The British Sleep Society has released a position statement in the Journal of Sleep Research advocating for the abolition of the twice-yearly clock changes in the UK and the restoration of permanent Standard Time (Greenwich Mean Time). This recommendation is based on scientific evidence highlighting the adverse effects of the clock change and Daylight Saving Time (DST) on sleep and circadian health.
The British Sleep Society emphasises that sleep is central to health and well-being and the enforced changes of clock time to DST can interfere negatively with sleep regulation. “What we often don’t realise is that DST changes our schedules, moving them forward by one hour while daylight remains the same. DST forces us all to get up and go to work or school one hour earlier, often in the dark,” said co-author Eva Winnebeck, PhD, of the University of Surrey. The Society stresses that natural daylight in the morning is crucial for maintaining an alignment of our body clocks with day and night, which is essential for optimal sleep and overall health.
“Some people even advocate switching to DST all year around. We think this is misguided, because it would leave us with dark mornings during the winter, and morning light is critically important for keeping our body clocks synchronized,” says coauthor Malcolm von Schantz, PhD, of Northumbria University.
Other sleep societies have also argued against year-round DST and advocate for the return to year-round Standard Time, but this position statement is the first published UK perspective. “The unique location and orientation of our UK landmass needs to be considered because permanent DST would over-disadvantage people west and north of London,” said first author Megan Crawford, PhD, of the University of Strathclyde.
To see National Health Insurance primarily as the setting up of a state-run medical aid scheme risks underplaying its massive potential to restructure how public healthcare services are organised and funded, and with that, its potential to boost the delivery of primary healthcare services in South Africa, argues Russell Rensburg.
It has been 30 years since South Africa emerged from centuries long racial suppression and state-sponsored apartheid and took her place among the community of sovereign, democratic nations. In 1996, we adopted the final Constitution, in which we committed to addressing the injustices of the past and building a society based on social justice and human dignity. That promise is carried through in the Bill of Rights, which under Section 27 includes the right to healthcare, food, and social assistance. The right to access healthcare services, like many socio-economic rights, is subject to the state taking reasonable legislative and other measures within available resources to progressively realise the right.
Pursuant to this, the National Health Act, which provides the framework for a structured uniform health system within the country, was adopted in 2003. The Act assigns the minister of health the obligation to ensure the provision of essential health services, which must include primary healthcare services. But, to date, no health minister has published regulations that define the exact scope of essential health services, nor has a framework been offered for the development of a defined package of care to be provided within the resources available.
The result is that, despite significant investments in public funded healthcare, the system and the services it provides has largely been shaped by existing infrastructure inequity. Put differently, health investments have typically gone where the infrastructure exists, rather than being guided by providing a defined package of primary healthcare services in all the places where it is most needed.
In the near term, the health system faces several immediate challenges. Per capita spending is declining. Spending is biased towards hospitals, with 42% of the national health budget spent on central and provincial hospitals. Another problem is that health service planning and budgets do not sufficiently account for our changing demographic profile – life expectancy has increased and we have a growing population of young people.
The National Health Insurance (NHI) Act is an attempt to address this through the establishment of the national health insurance fund, which initially will be the only purchaser of public sector healthcare services. Broadly, the NHI aims to pool funds to provide access to good quality, affordable healthcare services for all South Africans and certain foreign nationals, based on their health needs and irrespective of their socio-economic status.
This shift marks a substantial change from the existing setup, where 85% of the national health budget is allocated at the provincial level. In South Africa, the share provinces get of the national budget is largely determined by the equitable share formula. The health component of the formula includes a number of variables to account for healthcare need, including premature mortality (as a proxy for unmet need ), multi index deprivation (to account for social determinants of health such as poverty ), income, housing, and measures of sparsity (to account for rurality). But the biggest driver of funding is historical utilisation, which shapes resource allocation at the provincial level. The result is that the funding is overly focused on providing care under the existing systems, rather than progressively expanding access to healthcare, and boosting access to primary care in particular.
In short, NHI represents a major shift away from this paradigm by which provinces receive healthcare funds via the equitable share and based on historic spending.
How it will work
Under NHI, the public sector will budget according to level of care, initially prioritising the district health system through the establishment of district health management offices. These offices will support contracting units for primary care, which will comprise a district hospital, community health centres , primary healthcare clinics, and ward based outreach teams as well as provisions for integrated practice comprising GPs, pharmacists, dentists, and rehab professionals (occupational health, physiotherapy, and speech therapy). The district health management offices will be responsible for the achievement of health outcomes in districts.
In theory, this will allow for healthcare priorities to be shaped at the district level and for services to be more responsive to the healthcare needs of communities. For example, a district like OR Tambo could prioritise more resources towards addressing maternal mortality by expanding ante-natal services or developing responses to address the health access gaps for older people in rural areas. In urban districts, like the City of Johannesburg, it could prioritise expanding access to reproductive health services by contracting in private health providers who are better placed to respond to the needs of working women. Ultimately, such a shift to a more responsive and more localised health system could also help increase uptake of TB and HIV prevention and treatment services across the board.
How to get the ball rolling
Reorientating our health system towards primary healthcare will be a difficult and time-consuming process, given the complex nature of health systems. But, there are things we can do right away to get things moving. We don’t have to wait for full implementation of NHI.
The current District Health Programme Grant can be expanded to enable provinces to increase primary healthcare services. The grant currently focuses on resourcing the country’s response to HIV, which seems to have reached a plateau with fewer people initiated on treatment. Contracting in private providers using this grant could improve service accessibility for testing, reproductive health services and routine healthcare for the working poor. Indeed, contracting in non-state healthcare providers, such as healthcare NGOs, pharmacies, and GPs, can significantly improve the patient experience and help build the public trust that is needed for NHI. As we repurpose the District Health Programme Grant, we can also start building the systems we will need for the district health management offices envisaged under NHI, thus helping to ease the transition when it comes.
The biggest immediate opportunity however lies in improving the accessibility and acceptability of district health services for the working poor. A study by the Bureau of Market Research at UNISA estimated that around 75% of working people in South Africa earn less than R6 000 a month. The current structure of publicly funded primary healthcare services do not respond to their routine needs, which include accessing family planning, seeing a GP when ill, a dentist to address oral health issues or access to rehab services. Apart from meeting the needs of these people, expanding service points, particularly in urban areas, can also improve disease surveillance through increased testing, and increased uptake of HIV prevention and treatment services.
There are more areas where we can make progress now that will ease the transition to NHI. For example, the current National Tertiary Services Grant, with an allocation of R15 billion, can be used to support a deep dive into what services our hospitals offer, what resources they are allocated and why, and how all of that lines up with the health need in our districts. The data isn’t currently there to really know whether we are getting value for money from our public hospitals. As with primary care, we need to get a clearer understanding of the need and start re-engineering the system so that we are in a better position to meet that need as we start implementing NHI.
Ultimately then, it is limiting to think of NHI exclusively as the establishment of a state-run medical aid scheme – as it is often portrayed in the media. A public discourse dominated by debates over the future of medical schemes risks obscuring the substantial potential NHI offers for improving and restructuring how public health services are organised and funded. The reality is that with NHI, we have an opportunity to shift the focus of our healthcare system toward primary healthcare and in the process to make our health system much more efficient and equitable. It is imperative that we do whatever is needed to deliver on that potential.
*Rensburg is Director of the Rural Health Advocacy Project.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
By Reo Botes, Managing Executive at Essential Employee Benefits
22 October 2024
South African businesses operate in an environment in which many employees, particularly those in lower income segments, struggle to afford basic healthcare services. Healthcare benefits like medical aid are simply not affordable for the majority of the workforce, even if they are subsidised, which exacerbates the existing dichotomy. Addressing this issue should be a strategic imperative as well as a matter of ethical compliance and social responsibility.
While executives play a crucial role in setting strategy, many layers of employees are operationally required to fulfil said strategy. Keeping all layers of employees healthy by promoting access to quality healthcare, boosts both sustainability and competitiveness. We dare not wait for the National Health Insurance (NHI) to come into effect to solve this challenge; we have a responsibility to make private healthcare more accessible, and one way that companies can do this is by incorporating affordable health insurance products into their employee benefits basket.
A legacy of inequality
The legacy of apartheid has left an indelible mark on South Africa’s socio-economic landscape. This is reflected in the persistent inequality that permeates many facets of life, including significant disparities between rural and urban areas, as well as access to healthcare. Decades later, private healthcare remains predominantly accessible to the wealthy, while the majority of South Africans are left to rely on an overburdened public health system.
Medical aid has been the traditional path to affordably accessing private healthcare, but the premiums remain out of reach for the lower income earners, even if companies subsidise the cost. The lower-cost medical aid options have struggled to get off the ground, and the effective rollout of the NHI will take many years to come to fruition. Since most people cannot afford medical aid and cannot rely on universal access to public healthcare, there needs to be another option that will enable them to access healthcare affordably. Making health insurance benefits available with options that suit different income segments will not only help to address this issue, but it will also benefit businesses as well.
A healthy workforce just makes business sense
From a legal standpoint, South African companies are bound by the Labour Relations Act and the Occupational Health and Safety Act (OHSA), both of which mandate the provision of a safe and healthy working environment. While these regulations primarily focus on workplace safety, the concept of a healthy workplace extends beyond physical safety to encompass the overall well-being of employees. Ethical governance demands that companies do more than the bare minimum required by law; it requires a proactive approach to employee welfare.
Beyond ethical and compliance concerns, having a healthy workforce is simply good for business. Healthy employees are more likely to be engaged, motivated, and productive, which in turn contributes to the overall success of the business. Moreover, a company that invests in the health of its workforce is likely to see a return on investment (ROI) through reduced turnover, lower absenteeism, and higher employee satisfaction.
By offering health insurance benefits that are tailored to the needs of employees across different income brackets, companies can demonstrate a genuine commitment to their employees’ well-being. This not only fosters trust and loyalty among the workforce but also enhances the company’s reputation as an employer of choice.
Health insurance for all, not just for executives
Photo by Emmanuel Ikwuegbe on Unsplash
Budget constraints are often cited as a major barrier when it comes to subsidising healthcare costs, but health insurance products aimed at lower income segments are a fraction of the cost of the more comprehensive medical aid products offered to executive tiers, and the cost-benefit ratio of providing greater access to healthcare services can be profound. When employees have access to health insurance, they can seek medical attention promptly, reducing the likelihood of prolonged illness and absenteeism, which in turn are detrimental to business.
Even if businesses, particularly small and medium-sized enterprises, cannot afford to subsidise health insurance products, they can still offer access to them as part of employee benefits. Companies can negotiate group rates for health insurance on behalf of their employees, making it more affordable than taking out a policy on their own and thus reducing the cost without the need to subsidise. Aligning health insurance benefits with employee needs and income levels ensures that the cover is both relevant and accessible and supports long-term business goals by promoting a healthier, more resilient employee base.
Change comes from the top
Human Resources (HR) and executive leadership play a pivotal role in the implementation of inclusive health insurance benefits. While executives are responsible for setting the overall strategy, it is the HR teams that must operationalise these strategies and ensure they are effectively communicated and implemented across the organisation. This includes understanding the diverse needs of the workforce, negotiating with insurance providers, and designing benefits packages that are both affordable and impactful.
By integrating health insurance into the broader employee value proposition, companies can enhance their appeal to top talent, including high performers in lower income brackets. A comprehensive benefits package that includes health insurance is a key differentiator in a competitive job market, helping companies attract and retain skilled workers who are critical to executing business strategies.
Inclusivity drives resilience
Ultimately, the provision of health insurance benefits for all employees is about building a strong foundation for business success. A healthy, happy, and productive workforce is essential for any company looking to achieve long-term sustainability and growth. By taking care of their employees’ health, companies are not only doing the right thing from an ethical standpoint but are also making a smart business decision that will pay dividends in terms of productivity, employee retention, and overall organisational resilience.
South African companies must recognise the importance of inclusive health insurance benefits as a critical component of their business strategy. Addressing the historical inequalities in healthcare access, meeting legal and ethical obligations, and investing in the health and well-being of all employees are essential steps towards building a more equitable and prosperous future for both businesses and their workforce. Businesses can play a pivotal role as the country continues to grapple with the challenges of inequality and healthcare access.
The idea of mandatory medical scheme coverage for employed people has made a comeback after the case for it was made at a recent conference. The policy move was previously on the cards in South Africa but faded after the ANC opted for National Health Insurance (NHI) at its 2007 national congress where Jacob Zuma was elected as the party’s new leader. Chris Bateman unpacks how a system with mandatory medical scheme membership for the employed might work and asked local experts whether it represents a viable alternative to government’s NHI plans.
A vigorous public debate has ensued since outgoing Netcare CEO, Dr Richard Friedland, on behalf of the Hospital Association of South Africa (HASA) delivered a strongly argued case for a return to what he described as the original ANC healthcare plan. He was speaking on “Viable and Near-term Opportunities to Providing Enhanced Healthcare in South Africa,” at HASA’s annual conference in Sandton held early in September.
Since then, the leadership of Business Unity SA (BUSA) met with President Cyril Ramaphosa and Health Minister Dr Aaron Motsoaledi, and his deputy and other senior officials, in mid-September to discuss “matters of concern” related to the NHI. The President requested BUSA to put forward specific proposals on “the remaining matters of concern” as a basis for re-engagement.
Some observers have suggested to Spotlight that these consultations are a first sign of government openness to changing or tweaking its NHI plans. But whether this means the door is actually open for a system of mandatory health insurance, or for mandatory health insurance as a stepping-stone toward NHI, is still unclear.
The NHI Act, that was signed into law by Ramaphosa in May, envisages a single-payer system where medical schemes are only allowed to cover health services that are not covered by the NHI fund.
How mandatory health insurance would work
Under mandatory health insurance, everyone who is in formal employment, or who earns above a certain threshold, would be forced by law to be a member of a medical scheme. This will result in medical scheme membership swelling substantially and some pressure being taken off the public healthcare system. It is also expected to result in medical scheme premiums being reduced because more healthy, younger people will join the schemes. People who are unemployed or who cannot afford health insurance will still be dependent on the public healthcare system.
Friedland said such mandatory healthcare insurance will triple the medical scheme market from 9.2 million to potentially 27.5 million beneficiaries over time and reduce those dependent on the state from 53.8 million to 35.5 million. In so doing, it would boost public healthcare per capita spending by 52%, (from R5 054 to R7 659), without any additional funding of the public sector budget, alleviate the strain on public hospitals and clinics, shorten waiting lists, and free up money to hire more staff and improve infrastructure. He said it is a “far faster and more efficient tool” for achieving health equity.
Responding to the counter argument that a mandatory health insurance system would entrench existing health inequalities, Professor Alex van den Heever, Chair of Social Security Systems Administration and Management Studies at the University of the Witwatersrand, said the opposite is true. “It accelerates convergence between the two systems faster than the NHI proposals,” he told Spotlight.
The relief for people who can afford medical scheme cover could also be significant. Friedland said mandatory medical scheme membership would bring more young and healthy people into the system, thus reducing the cost of monthly premiums by 25% to 30%.
Mandatory contribution schemes for civil servants have been implemented in more than half of the countries in Africa, while Thailand and many other Asian countries have started with mandatory cover for the formal sector before expanding to the non-formal sector. Such systems with what amounts to many medical schemes, rather than a single large fund, are also in place in several European countries, including the Netherlands and Germany.
Not a new idea
Mandatory health insurance, or an expanded role for medical schemes, are by no means new ideas in South Africa. Friedland told Spotlight that the ANC government’s own broad ranging 2002 inquiry into the various social security aspects of the South African health system concluded that national health insurance or the complete nationalisation of the private sector, could not be seriously considered as a reasonable option. (The inquiry itself was based on the Health Subcommittee Findings of the Committee of Inquiry into a Comprehensive System of Social Security.)
That 2002 report concluded: “National health insurance is not an option that emerges overnight as an alternative to social health insurance. Instead, it becomes feasible within market economies where formal employment levels are high. Prior to this, mixed systems are inevitable.”
One indication of how committed government was to such a mixed system with an expanded role for medical schemes in the early and mid-2000s, is the fact that the legislative framework to enable the expansion of medical scheme coverage was incorporated into the 2008 Medical Schemes Amendment Bill. That bill did not go as far as making scheme membership mandatory, but a mandatory system was clearly a next step on the reform agenda, as outlined in the very wide-ranging 2002 Taylor report on social security in South Africa. But presumably because of the NHI proposals, the 2008 amendments were allowed to lapse – and the scaffolding for a progressive expansion of medical scheme coverage collapsed.
There have since been several committees of inquiry and technical processes that validated an ongoing role for medical schemes, of which the Competition Commission’s Health Market Inquiry (HMI), that ran for five years (2014 to 2019), was the most technically detailed, consultative and authoritative. The HMI report did not recommend that medical scheme membership be made mandatory for people who are employed, but it did recommend a continued role for medical schemes and suggested that the most viable path to NHI may well involve first fixing the regulation of medical schemes.
Van den Heever said South Africa needs to quickly return to the pre-2008 reform trajectory to help stabilise the health system, “before more harm is done”. Government needs to summon up the political will to address the systemic governance failures of the public health system, removing the “bad actors and provincial cabals” that were destroying the integrity of South Africa’s free public health services, he added.
Better regulation also needed
For a system of mandatory health insurance to work, medical schemes will have to be more effectively regulated. Here the HMI report found that government had dropped the ball. It attributed the private health market failure and rampant medical inflation directly to government neglecting to regulate the private healthcare industry.
Health actuarial consultant, Barry Childs, joint CEO of Insight Actuaries and Consultants, told Spotlight private healthcare sector reforms urged by the HMI were ignored, resulting in ongoing confusion, high costs, complicated products and waste, among other problems. “Our incomplete medical scheme regulation keeps costs up, (for example anti selection, Prescribed Minimum Benefits), with benefits out of reach of most. We still don’t have a proper framework for lower cost-lower benefit products for those who cannot afford medical schemes,” he said.
The HMI report recommended a framework that went “way beyond naïve approaches to price control”, said Van den Heever, and addressed the powerful incentive structures driving unproductive forms of competition. In addition, he said, the industry-wide pooling approaches (risk equalisation and social reinsurance) followed international best practice and fully addressed issues of pooling fragmentation.
In the five years since the publication of the Commission’s HMI report, none of its major recommendations have been implemented.
Jobs and taxes
One common thread running back to the 2002 report, is the idea that South Africa is not economically ready for NHI and that a mixed system, possibly with mandatory health insurance, is more compatible with the current realities of high unemployment and a relatively small tax base.
“The root cause of inequity and inequality is not just a new form of apartheid. The real reason is the catastrophic level of unemployment. Until we address that, we will not solve an entire range of inequities, including food security, housing, education, and healthcare,” said Friedland.
On joblessness, Childs said South Africa was on track with the rest of the world’s growth up to 2008 but thereafter flat lined for over a decade. “We have dramatically underperformed the rest of the world and our peer group of middle-income countries in long term economic growth.”
In South Africa, unemployment is at an extremely high 33.5%, while in 2002 it was at 26%.
“If an NHI was unaffordable in 2002, how much more so is it today?” Friedland asked. He said that in this context, strong partnership, collaboration, and co-operation between the public and private sector is needed to bridge the polarisation that has arisen.
Analysis commissioned by BUSA found that raising the extra R200bn the health department says it needs to fund NHI would entail unrealistic and unaffordable tax hikes. It would either increase personal income tax by 31%, push VAT from 15% to 21.5%, or require the collection of a payroll tax of R1 565 per month from everyone in formal employment.
Van den Heever said that while government has a discretion to increase tax rates to any level it chooses, it cannot control the resulting amount of funds raised. He said that once tax capacity is reached, a hard ceiling on government revenue results at any given level of economic growth. The only way to grow revenues thereafter is through economic growth, failing which, revenues stagnate beyond government control.
The “big idea”, he said, was that new taxes would fund the move of medical scheme members to the public sector, in the form of a single NHI Fund, such that both public sector and medical scheme populations were covered in the same system – with net gains in coverage for both.
However, contrary to what was “correctly understood” from 1994 to the 2002 Taylor Commission, “the maths for such an approach, just does not add up”, said Van den Heever.
“The fastest way to de-segment the system is to allocate all new government revenues arising from economic growth to the people who need it most. This is not what the NHI proposals envisage. They want to dilute the public spend by trying to cover higher income groups. It is dangerous magical thinking that allows government to avoid dealing with the complex problems of the health system. Government needs to get back to its day job and do the heavy lifting needed to get our health system working again.”
Government response
Spotlight shared an earlier draft of this article with the National Department of Health for comment. While the department did not comment directly on mandatory health insurance, Foster Mohale, the department’s Director of Communications, emphatically reiterated their support for NHI and the NHI Act that was signed into law in May.
“There is no better time than now to reform South Africa’s health system. It is time to do away with the apartheid type of health system, and to reconfigure it into one that ensures that every South African gets the health care that they need, when they need, where they need and without incurring financial hardship. With the enactment of the NHI Act, the time for piecemeal approaches that retain benefits for the few and leave the majority to the whims of the market is no more,” Mohale told Spotlight.
He said that many countries, including Japan and the United Kingdom, have implemented health system reforms directed at achieving universal health coverage during times of crisis and low economic growth. “Therefore, to say that South Africa must sit and wait for some oracle numbers to emerge before instituting NHI is merely to argue that we must consciously let those that are carving profits and dividends from the anomalies that characterise our health system to continue. This is an irresponsible position that the Department cannot adopt as health is a constitutionally enshrined right for every South African, not just a privileged few,” he said.
On the questions of taxes, Mohale said: “We will not delve into the projected tax implications because we believe this is a matter that squarely falls under the purview of the National Treasury and the Minister of Finance. Suffice to say at the right time, and after necessary deliberations through formal government structures and processes, any information relating to this will be communicated to the public for comments prior to finalisation.”
Note: The 2002 Tailor report titled ‘Transforming the present – Protecting the future’ is not readily available online. There is this PDF version (unfortunately not searchable and with poor accessibility). For ease of use, we have created a Word version of the document that you can access here. Health is discussed in chapter 8.
ISO accreditation is a strategic investment that empowers businesses to enhance their competitiveness, mitigate risks, and seize new market opportunities. By adhering to globally recognised standards, organisations can build trust, streamline operations, and achieve sustainable growth. While the initial outlay may seem substantial, the long-term returns in terms of efficiency, customer satisfaction, and regulatory compliance far exceed the costs.
Building credibility and adherence to global standards
In today’s increasingly globalised business landscape, standing out from the competition is essential. ISO accreditation acts as a powerful endorsement, signifying a company’s commitment to quality, efficiency, and adherence to international best practices. By obtaining ISO certification, businesses can better mitigate risk while demonstrating their credibility and reliability to customers, suppliers, and stakeholders alike.
How ISO standards provide a framework for best practices
ISO standards provide a structured approach to managing various aspects of an organisation’s operations, ensuring consistent performance and compliance with customer and regulatory expectations. These standards offer a comprehensive framework that guides companies in identifying, managing, and continually improving their processes, which ultimately provides an effective means of identifying and managing risk throughout the business. Here’s a brief breakdown of how specific ISO standards contribute to this:
ISO 9001: Quality Management System
Customer focus: Defines processes to understand customer needs and expectations, ensuring products or services meet or exceed these requirements.
Process-based approach: Establishes a systematic approach to identifying, managing, and controlling processes to achieve desired outcomes.
Continuous improvement: Promotes a culture of continual improvement by monitoring processes, identifying opportunities for enhancement, and implementing changes.
ISO 14001: Environmental Management System
Environmental Impact Assessment: Requires organisations to identify, assess, and control environmental impacts of their activities.
Legal compliance: Ensures adherence to environmental laws and regulations.
Resource efficiency: Promotes the efficient use of resources and waste reduction.
Stakeholder engagement: Encourages dialogue with stakeholders to address environmental concerns.
ISO 22000: Food Safety Management System
Hazard Analysis and Critical Control Points (HACCP): Implements a systematic approach to identifying, assessing, and controlling food safety hazards.
Supply chain management: Addresses food safety throughout the entire supply chain.
Regulatory compliance: Ensures compliance with food safety regulations and standards.
ISO 45001: Occupational Health and Safety Management System
Risk assessment: Identifies and assesses occupational health and safety risks.
Legal compliance: Ensures compliance with occupational health and safety legislation.
Emergency preparedness: Develops and implements emergency procedures.
Employee involvement: Encourages employee participation in health and safety initiatives.
ISO standards incorporate several fundamental elements to ensure consistent performance and improvement. These include the Plan-Do-Check-Act (PDCA) cycle for continuous enhancement, robust risk management practices, comprehensive documentation, regular internal and external audits to assess effectiveness, as well as periodic management reviews to evaluate overall performance and identify areas for improvement. By adopting these standards, organisations can leverage this robust framework for managing their operations, ensuring consistent performance, which positions the organisation to be able to meet the evolving needs of customers and regulatory authorities.
The benefits of working with ISO-certified suppliers
Choosing ISO-certified suppliers can significantly enhance a business’s supply chain resilience. This choice gives companies the peace of mind that their new suppliers adhere to rigorous standards, which ensures improved product and service quality, as ISO certification guarantees consistent product or service quality, reducing the risk of defects or errors.
There is also a reduction in the risk of non-compliance, as ISO-certified suppliers have robust systems in place to manage compliance with regulatory requirements, mitigating legal and financial risks. Additionally, ISO accreditation promotes efficient operations and well-documented processes lead to smoother collaboration and predictable outcomes. In short, partnering with ISO-certified suppliers strengthens a company’s supply chain reputation, inspiring trust among customers.
The bottom line of ISO accreditation
While the initial costs of ISO accreditation may be substantial, the long-term benefits are undeniable. By investing in ISO certification, businesses can enhance their credibility, improve operational efficiency, mitigate risks, and gain a competitive edge. Just as important, working with ISO-certified suppliers strengthens a company’s supply chain, ensuring the delivery of high-quality products and services. This in turn leads to increased customer satisfaction, loyalty, and business growth.
As such, ISO accreditation is not merely a compliance exercise; it is a strategic investment that empowers businesses to thrive in today’s challenging market. By understanding the value of different ISO standards and the advantages of working with ISO-certified suppliers, companies can make informed decisions to drive sustainable success.
By adopting bold, transformative strategies, the healthcare industry can overcome critical challenges and foster innovative collaborations to create a more equitable and sustainable healthcare future for southern Africa, writes Dr Katlego Mothudi, Managing Director at the Board of Healthcare Funders (BHF).
Committed to promoting collaboration and creating actionable insights within southern Africa’s healthcare ecosystem, BHF’s recently published report highlights significant trends, obstacles and breakthrough solutions from key figures in the healthcare sector, and charts the course for a robust, inclusive healthcare future.
By interviewing industry leaders – including funders, hospitals, clinicians, and the pharmaceutical sector – the report presents a strategic path forward that promises to revolutionise the region’s healthcare landscape. As southern Africa grapples with rising healthcare costs, a growing burden of non-communicable diseases (NCDs), and economic instability, this report charts the course for a robust, inclusive healthcare future.
The evolving landscape of southern African healthcare
Healthcare organisations in southern Africa are navigating a complex landscape filled with escalating challenges and promising opportunities. The rapid increase in the burden of non-communicable diseases (NCDs) and economic volatility is driving a critical shift toward more sustainable healthcare models while increasing healthcare costs and reducing affordability.
Concurrently, there is a renewed commitment to achieving health equity, with concerted efforts to ensure healthcare is universally accessible. Universal Health Coverage (UHC) is in various stages of rollout across the region, reflecting varying national priorities and capabilities. In South Africa, the proposed National Health Insurance (NHI), despite its controversies, is being closely watched for its potential impact on other countries if implemented pragmatically.
In the private sector, the health insurance market shows notable growth. This is in contrast to stagnation relating to traditional medical schemes. These schemes face slow or no membership growth and rising utilisation rates, pushing a gradual shift towards value-based care with strategies to strengthen contracting arrangements, control expenditure and improve health outcomes.
High levels of fraud, waste and abuse persist, particularly in southern Africa, where economic conditions have severely limited the growth of private health insurance or medical scheme coverage, highlighting the critical need for innovative healthcare financing solutions.
Additionally, the post-COVID acceleration of digital healthcare is gradually reshaping service delivery. Significant investments in artificial intelligence and predictive analytics are set to strengthen health risk management, boost patient care and enhance operational efficiency.
This era of digital transformation is marked by collaborations with local and global tech innovators and a strategic internal focus on tech integration to overhaul legacy systems and traditional practices. This complex tapestry of trends indicates a critical juncture for the region’s healthcare, laden with challenges, yet rich with opportunities for pioneering change.
Bottlenecks and barriers
Southern Africa’s healthcare systems face significant barriers to sustainability, including inefficient and politicised regulatory environments, inadequate workforce training, economic instability and the growing corporatisation of healthcare, all of which hinder innovation, affordability and access while threatening both public trust and the quality of care.
Reactive responses to emerging challenges
In response to the bottlenecks and challenges facing the sector, healthcare organisations across southern Africa are collaborating with government and business coalitions, such as Business for South Africa, to address fiscal risks and policy uncertainties, and promote private sector participation, regulatory harmonisation and advanced technologies.
They are prioritising integrated healthcare models focused on primary care and value-based approaches, investing in digital innovations such as telemedicine, electronic health records and AI to improve efficiency and outcomes. Efforts to optimise resource allocation and care quality through digitalisation and process reengineering are also underway.
While these actions address immediate challenges, longer-term systemic solutions are necessary to achieve UHC and future-proof their markets.
Proactive systemic responses
To create a sustainable and equitable healthcare environment in southern Africa, long-term strategic solutions are essential, and aimed at broadening healthcare access, enhancing system efficiency and ensuring financial sustainability.
To achieve UHC, access through a multi-payer system that guarantees quality, affordable healthcare for all is instrumental. Implementing UHC principles will promote preventative care, care coordination, and effective management of chronic diseases. Additionally, advancing public-private partnerships (PPPs) can significantly enhance access and care quality, with proactive private sector engagement helping to overcome existing barriers and drive progress.
To improve policy and regulation, it is crucial to enhance the oversight and effectiveness of regulatory institutions while fostering regional inclusivity across the Southern African Development Community (SADC) for better knowledge sharing.
In South Africa, aligning the NHI with a multi-funder framework will integrate private funders and recognise employers’ roles in system sustainability. Updating benefits to reflect current health needs and economic conditions will make healthcare more affordable and less hospital-centric. Introducing Low-Cost Benefit Options (LCBOs) within medical schemes will broaden access, while strengthening competition and optimising private sector performance, will enhance care quality. Additionally, establishing a risk equalisation fund and mandating medical scheme membership is key to stabilising the insurance market and lowering costs.
To advance healthcare, investments in infrastructure and technology are essential, especially in underserved areas, to ensure equitable access. Strengthening healthcare training and updating practice guidelines will improve care quality and expand capabilities, while better workforce planning and collaboration between academia and healthcare providers will align training with industry needs. Additionally, leveraging digital health initiatives, such as telemedicine and electronic health records, will enhance service reach and efficiency.
Furthermore, incorporating Environmental, Social, and Governance (ESG) principles is crucial for promoting resilience and establishing southern African healthcare systems as leaders in sustainable practices. Adopting ESG standards will enhance the sustainability and governance of these healthcare systems.
These strategies are designed not only to address immediate healthcare challenges, but also to establish a robust foundation for a future where high quality healthcare is universally accessible in southern Africa. By implementing these solutions, the region can bridge the current gaps and pave the way for a resilient healthcare system.
Through collaborative efforts, strategic reforms, and innovative solutions, southern Africa’s healthcare sector is not only meeting current needs but also preparing for future demands that are defined by innovation, equity and sustainability.
By Dr Ali Hamdulay – CEO, Metropolitan Health Corporate
South Africa’s healthcare sector, a sophisticated and ever-changing industry, is central to the health and prosperity of our communities. Its effective operation, however, hinges on the strength and direction of its leadership.
Leadership, given the broad healthcare landscape, is far from a singular role; it’s a complex undertaking that requires comprehensive understanding of the wide medical ambit, the regulatory environment, compassion, and a forward-thinking mindset. Leaders are the primary builders of healthcare infrastructure, moulding it to encourage innovation, prioritise patient-focused care, and maintain the highest ethical standards.
Attracting and retaining skilled healthcare workers is a critical role that leadership in South Africa’s healthcare landscape must play. This includes attracting and retaining a diverse range of healthcare professionals such as doctors, nurses, and specialists. Leaders are responsible for creating a conducive work environment that not only draws in skilled workers but also motivates them to stay and thrive. Furthermore, leaders are advocates for healthcare workers, ensuring they have the necessary resources and support to carry out their roles effectively.
The rise of technology has ushered in substantial shifts in the healthcare sector. From telemedicine and AI diagnostics to electronic health records, technology has revolutionised how we provide care. Integrating these innovations into the healthcare system, though, is a challenging task that demands visionary leadership.
Leaders must understand these technologies, evaluate their potential advantages and risks, and oversee their implementation in a manner that enhances patient care without jeopardising privacy and security. Teams must also be equipped with the necessary skills to adapt to these changes and effectively implement new procedures.
A pivotal role of a healthcare leader is to champion health equity. Despite progress in healthcare, disparities in access and outcomes remain. Leaders play a crucial role in creating pathways to eradicate these disparities and to ensure that everyone, irrespective of their background, has access to quality healthcare. This involves understanding the social determinants of health, implementing policies that promote equity, and establishing an inclusive and respectful culture within the healthcare environment.
This cannot be done without support.
Leadership isn’t solely about leading; it’s also about inspiring others to lead. By exemplifying excellence and integrity, leaders can inspire their teams to aspire to the same standards. They can cultivate a culture of continuous learning and improvement, encouraging everyone to contribute their ideas and expertise.
A resilient healthcare system is anchored by robust leadership. It requires a mix of knowledge, skills and attitudes, a thorough understanding of the healthcare landscape, the ability to make critical decisions, the vision to embrace innovation, the empathy to advocate for health equity, and the charisma to inspire others.
We must elevate both individual and group thinking within our operating environments if we are to make meaningful progress in establishing a healthcare sector that prioritises access and quality. This approach contributes to a resilient healthcare workforce—one that can adapt to the dynamic landscape and is essential for the sector’s long-term viability and the overall health of South Africa’s population. By embracing this combination of collective and individual thinking, we propel the sector forward across businesses, the healthcare industry, and the nation as a whole.
Navigating the intricacies of the healthcare sector, particularly in the dawn of South Africa’s Government of National Unity, underscores the critical role of strong and reliable leadership. This fresh political landscape brings with it a wave of optimism. It has the potential to catalyse transformative change in our healthcare sector, from policy reforms and resource reallocation to the introduction of initiatives aimed at enhancing healthcare quality.
In our journey towards a more equitable and efficient healthcare system in South Africa, the focus on public-private partnerships must remain steadfast. These partnerships are instrumental in leveraging the strengths of both sectors to deliver better healthcare outcomes. They foster innovation, improve service delivery, and enhance accessibility, making them a crucial component of a robust healthcare system.
During this era of change, leadership is our compass guiding us towards quality access to healthcare for all. The role of leadership in ensuring progress and maintaining stability cannot be overstated. It is the driving force behind a healthcare sector that truly serves its people.
The future of South Africa’s healthcare sector is promising, but it requires the collective effort of all stakeholders. As a business, we recognise the critical role of nurturing our emerging leaders through mentoring and coaching. Our partnerships ensure continuity and preserve the essential skill and knowledge base of our healthcare workforce. These partnerships are key in establishing a healthcare system that is accessible to all and provides quality care.
As we commemorate Nelson Mandela Day, let us honour his unwavering commitment to justice, equality, and compassion. Our responsibility lies not only in the present but also in shaping a legacy for future generations. Let us build a healthcare system that echoes Mandela’s vision—a system that ensures access for all and equips our leaders to carry forth their roles with purpose and resilience.
By James White, Sales Director at Turnberry Management Risk Solutions
Celebrating Corporate Wellness Awareness Week by highlighting the vital role that companies play in fostering employee health and well-being is not just a matter of timing; it’s a matter of necessity. A healthy workforce is a productive workforce, and a focus on wellness goes beyond just physical health.
This is particularly relevant given that the magnitude of medical expenses has shifted over the years. While common illnesses like influenza pose a threat, the bigger concern lies in hospital stays and unexpected medical procedures. These events can leave employees with significant financial burdens, impacting their well-being and productivity.
The role of employers in mitigating costs
While encouraging healthy lifestyles through fitness programmes and mental health support is vital, ensuring financial security in the face of unforeseen medical expenses is equally important. Employers play a significant role in ensuring their workforce has access to adequate healthcare. Traditionally, medical aid cover has been a common employment benefit, but rising costs have made it less affordable for some employers and their employees. Nevertheless, employers can still help by offering their people assistance through:
Understanding medical aid options: A knowledgeable broker can guide employers through the complexities of medical aid options. This includes explaining the benefits, limitations, and potential shortfalls associated with each plan.
Considering primary healthcare: For employees who cannot afford comprehensive medical aid, primary healthcare plans are short-term insurance products that offer access to doctors, specialists, and medication, often with capped benefits for private hospital visits.
Offering gap cover: Gap cover bridges the gap between medical aid payouts and the actual costs charged by specialists and hospitals, acting as a financial safety net to provide peace of mind for employees facing unforeseen medical expenses.
Common unforeseen medical expenses
Hospital stays: These can be particularly expensive, with costs varying depending on the condition and treatment required.
Specialist charges: Specialists often charge above the rates covered by medical aid plans, leaving patients with significant bills.
Emergency room visits: Even a seemingly minor trip to the ER can result in a hefty bill.
Addressing misconceptions about medical aid
Many employees believe that medical aid offers complete coverage. Brokers can help dispel this myth by explaining the intricacies of the available plan options, such as co-payments, network restrictions, and shortfalls. Some plans limit coverage to specific hospitals or providers, and employees need to be aware of these restrictions to avoid surprise costs, while certain medical aid plans require co-payments for specific procedures or medications, leaving employees with out-of-pocket expenses. Even with medical aid, specialists’ fees often exceed the amount reimbursed and gap cover addresses these shortfalls.
Financial security boosts workplace wellness
By offering (and even subsidising) a combination of medical aid, primary healthcare options, and gap cover, employers can significantly improve the well-being of their people. This is because financial security in the face of medical emergencies will reduce stress and boost morale. Employees with peace of mind regarding healthcare costs are more likely to be happy, productive, and less prone to absenteeism.
However, such assistance is more than simply offering access to such benefits. Employers need to ensure that their workforce can make informed decisions about the healthcare benefits available to them by partnering with a qualified broker. The broker can fulfil a vital educational role by conducting informative workshops to explain medical aid options and limitations and advocate for the value of gap cover.
It makes business sense to invest in a healthy workforce
By prioritising a holistic approach to employee wellness that encompasses both physical and financial health, companies can create a thriving workplace environment. Offering a more comprehensive benefits package that includes access to gap cover demonstrates a commitment to employee well-being, ultimately leading to a happier, healthier, and more productive workforce.
About Turnberry Management Risk Solutions
Founded in 2001, Turnberry is a registered financial services provider (FSP no. 36571) that specialises in Accident and Health Insurance, Travel Insurance, and Funeral Cover.
With extensive experience across healthcare and insurance industries in South Africa, Turnberry offers unsurpassed service to Brokers and clients. Turnberry’s gap cover products are available to clients on all medical aid schemes, as they are independently provided and are therefore transferable in the event of a change in the client’s medical aid scheme.
Turnberry is well represented nationally, with its Head Office based in Bedfordview, Johannesburg with Business Development Managers in Cape Town and Durban. The Turnberry Team’s focus on outstanding client service comes from having extensive knowledge and experience in the financial services sector and is underwritten by Lombard Insurance Company Limited. Lombard Insurance Company Limited is an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.
By Ben Selier, Vice President: Secure Power, Anglophone Africa at Schneider Electric
The adage, knowledge is king couldn’t be more applicable when it comes to the collection and utilisation of data. And at the heart of this knowledge and resultant information lies the datacentre. Businesses and users count on datacentres, and more so in critical services such as healthcare.
Many hospitals today rely heavily on electronic health records (EHR), and this information resides and is backed up in on-premises datacentres or in the cloud. Datacentres are therefore a major contributor to effective and modernised healthcare.
There are several considerations when designing datacentres for healthcare. For one, hospitals operate within stringent legislation when it comes to the protection of patient information. The National Health Act (No. 61 of 2003), for example, stipulates that information must not be given to others unless the patient consents or the healthcare practitioner can justify the disclosure.
Datacentres form part of critical systems
To add an extra layer of complexity, in South Africa, datacentres should feature built-in continuous uptime and energy backup due to the country’s unstable power supply. Hospitals must therefore be designed to be autonomous from the grid, especially when they provide emergency and critical care.
Typically, datacentres are classified in tiers, with the Uptime Institute citing that a Tier-4 datacentre provides 99.995% availability, annual downtime of 0.4 hours, full redundancy, and power outage protection of 96 hours.
In healthcare and when one considers human lives, downtime is simply not an option. And whilst certain healthcare systems and its resultant availability are comparable to a typical Tier-3 or Tier-4 scenario, critical systems in hospitals carry a higher design consideration and must run 24/7 with immediate availability.
In healthcare, the critical infrastructure of a hospital enjoys priority. What this means is the datacentre is there to protect the IT system which in turn ensures the smooth running of these critical systems and equipment. There is therefore a delicate balance between the critical systems and infrastructure, and the datacentre, one can’t exist without the other.
Design considerations
To realise the above, hospitals must feature a strong mix of alternative energy resources such as backup generators, uninterrupted power supply (UPS) and renewables such as rooftop solar.
Additionally, like most organisations, storage volume and type and cloud systems will also vary from hospital to hospital. To this end, datacentre design for hospitals is anything but cookie cutter; teams need to work closely with the hospital whilst meeting industry standards for healthcare.
When designing healthcare facilities system infrastructure, the following should also be considered:
Software like Building Management Systems (BMS) are not just about building efficiency but also offer benefits such as monitoring and adjusting indoor conditions like temperature control, humidity, and air quality.
The BMS contributes to health and safety and critical operations in hospitals whilst also enabling patient comfort.
Maintenance – both building and systems maintenance transcend operational necessity and become a matter of life or death.
As mentioned, generators are essential when delivering continuous power which means enough fuel must be stored to run it. Here, hospitals must store fuel safely and in compliance with stringent regulations. In South Africa, proactively managing the refuelling timelines is also critical. The response times of refuelling these (fuel) bunkers can be severely hindered by issues such as traffic congestion as a result of outages and lights now working.
Selecting the right equipment for hospitals is therefore a delicate balance between technological advancement and safety. For instance, while lithium batteries offer many benefits, when used in hospitals, it is paramount that it is also stored in dry, cool and safe location.
Here, implementing an extinguishing system is a must to alleviate any potential damage from fire or explosions. That said, lithium batteries are generally considered safe to use but it’s important to be cognisant of its potential safety hazards.
Ultimately, hospitals carry the added weight of human lives which means the design of critical systems require meticulously planning and executed.
Is complementing in-person care with virtual care (hybrid care) a key part of the answer to South Africa’s NHI aspirations, asks Deon Bührs, Managing Director of Genie Health SA, who suggests that technology is the ‘unreasonable man’ in complementing decent universal healthcare and that self-empowerment is the only solution to sustainable wellness.
“The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.”
George Bernard Shaw
There is a school of thought that a young democracy can benefit from a well-considered blend of socialism and capitalism, particularly when it comes to healthcare and education. I would second that, to a degree. That South Africa requires a more equitable health system goes without saying though, as the apparent disparity and divisions between the haves and have nots is ever widening.
The status of our public healthcare system and the spiralling costs of the private offering need to find parity. A sad situation indeed, because at one stage, South Africa had one of the best public health sectors in the world, where groundbreaking heart transplants, for example, were done.
To the question of universal healthcare then. If it means that universal healthcare is a fundamental human right that everyone should aspire to, then it’s a yes, the NHI is essential. It should not be a matter of political affiliation, and let’s be clear, there is already healthcare for all in South Africa, through the public health system, free at the point of care for those who cannot afford care. But it is the quality of this care, and the effective management of these services that lie in stark contrast to that of the private healthcare system.
Signed in literally at the 11th hour before the country went to general elections, the National Health Insurance (NHI) bill is a polarising topic for many. The massive cost of providing a functioning NHI as per the bill, has been estimated conservatively at more than R200 billion a year, while some estimate closer to R1 trillion. With an already strained tax base, we must adopt new thinking as to how to deliver healthcare in a cost sensitive and effective way.
To my mind, one of the most effective ways of ensuring there is universal care that works, is recognising and supporting the role the patient plays in empowering their own health, recovery and wellness journey. They appear, however, to have been forgotten in the conversation that is the NHI bill to date.
For me, in its current guise, the NHI will unfortunately not bridge the quality divide. In fact, if we are not careful and if we do not find common ground, and hold government and the private sector to account, our entire healthcare system could well be in danger of failing – completely.
The unreasonable man test – laying the groundwork for new ways of healthcare delivery
Although expediently signed into law with little regard to comments or concerns raised from many sectors including health and business, the NHI does lay the groundwork for new ways of delivering healthcare and sets the scene for changing the mindset from the current sick-care system mentality to one of a patient-empowered HEALTHcare system.
Change must happen, but the extent of that change often depends on what Irish playwright and political activist, George Bernard Shaw, once stated as: “The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.”
At present, Prof Nicholas Crisp who has been tasked with helming the delivery of the NHI, could be seen as Shaw’s “unreasonable man” in his efforts to equalise and deliver universal healthcare. Ensuring that the lever of technology is utilised in an effective way is critical though, to ensure that we don’t try and replicate previous perceived successes, and not move forwards.
With a challenged healthcare system, both public and private, we are called to not give up hope, but to lean into the solution, and at the same time, avoid a defensive posture of that which only served the few. I believe that these circumstances force us to innovate, and to seriously consider new ways of providing healthcare for all. It should be seen as an exciting time of just where we can push the future of healthcare.
For instance, we already know that a traditional healthcare delivery system, with its associated costs and accessibility challenges for those living in remote parts of our country just won’t cut it. But unlocking technology as the new delivery channel of healthcare complimented by affordable and fast internet, could well be the solution to cracking the code of healthcare for all.
Through technology we can drive the patient-centric approach to health and open the door for patients to more easily access the multi-disciplinary team of healthcare professionals they need.
The best of both worlds – prevention, and when required, recovery
An example of doing things differently, is a new approach to musculoskeletal health that has been facilitated by digital transformation, and which is finding growing adoption in South Africa. With objective improvements in patient outcomes, satisfaction scores and recovery times, virtual care teams can support patients through their recovery programmes, ensuring improved compliance and ownership of their health journey. And empowering patients to embrace exercise and activity over surgery and pharmaceuticals where appropriate, has a dramatic impact on the overall healthcare spend.
Imagine patients having the choice to access a multi-disciplinary team of experts anywhere in the country – from the comfort and convenience of their own home or workplace, all at the tips of their fingers. No need to be transported to a clinic or hospital every time they need healthcare services. This is entirely possible, with platforms like Genie Health, that provide a hybrid approach in complimenting in-person care with virtual care.
NHI needs a strong front loader like these hybrid platforms that provide the full range of allied healthcare services, to reduce the burden of care and cost on an already strained system, by reducing unnecessary hospital admissions, surgeries, medication and travel costs and allowing for the existing framework to be brought up to date and even surpass expectations.
With ICASA reporting over 75% of the population having Internet access in South Africa and more than 90% smartphone penetration, pressure on Mobile Network Operators to provide zero rated data for healthcare applications (as they have done in education and other areas) mounts.
If measures like this can be implemented, they will have a tremendous impact on reducing the burden on the existing healthcare system through a self-health-empowered approach, with the backing of a full clinical team on the ready to assist the patient.
The ultimate question is how do we make healthcare more affordable and accessible to all South Africans, which is the core aim of the NHI?
The answer – we need to renew our focus on the key stakeholder, our patients – and empower them to drive their own health, by using technology as the backbone for sustainable wellness. It could well be, that with a renewed mindset and health-empowered citizens, the NHI is the true gamechanger for progress in HEALTHcare that we all need.
