham Moodley, chairperson of the Independent Community Pharmacy Association, pointed out that South Africans are currently under-diagnosed and under-treated for most chronic conditions. “Pharmacy-based screening programmes can be an important part of disease prevention and managing public health,” he said.
However, he added that the current strategy in pharmacy is ‘uncoordinated, ad hoc, under-resourced and not aligned to the National Health Strategy’.
He made the point that there is sufficient geographic spread of independent pharmacies with the human resources and capabilities to address primary healthcare in all areas of South Africa. His association is proposing that patients be attended to by district-based GPs, with medication dispensed at the local pharmacies and monitoring taking place there. The pharmacist can then refer back to the GP if positive patient outcomes are not achieved.
He also pointed out that pharmacies can deal with many of the minor ailments that currently come before GPs. “In the NHS-UK, 1.4 million GP consults per year are for minor ailments, amounting to 18% of the workload,” he said.
Of those consults, 75% were for the following conditions: back pain, indigestion, dermatitis, nasal congestion, headache, constipation, migraine, acne, cough and muscle strain. In response, a Minor Ailment Passport Scheme was introduced which refers these patients to pharmacists, freeing up GPs to focus on more major ailments, which in turn relieved congestion at the hospitals.
Moodley says that this scheme could be replicated in South Africa, with similar benefits for the population and for national healthcare. “This presents an immediate opportunity to reduce patient load,” says Moodley. “It absorbs a significant portion of the healthcare spend.”
Another mechanism for reducing healthcare spend was put forward by Bryan Sidders, CEO of the Prior Institute. “Mobile technology is the most underutilised resource in the healthcare industry,” he said.
He said that mobile technology already has a nationwide infrastructure, is an ideal communication medium and has a target market that knows how to use it. He pointed out that mobile technology can increase communication and interactivity with patients, assist in chronic medication compliance and send small amounts of clinical record compliance to practitioners.
Jeanette Hunter, CEO of The Health Systems Trust presented how the District Health Barometer (DHB), developed by the NGO, can support strategic decision-making for healthcare reform.
“The DHB integrates various data sources to provide information about key health indicators,” she said. “It provides a regular snapshot of the health status and health service delivery at country, province and district level.”
Health Minister Aaron Motsoaledi indicated at the February 2012 launch that the Department of Health will use the DHB to reflect and reassess its interventions for the coming years. “It facilitates decision-making at various levels of the public health system by enabling comparisons between districts and provinces,” said Hunter.
A final presentation was made by Ntobeko Mpanza, Director of Pharmaceutical Economic Evaluation at the National Department of Health. She informed the audience on how pharmaceutical pricing legislation can provide lessons for the reform of the healthcare industry. “Legislative revisions are going to support local pharmaceutical manufacturers,” she said.
“The Department of Trade and Industry (DTI) is going to be very aggressive in giving preference to local manufacturers,” she said. “The rationale behind the DTI managing medicine prices is that it ultimately protects the consumer from paying more.”
She explained that this is part of the bigger picture of making healthcare affordable and accessible. In closing, she said, “There are good ideas on the table, but no one wants to get started. The road to the NHI is taking longer than necessary because there are so many ideas.”
In response to a comment that, “for the sake of progress, South Africans should not shy away from confronting each other”, Hunter added a forward-thinking sentiment. “It's good to hear that the private sector speakers are committed to reform,” she said. “Confrontation wastes time and resources and comes from immutable stands. We need to listen to each other and cooperate to see how we can achieve the aspiration of universal access to healthcare.”
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