Category: Expert Opinion

Categories : Environmental Effects Expert OpinionTags :

Opinion: Safer Sanitation Solutions – The Quest to Eradicate Pit Latrines in South Africa 

On By ModernMedia
Robert Erasmus

By Robert Erasmus, Managing Director at Sanitech 

In South Africa, the use of pit latrines remains a prevalent human rights issue, infringing on every person’s right to life, dignity, and health, as well as their right to access water and adequate basic sanitation. Despite their unavoidable application in certain contexts, pit latrines pose numerous risks to life, health, and safety, particularly in schools and areas lacking proper sanitation infrastructure such as informal settlements, prompting efforts to eliminate their presence in the country.

As far back as 2019, the Department of Water and Sanitation (DWS) launched a campaign called Khusela, which means “to eradicate” in isiZulu, to abolish pit latrines by 2030. Given the extensive challenges related to sanitation infrastructure, eradicating pit latrines is going to take time, particularly in rural areas. Nonetheless, this human rights issue must be squarely addressed and that functional, sustainable alternatives to open pit latrines are given the proper prioritisation.  

Pit latrines: the shocking numbers  

From a sanitation perspective, there are 380 schools in South Africa with no running water. 3392 schools still use pit latrines, which affects 34 489 teachers and 1 042 698 learners. While it is difficult to ascertain exact population figures, it is estimated that there are still four million pit latrines in use by communities throughout the country, of which only two million are Ventilated Improved Pit (VIP) latrines, while the remainder are ordinary pits with, or without covers. VIP latrines are a type of pit latrine that has a ventilation pipe that allows air to circulate through the pit, which helps to reduce odours and the breeding of flies. These latrines are also typically constructed with a more substantial exterior structure than ordinary pit latrines.  

Endangering communities 

The use of pit latrines can be perilous, posing a safety risk, particularly for young children, females, and vulnerable individuals. Without proper maintenance or safety precautions, accidents such as falls, injuries, and even drownings occur. Pit latrines contribute to the spread of disease, posing a major health hazard to users and nearby residents, as inadequate waste management and poor sanitation practices contaminate the groundwater and soil, as well as nearby water sources which lead to the transmission of waterborne diseases like cholera, diarrhoea, and dysentery. Pit latrines often lack essential sanitation facilities, such as handwashing stations or proper waste disposal systems, which results in unhygienic environments, poor personal hygiene practices, and an elevated risk of infections and diseases.  

For affected communities, the lack of access to clean water and proper sanitation has a significant impact on health and well-being. The lack of access to safe and hygienic sanitation facilities can lead to health problems, which can make it difficult for people to work and earn a living. The correlation between adequate sanitation and poverty is a complex issue, with several contributing factors. As such, it is important to address these factors to improve sanitation and ultimately reduce poverty. 

Challenging to service 

Pit latrines are used primarily in areas that do not have access to water. These gradually fill up over time, primarily with solid waste as most liquid waste evaporates or is absorbed into the soil. Originally estimated to last seven to ten years, these latrines often require maintenance in just two to three years due to the significant amount of additional waste they receive. Decisions must then be made to either close the latrine and dig a new hole or seek servicing, a challenging task that involves treating the solid waste to create a more liquid environment before using a honey sucker or vacuum tanker to extract and dispose of the waste in a treatment plant. The remote locations of many facilities add to the complexity of the process. 

Seeking practical solutions and facing reality  

This highlights the urgent need for practical solutions when addressing the challenges posed by pit latrines. To illustrate the practicalities, consider the sheer number of pit latrines – four million, with two million being VIPs and two million standards. Replacing all of these with waterborne sanitation is simply unfeasible in the short term, as this would require an additional one billion litres of water daily for flushing alone. This is currently an insurmountable obstacle in terms of water supply and treatment, considering the condition of existing waste treatment plants. The South African private sector has sought to find the most practical and effective way to address the critical issues of safety, environmental impact, and serviceability of these facilities. To make a tangible difference, it is necessary first to acknowledge that an immediate conversion to waterborne solutions is not practical, in the short and medium term.  

Attainable, cost-effective alternatives 

A safer alternative to pit latrines has been developed and tested extensively and is ready for implementation in communities. It is a cost-effective, dry sanitation unit that addresses health and safety shortfalls, installation difficulties and servicing problems with pit latrines while ensuring that environmental and underground water contamination cannot occur. The main structure consists of concrete and the door is made of injection moulding plastic, with a ventilation pipe to limit odours. The waste containment unit has a 1500-litre bladder with a 3–5-year guaranteed life cycle, which can be removed without disabling the unit. The units are mobile, and no pit must be dug, which reduces installation costs and limits the abandonment of land. The unit itself is shaped in an ellipse to maximise space utilisation and waste containment, using a rotating bowl to dispose of waste, which prevents contact with faecal matter. The unit is sealed to prevent insects from entering or exiting the system and uses environmentally friendly products to treat waste, all of which address environmental concerns.  

A cleaner, safer future 

The need to eliminate pit latrines in South Africa is clear, given the multitude of risks they pose to the health, safety, and environment of communities. While an immediate conversion to waterborne sanitation may not be practical due to water supply and treatment limitations, the development of safer alternatives, such as the dry sanitation unit, offers promising possibilities. By prioritising the implementation of such practical and effective solutions, South Africa can significantly enhance the well-being and quality of life of its communities, making strides towards a future where pit latrines are replaced with safe, sustainable, and healthier sanitation options for all citizens. 

Categories : Expert OpinionTags :

Can the Health System Help Answer South Africa’s Youth Unemployment Issue?

On By ModernMedia
Photo by Ivan Samkov on Pexels

Amid skyrocketing youth unemployment, healthcare, a vast sector which touches all of our lives at some point, seems a sensible space for young people to set their sights on for opportunities. From clinical sciences to pharmacy, there is a myriad of careers in the healthcare ecosystem, but there are also factors preventing this potential from being unleashed, writes Bada Pharasi, CEO of The Innovative Pharmaceutical Association South Africa (IPASA).

A career in health has long been seen as a symbol of success in South Africa. The no-nonsense nurses in our communities, the hard-working doctors and the knowledgeable pharmacists have long represented those who had “made it”.

For many of us, these were the lucky ones who had found a career path that was both rewarding and respected. This has also been the way that South Africans view the myriad of the less visible jobs in healthcare (lab technicians, pharmacist assistants, dieticians, the list is endless).

Bada Pharasi, Chief Executive Officer of IPASA

As South Africa grapples with the highest unemployment rate1 in the world, with youth unemployment being the biggest concern (currently at more than 60%2), it’s not difficult to see why the healthcare system with its vast range of careers would present a solution. Careers in health not only benefit young people looking for a start in life, but they also build South Africa’s capacity to provide care for millions who desperately need it.

As young people search for the stepping stones to long, rewarding careers, many will be advised by well-intentioned family and friends to seek a future in healthcare. And it’s not bad advice.

As a sector that can generate employment opportunities at both ends of the value chain – from highly skilled specialists in technology and research to those who operate in palliative or frail care environments2 – the recent effects of the Covid-19 pandemic underscored the essential value and role that healthcare workers play in bolstering South Africa’s socio-economic and overall health resilience.

Human resource gaps in healthcare are clear

In 2020, the Hospital Association of South Africa suggested that there was a shortage of between 26 000 and 62 000 professional nurses and this shortage is expected to increase to between 305 000 and 340 000 by 2030 as the country’s population continues to grow. Alarmingly, estimates suggest that only 26 ,000 will be trained by then3.

South Africa also has less than one doctor per 1000 patients4. In a country with serious disease burdens, the situation is far from ideal.

The need for long-term planning

A challenge often cited when posts are frozen in healthcare is funding. While there are undoubtedly funding constraints in the healthcare system, it seems unlikely that the addition of funds will solve the challenge. It’s worth rethinking the way the human resources pipeline in South Africa is structured and where the bottlenecks lie.

South Africa’s history of inequality, which is deeply entrenched in the country’s healthcare system, has created the twin challenge of a shortage of skills and inadequate capacity to manage and distribute those skills to where they’re most needed. There are also policy bottlenecks that can hinder progress.

For instance, while complementing the qualification with some kind of work experience and community service spent in the public sector is an applaudable initiative, it becomes counterproductive when there aren’t enough posts in the public sector to place people coming out of training institutions. This, in turn, limits the number of professionals who can qualify, adding incrementally to the shortage of personnel every year. 

Similarly, the cap on the number of personnel that the Nursing Council can accredit per year may limit the number of posts needed, but it doesn’t help address the shortage of nurses in South Africa.

The burden of disease in South Africa, coupled with the uneven spread of healthcare facilities means that it’s also a singularly challenging environment to work in. This means that retention policies, and initiatives that prioritise the well-being of healthcare workers are also important considerations.

It’s worth noting that over the past few decades, there have been a number of well-considered human resources strategies for the healthcare system in South Africa5. Unfortunately, these have suffered from inadequate implementation. This long-term planning and implementation is critical.  

Ultimately, it means ensuring that we’re able to encourage young people to take up these worthy careers with the guarantee that once they qualify, their skills will be put to good use. 

As the National Department of Health prepares to move South Africa toward the National Health Insurance scheme, the question of staffing becomes even more critical. It’s going to call for long-term strategies that will need to be implemented over generations.

References:

  1. Leshoro D. 179 000 job losses means South Africa now leads the world in unemployment [Internet]. Citypress. 2023 [cited 2023 June 5]. Available from: https://www.news24.com/citypress/business/sas-deepening-unemployment-headache-20230516
  2. [No title] [Internet]. [cited 2023 June 15]. Available from: https://www.statssa.gov.za/?p=15407
  3. Health sector can create thousands of jobs in SA [Internet]. SABC News. 2019 [cited 2023 June 5]. Available from: https://www.sabcnews.com/sabcnews/health-sector-can-create-thousands-of-jobs-in-sa/
  4. Francke RL. Nursing shortage puts rural South Africans at risk – report [Internet]. DFA. 2023 [cited 2023 Jun 6]. Available from: https://www.dfa.co.za/opinion-and-features/nursing-shortage-puts-rural-south-africans-at-risk-report-2355a0bd-ea21-4483-9429-cb9351ac0a1d/
  5. Critical shortage of doctors in SA – less than 1 doctor for every 1 000 patients [Internet]. Democratic Alliance. [cited 2023 June 7]. Available from: https://www.da.org.za/2022/05/critical-shortage-of-doctors-in-sa-less-than-1-doctor-for-every-1-000-patients#:~:text=09%20May%202022%20in%20News,doctors%20per%201%20000%20patients.
  6. Ryneveld Mv, Schneider H, Lehmann, U – Looking back to look forward: a review of human resources for health governance in South Africa from 1994 to 2018 [internet]: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-020-00536-1
Categories : Cardiovascular Disease Expert OpinionTags :

Consider More People with PE for Surgery, AHA Statement Urges

On By ModernMedia
Credit: American Heart Association

A new American Heart Association scientific statement suggests surgery be considered for more people with high-risk pulmonary embolism (PE). The statement, published in the journal Circulation, also calls for data quality registries for high-risk patients with pulmonary embolism and more research to better understand the disease process and effective treatments.

Nearly 45% of patients experiencing PE will progress to severe symptoms, where the clot causes high pressure in the lungs and subsequent damage to the right heart chamber, with a high risk of death. Even therapy following current guideline-directed treatment has a high rate of death, estimated at approximately 40% of cases in some groups.

Treatment options for patients with severe pulmonary embolism include anticoagulation therapy or thrombolysis (either intravenously or via catheter procedure), or advanced surgical interventions such as surgical embolectomy and mechanical circulatory support. Often, surgical techniques are a last resort after other treatments are unsuccessful. The statement suggests that considering surgery earlier may help improve survival for patients with severe PE.

“This statement demonstrates that modern surgical management strategies and mechanical circulatory support results in excellent survival (97%) even among the sickest patients, including those who present with cardiac arrest and have had CPR,” said Joshua B. Goldberg, MD, chair of the statement writing group. 

“Modern surgical strategies and mechanical circulatory support are drastically underutilised,” he said. “It is the hope of the multidisciplinary group of authors that this scientific statement will provide a greater awareness of the safety and efficacy of modern surgical management and mechanical circulatory support in treating the most unstable patients so that lives may be saved. In addition, we hope this statement will facilitate improved understanding of the disease process and effective treatments and encourage future research to improve the survival of patients with this common and deadly disease.”  

The writing group proposes strategies to determine risk more accurately and identify earlier which PE patients may benefit from surgical intervention. They also suggest increased education for clinicians to encourage the use and integration of surgical strategies earlier in PE treatment. Additionally, the statement supports the development of patient registries, particularly focused on data that provides useful context for clinicians and surgeons to understand the progression from intermediate to high-risk pulmonary embolism and treatment outcomes across patients at various risk levels.

Source: American Heart Association

Categories : COVID Expert OpinionTags :

‘Stepwise Emergence’ Scenario of Omicron in Africa Challenged

On By ModernMedia
Image by Quicknews

A widely reported study published in Science that presented evidence for a distributed, ‘stepwise’ origin for Omicron across the African continent has drawn criticism from a number of prominent scientists.

Dr Tulio Oliveira, the director of CERI (Centre for Epidemic Response & innovation) and KRISP (KZN Research Innovation & Sequencing Platform) was one of these scientists expressing their doubts over Twitter.

Dr Oliveira tweeted that, like many other scientists, he was sceptical of the Science paper’s narrative of a stepwise emergence of Omicron in Africa.

“First, the ‘fishing’ of intermediates in Africa should also have been performed in Europe and the USA, which were the regions of the world that introduced the majority of Omicron lineages to Africa -“

He also questioned the accuracy of their results due to possible contamination, and also the strength of their analyses, noting that phylogenetic analyses are weak.

For his fourth point, he says that “the Benin sequences could be recombinants of Delta and Omicron, real recombination, or recombination through contamination of the sequencing process.” He was unable to check for the prevalence of mutations.

He also makes a very simple observation regarding the timing of waves: if Omicron arose first in West Africa, why then did South Africa experience the Omicron wave before them?

The paper was also not presented as a preprint to allow for the research community to give feedback and improved the manuscript, a criticism echoed by biologist and physicist Richard Neher.

“Lastly, the results presented do not reject any of the three hypotheses of Omicron evolution (i.e. unsampled location, immune suppressed individual, animal reservoir).”

Nevertheless, he says that “I have many colleagues and collaborators in this paper and would like to recognize that the allele qPCR system to identify BA.1 is a great tool. Also that their mutation analyses are also good.”

Categories : Expert Opinion HIVTags :

Opinion: Keep an Eye on Quality as We Rush to Test People for HIV

On By ModernMedia
HIV themed candle
Image by Sergey Mikheev on Unsplash

By René Sparks

As we approach World AIDS Day on 1 December, healthcare providers will be offering HIV screening and testing as part of a comprehensive health service.

The theme for this year’s World AIDS Day is: “Equalise and Integrate to End AIDS”.

One aspect in which more equality is arguably needed is between the quality of HIV testing services and aiming to test as many people as possible.

Progress against targets?

It is estimated that 13.9% of South Africa’s population is living with HIV and that the absolute number of people living with HIV in the country has increased from 3.8 million in 2002 to 7.8 million in 2021. This number has continued to rise since the death rate has declined much more rapidly than the rate of new HIV infections.

The most widely used measure of a country’s HIV response in recent years has been the UNAIDS 90-90-90 targets. These aim at 90% of people living with HIV knowing their status, 90% of those diagnosed started on ARVs, and 90% of those on ARVs being virally suppressed by 2020. The goal post has now shifted to 95-95-95.

Earlier this year, Health Minister Dr Joe Phaahla said that in South Africa we are on  94-78-89.

This indicates that we are close to reaching the first 95. It also suggests that our HIV testing efforts have generally been a success, including the introduction of HIV Rapid Testing and HIV Self Screening as HIV testing models. But, as we collectively meet these targets, it is important to focus on the quality of HIV rapid testing to ensure that we align with HIV testing standards.

Focus on quality

The quality of HIV Rapid testing to some extent depends on laboratories, but often it is driven by HIV counsellors and service delivery NGOs. As a public health professional managing the National HIV Testing Quality Assurance and Laboratory Systems Strengthening programme, seconded to the Department of Health through SEAD Consulting, it is my job to support NGOs, the Department of Health, and the Department of Correctional Services in implementing quality assurance of HIV Testing and in improving the laboratory systems between health facilities and the National Health Laboratory Service.

As someone who has worked in all aspects of primary healthcare, I am painfully aware of the shortcuts sometimes taken, but also of the impossible expectation of ‘quick services’ linked to HIV testing.

As a healthcare provider, I received peer mentorship upon entry into primary healthcare settings – but I later learnt that this mentorship provided incorrect guidance on HIV testing.

This gave me sleepless nights and fuelled my desire to support other healthcare workers in conducting quality HIV testing to avoid possible misdiagnosis and delays to critical treatment. It is imperative that everyone understands their role when it comes to HIV testing and that we move away from siloed approaches in prevention and curative spaces but integrate both quality and ambitious targets. One cannot be seen in isolation from the other.

So, how are HIV tests supposed to be done?

Firstly, there are multiple things to look out for when having an HIV test done. HIV testing should be conducted by a trained healthcare worker, using nationally approved test kits which are kept in temperature-controlled spaces. Test kits should not be exposed to extreme heat of more than 30 degrees Celsius as it fries the device, which could lead to incorrect results.

Secondly, each test has an expiry date, its own pipette (plastic or glass device to collect the blood), its own buffer (liquid that assists the blood to move across the test strip) and its own incubation time (time it takes for a reaction or outcome of the test).

When being tested, the fingertip needs to be cleaned with an alcohol-based swab, and then the first drop of blood should be wiped away to avoid contamination of the sample. The second drop of blood is then collected with the specific pipette to the required amount for that test. Once collected, the blood is inserted into the well of the test and the required number of drops of buffer is added. Lastly, the timer is set to the manufacturer’s time for each test kit.

The time is of utmost importance, as reading it too early could lead to false HIV-negative results, whereas reading it too long after the time could lead to false HIV-positive results. It is for this reason that each HIV tester needs to have a digital timer that is able to count down and sound an alarm when the time has been reached.

Additional aspects linked to the quality of HIV testing are Personal Protective Equipment (Aprons, gloves, and sanitiser) – these need to be worn by the HIV tester as part of infection control. Also important are ice packs – if you are being tested in a gazebo in the community, the HIV tester needs to ensure that the HIV test kits are kept cool to avoid malfunction or damage.

These are the basics we must get right.

The quality of HIV testing is as important as getting the test done. Too often short cuts, time constraints, and lack of staff impact the quality of testing. To be in a position where we can really celebrate the numbers – the progress – it is essential that we must get these basics right.

*Sparks is a Public Health Professional at SEAD consulting, a co-convenor at the School of Public Health, University of the Western Cape, a Senior Aspen New Voices Fellow, and a Global Atlantic Fellow for Health Equity.

Republished from Spotlight under a Creative Commons 4.0 Licence.

Source: Spotlight

Categories : Cardiovascular Disease Expert OpinionTags :

Consensus Decision Pathway for Nonstatin Therapies Released

On By ModernMedia
Source: Wikimedia Commons CC0

An expert consensus decision pathway on the role of nonstatin therapies for LDL-C lowering in the management of atherosclerotic cardiovascular disease (ASCVD) risk reduction has been published to address the recent development and commercial availability of newer nonstatin agents. The American College of Cardiology drafted the decision pathway in order to bridge gaps in expert guidance on the topic.

The 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Diseases Risk is available online in the Journal of the American College of Cardiology. It was endorsed by the National Lipid Association.

The document provides guidance on clinical scenarios not covered in the 2018 AHA/ACC Guideline on the Management of Blood Cholesterol and refines criteria for treating individuals determined by baseline LDL-C levels. The clinical policy focuses on individuals at very high-risk as well as not very high-risk of future ASCVD events, individuals currently with or without a clinical diagnosis of familial hypercholesterolemia, primary prevention for individuals with and without diabetes, and individuals with statin-associated side effects. The writing committee also addresses factors to consider in the clinician-patient discussion reinforcing patient preference with regard to the addition of nonstatin therapies.

Source: EurekAlert!

Categories : Expert Opinion HospitalsTags :

Proper Handwash Basin Design and Use is Critical to Controlling AMR

On By ModernMedia
Photo by Piron Guillaume on Unsplash

Some 10 million people annually are projected to die annually from antimicrobial resistance AMR in 2050, says Briëtte Du Toit, Programme Manager and Training Coordinator at Infection Control Africa Network (ICAN). While efforts to develop new antibiotics and conserve current ones are under way, it is vitally important to limit hospital-acquired infections as this is where many resistant strains spread. One of the key ways of controlling this is through the proper use of handwash basins, which necessitates a collaboration between the medical and engineering disciplines.

Presenting at the 14th SAFHE Southern African Healthcare, Du Toit stressed the importance of proper handwashing protocol and the critical importance of handwash basin design and placement to control the spread of hospital-acquired infections amid rising antimicrobial resistance.

The simple protocol of hand washing is perhaps one of the most important in modern medicine. In the past, clinicians might perform and autopsy and then deliver a child, all without washing their hands. It was only until the mid 1800s when Hungarian doctor Ignaz Semmelweis discovered the importance of hand washing, causing infection rates to plummet after the introduction of this most simple of protocols.

In modern hospitals, handwash basin design and placement, along with inadequate water supply and inadequate knowledge on the part of staff, contributes to inadequate hand washing and therefore high infection rates, Du Toit pointed out.

The design of handwash basins may seem straightforward, but there are many factors to consider. Water may drop onto other surfaces, or splash onto HCWs’ clothes. If medical supplies are stored nearby, then stray water droplets may also land on them.

A study of handwash basins showed that only 23% of basins were used for handwashing, while the remainder were used for a variety of activities including waste disposal. Of the basins used for waste disposal, 55% were contaminated. Another study showed that, in the ICU setting, washbasins were used for handwashing a mere 4% of the time. A sluice is also needed in close proximity to patients, otherwise staff will use handwash basins for incorrect disposal of body fluids.

Having the outlet directly beneath the tap as in a traditional domestic basin increases contamination. A bowl depth less than 19cm also contributed to contamination. Without a bowl cover, 9% of gowns and 6% of hands were found to be contaminated with gram-negative bacili (GNB), versus 2% of gowns and 0% of hands when a cover was present.

Significant improvements were also seen in ‘water-free’ protocols at the point of care, which involved the extensive use of disposable wipes, bottled water and practices such as using electric shaving. The implementation of water-free protocols at one hospital saw a drop in GNB colonisations from 26.3 to 21.6 / 1 000 ICU admission days. An even greater effect was seen for long-term ICU stays, with a 3.6 fold-reduction for stay exceeding 14 days.

Du Toit concluded by stressing the importance of collaboration between the medical and engineering fields, sharing data. Engineers should also be on IPC committees. Likewise, medical personnel should be part of the project team during building and renovations.

Categories : COVID Expert OpinionTags :

COVID Risks a ‘Lost Generation’ for Psychiatry Research

On By ModernMedia
Photo by Alex Green on Pexels

The field of psychiatry research risks a “lost generation” due to the difficulties of COVID, warn the authors of an editorial published in The Lancet. The burden of the pandemic has strained the critical aspect of the mentor-mentee relationship and the difficult period between the end of training and beginning research as an independent professional.

The authors, Erika E Forbes and David J Kupfer, are directors of the US-based Career Development Institute for Psychiatry, which provides teaching and mentoring programme for those embarking on a career into academic psychiatry, note that the pandemic has had a significant impact on this stage of development. The same challenges noted by the authors no doubt apply to the field of clinical psychology as well, which is also dependent on mentoring.

Both mentors and mentees are exhausted from health-related uncertainty, from Zoom meetings, and struggling to effectively collaborate, they wrote.

They note that starting a career as a scientist is a challenge even in the most stable times, but is now particularly gruelling, something they have recently borne witness to.

“At our April 2022 annual workshop, our fellows were dispirited, telling us that they feel neglected, undermined, and in some cases emotionally abused by the mentors at their home institutions. Many cannot envision a way forward.”

Though the authors are optimistic about adapting to COVID, with the limited of virtual settings and the new acknowledgement of how daily struggles impact work, they cannot deny that cannot deny that “psychiatry research is in a mentoring crisis.”

“There is a danger of losing a generation of talented, promising scientists, and this could stall progress in understanding and treating psychiatric illnesses,” they warn. To deal with this, mentors must still provide the “traditional elements of mentoring”, ie, guidance, advocacy, training, and access to professional networks, along with embracing technology and empathy. It is crucial to understand the mentee and provide them with more of the same basic support, because the usual challenges are amplified.

Mentoring is different in the COVID era, they stress. “If we accept that research will not go back to the pre-pandemic ways, adapt our behaviour to current realities, and enhance our commitment to supporting and guiding others, early-career scientists will again be able to thrive,” the authors conclude.

Categories : Expert Opinion Medical IndustryTags :

Act Now to Stop the Bleed on Medical Schemes Industry

On By ModernMedia

By Junior Biola

Last year, fraud and abuse of medical aids resulted in a loss of R22 billion for medical scheme funds according to The Board of Healthcare Funders – a loss which could be avoided with the implementation of fraud mitigation services.

Medical aid fraud is certainly nothing new: for years, medical schemes have railed against members collaborating with medical practitioners – from doctors to pharmacists – for personal gain. There are the members who convince practitioners to admit them to hospital, for example, and pocket the monies received from their hospital cash back plans; the pharmacists who bill their customers for ‘medicine’, when their baskets are in fact filled with non-medicinal items; or even the practitioners who bill patients for treatments which never take place.

Since the advent of the Covid pandemic, such activities have escalated. In fact, it is no longer rogue pharmacists or practitioners taking advantage of medical aids; the industry is now affected by dishonest members and criminals using stolen cards to deplete medical savings accounts or take advantage of benefits.

The results are catastrophic for an industry which is frequently accused of charging members exorbitant fees. In truth, players are under siege from the steeply rising costs of healthcare, and while they are doing their best to limit the impact on members, this is no easy task when those very members are, in effect, stealing from the scheme through fraudulent claims.

The impacts are far-reaching for all stakeholders. Medical funds have no choice but to raise the price of contributions – after all, they need to maintain a steady pool of funds in order to be able to pay out claims, and if members are dipping into that pool for illicit reasons, it needs to be replenished. Naturally, this affects members severely, especially as many are already challenged by the rising cost of living. On the other side of the equation, practitioners also take a hit: when the pool of medical funds decreases, a less profitable practice is inevitable.

The prevalence of fraud is understandable when you consider that few controls are in place to prevent it. Think of the average consumer entering a retail chain pharmacy, for example: they may be asked to present their loyalty card, and while this may be considered a form of identification, the reality is that it is rather ineffective as a verification tool. The absence of an identification photo means that the purchaser could well be someone besides the patient for whom the script was written; nor is there anything to stop them from adding over-the-counter items to purchase and claiming them from their savings.

The good news? Fraud mitigation is both effective, and simple to implement. Establishing a ‘safety net’ of identity and biometric recognition makes it possible for medical schemes to ensure that members claim only for medicines and treatments they have been prescribed, while also protecting against scripts that have been falsified.

The result? A healthier medical aid industry – for the benefit of all.

Junior Biola is CEO of Johannesburg-based fintech company, Bitventure, a provider of state-of-the-art real-time automated verification and payment solutions. www.bitventure.co.za

Categories : Diet and Nutrition Expert OpinionTags :

Multivitamins and Dietary Supplements are a ‘Waste of Time’ for Most

On By ModernMedia
Vitamin C pills and orange
Photo by Diana Polekhina on Unsplash

For those who aren’t pregnant, vitamins are a waste of money because the evidence for cardiovascular disease or cancer prevention is lacking, according to researchers at Northwestern University Feinberg School of Medicine.

“Patients ask all the time, ‘What supplements should I be taking?’”

Dr Jeffrey Linder, Northwestern University

The researchers penned an editorial in JAMA that supports new recommendations from the United States Preventive Services Task Force (USPSTF), a national panel which makes evidence-based recommendations on clinical prevention. 

Based on a systematic review of 84 studies, the USPSTF’s new guidelines state there was “insufficient evidence” that taking multivitamins, paired supplements or single supplements can help prevent cardiovascular disease and cancer in otherwise healthy, non-pregnant adults. 

“Patients ask all the time, ‘What supplements should I be taking?’ They’re wasting money and focus thinking there has to be a magic set of pills that will keep them healthy when we should all be following the evidence-based practices of eating healthy and exercising,” said Dr Jeffrey Linder, one of the editorial’s authors.

“The task force is not saying ‘don’t take multivitamins,’ but there’s this idea that if these were really good for you, we’d know by now,” Dr Linder added. 

The task force is specifically recommending against taking beta-carotene supplements because of a possible increased risk of lung cancer, and is recommending against taking vitamin E supplements because it has no net benefit in reducing mortality, cardiovascular disease or cancer.

“The harm is that talking with patients about supplements during the very limited time we get to see them, we’re missing out on counselling about how to really reduce cardiovascular risks, like through exercise or smoking cessation,” Dr Linder said.

No substitute for actual fruits and vegetables

Eating fruits and vegetables is associated with decreased cardiovascular disease and cancer risk, they said, so it is reasonable to think those key vitamins and minerals in pills could prevent disease. But, they explain, whole fruits and vegetables contain a mixture of vitamins, phytochemicals, fibre and other nutrients that probably act synergistically to deliver health benefits. Micronutrients on their own may also have a different effect than when consumed with others in foods.

Dr Linder noted that individuals with vitamin deficiency can still benefit from taking dietary supplements, such as calcium and vitamin D, which have been shown to prevent fractures and perhaps falls in older adults. 

New guidelines do not apply to those who are pregnant

The new USPSTF guidelines do not apply to people who are pregnant or trying to get pregnant, said JAMA editorial co-author Dr Natalie Cameron, a physician at Northwestern. 

“Pregnant individuals should keep in mind that these guidelines don’t apply to them,” said Dr Cameron. “More data is needed to understand how specific vitamin supplementation may modify risk of adverse pregnancy outcomes and cardiovascular complications during pregnancy.” 

Source: Northwestern University