Category: Expert Opinion

Categories : Expert Opinion Healthcare Politics and RegulationsTags :

Debunking Myths: The Truth About Medical Schemes in South Africa 

On By ModernMedia

Despite the promise of Universal Health Coverage (UHC) for all, the recent signing of the NHI Bill has brought with it several misconceptions around medical schemes that undermine the very foundation of our healthcare system, writes Dr Katlego Mothudi, Managing Director at the Board of Healthcare Funders (BHF).

In a historic move aimed at transforming the South African healthcare landscape, President Cyril Ramaphosa signed the National Health Insurance (NHI) Bill into law. This landmark decision promises to move South Africa towards Universal Health Coverage (UHC) for all citizens, regardless of socio-economic status.

While the goal of UHC is commendable, the rhetoric leading up to the NHI Act’s announcement has created misconceptions about the role of medical schemes. 

With many believing that they should cancel their memberships immediately to enjoy free health services for the foreseeable future. However, Dr Katlego Mothudi clarifies that the implementation of NHI will take several years, dispelling this misconception.

The NHI Act introduces a single-payer system, central to the idea is that healthcare is a ‘public good’, suggesting all healthcare funding should exclude medical schemes, and should be government-funded. Dr Mothudi counters that healthcare is more accurately described as a social good. A public good, like military services, is one that the government must provide and from which no one can be excluded, regardless of payment. While healthcare is essential, it is not feasible to provide it as a public good.

The Board of Healthcare Funders (BHF), concerned about the numerous misconceptions propagated by government representatives since 2009, commissioned Professor Alex van den Heever, Chair of Social Security Systems Administration and Management Studies at Wits Health Consortium, to investigate these claims. Despite their hyperbolic nature and lack of systematic research, these statements have significant weight due to their endorsement by influential individuals. Prof van den Heever’s report identified frequently repeated assertions that he concluded were unsubstantiated and untrue.

Key Findings from the Report:

1. Medical Schemes are Unsustainable – False

In 2009, claims suggested that many medical schemes were headed for collapse due to unsustainable financing models, with 18 schemes reportedly nearing insolvency. Prof van den Heever’s report refutes this, showing stability in medical schemes from 2005 to 2022. The number of beneficiaries increased by over one million from 2009 to 2022, with consolidated reserves of R114 billion in 2022, far exceeding the required 25% reserve ratio. Broker costs have not been a systemic concern, and total non-health costs per average beneficiary per month for all medical schemes decreased by 34.7% in real terms from 2005 to 2020.

2. Health Services are a Public Good – False

   In 2011, Health Minister Aaron Motsoaledi claimed that private healthcare was a “brutal system” due to commercialisation. However, Prof. van den Heever clarified that healthcare is not a public good in the economic sense, as it does not meet the criteria of being jointly consumed without exclusion. Healthcare is a crucial service but providing it as a public good is not feasible.

3. Most Medical Scheme Beneficiaries are White – False

Last year, Prof Olive Shisana, an honorary professor at the University of Cape Town and special advisor to President Ramaphosa, stated that the private sector predominantly serves the privileged white population. However, Statistics South Africa’s 2021 research indicates that of the total population utilising private healthcare services, 50.2% are Black African, 32.3% are White, 9.8% are Coloured, and 7.6% are Indian/Asian.

Need for Balanced Perspectives

While the BHF supports healthcare reform, it raises concerns about the NHI Act’s constitutionality and calls for a factual review of claims about medical schemes. It is crucial to present both sides of the debate to understand the implications fully. Including government perspectives and addressing how the NHI will affect individual citizens would provide a more comprehensive view.

Medical schemes remain a valuable national asset that plays a crucial role in ensuring the long-term viability of South Africa’s healthcare ecosystem. BHF advocates for a balanced approach to healthcare reform that considers both public and private sectors’ strengths and weaknesses.

For a comprehensive look at findings from the report commissioned by BHF, see Prof van den Heever’s presentation at the 2024  Annual BHF Conference here. (Click to download PDF)

Categories : Expert Opinion Healthcare Politics and RegulationsTags :

Let’s be Pragmatic – the NHI has Constructive and Contentious Aspects

On By ModernMedia

By Susan Cleary for Spotlight

Professor Susan Cleary delivering her inaugural lecture as part of a lecture series by the University of Cape Town. (Photo: Supplied)

President Cyril Ramaphosa recently signed the NHI Bill into law. The question is whether this will bring South Africa closer towards Universal Health Coverage. Professor Susan Cleary argues that the NHI is a wide ranging reform with both positive and controversial aspects. The key will be to find a middle ground in order to continue on the journey to UHC.

President Cyril Ramaphosa signing the National Health Insurance (NHI) Act on the eve of the elections is a smart move from the perspective of a political party seeking to shore up its base. The concern though to those of us working to strengthen the health system is whether the NHI will enable the country to move closer towards Universal Health Coverage.

For the NHI naysayers, perhaps it would be important to alleviate some fears and concerns. The NHI is a long-term project. In the 2024 budget, National Treasury reduced the conditional grant allocations to the NHI in comparison to what was allocated in the 2023 budget. While signing the NHI Bill into law is a step forward, the reduction in resources towards NHI implementation reminds us that this is a long term project. In addition, it is likely that there will be legal challenges which will lead to considerable delays for the scheme to be fully implemented.

The NHI is a wide-ranging reform, with many positive aspects sitting alongside some key controversial aspects. Positive aspects include the opportunity to enable greater use of evidence and transparency in priority setting through the further institutionalisation of Health Technology Assessment processes (akin to ‘NICE’ in the UK), as well as the opportunity to use national-level purchasing power to drive down the prices of commodities such as medicines. The role of private multidisciplinary practices (GPs, nurses, health and rehabilitation professionals, etc) in the future NHI also holds some promise to improve access to healthcare particularly to parts of the country with limited access to public clinics.

On the other hand, there are two key controversial aspects. The first is related to what may or may not happen to medical schemes and medical scheme administrators once the NHI is fully implemented. My sense is that there is no short-term concern in this regard. A bigger concern is whether a single pot of money in the NHI fund will present a larger or a smaller corruption risk than the current situation of multiple pots spread across provincial treasuries and medical aid schemes.

Another concern is that the NHI reform might disrupt our ongoing progress towards Universal Health Coverage within our existing public sector. Our public sector is not perfect, but it is a system that has equity at its heart. The common definition of Universal Health Coverage is to provide all individuals and communities with access to needed promotive, preventive, resuscitative, curative, rehabilitative and palliative health services of sufficient quality to be effective, while ensuring that the utilisation of these services does not expose users to financial hardship.

The two main goals of Universal Health Coverage are: (1) the provision of quality health care services to those in need and (2) the avoidance of financial catastrophe in this process. Clearly healthcare is far from free – indeed it is very expensive – and so the goal of avoiding financial catastrophe is about implementing prepayment and risk pooling mechanisms, whether these are tax or insurance based.

Let’s first look at how we are doing on the provision of quality services. The below figure plots countries according to their achievements on the Universal Health Coverage Service Coverage Index. In this context, coverage of essential health services is measured based on indicators that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access, among the general and the most disadvantaged populations.

On this index, South Africa’s achievement is at just over 70%, similar to many other middle-income countries. While there would be room for improvement, our performance is in line with our global peers.

Global comparison of countries in terms of service coverage and quality

Source: World Health Organization – Global Health Observatory (2024) processed by Our World in Data. Accessed May 2024.

The second indicator is financial risk protection. The below figure plots countries against the percent of total health expenditure that is paid out of pocket at the point of use. On this indicator, we score 5.7%, indicating extremely high levels of financial risk protection.

Global comparison of countries in terms of the percent of total health expenditure that is paid out of pocket

Source: World Health Organization (via World Bank) processed by Our World in Data. Accessed May 2024.

While this does not mean that there are no instances of financial catastrophe, undoubtedly there would be, particularly for those seeking treatment for certain types of cancers. That said, over the past two decades I have studied this issue extensively. Across a wide range of conditions in diverse settings, we have interviewed tens of thousands of people to understand the costs that they face in using health services, including everything from transport costs, to costs of food, shelter or accommodation, costs of child care, lost income, under the counter payments to public sector providers (which we never found), fees paid to private providers or money spent at pharmacies. This research consistently showed that the level of catastrophic spending was very low. Our performance on financial risk protection is outstanding. I celebrate the work of those colleagues that shepherded in the removal of user fees in our national health system during the dawning of our democracy. We should all be thanking them.

Despite these successes on Universal Health Coverage, there are areas of concern for the South African health system. We do not achieve health outcomes commensurate with our level of investment. My sense is that this is driven by our relatively high burden of disease; for example we continue to have the world’s largest HIV treatment programme. While our average life expectancy steadily increased with the introduction of antiretroviral therapy (although note the downturn from 2020 which coincides with the Covid-19 pandemic – see the below figure), the HIV epidemic has been a cruel setback that needs to be considered when we seek to make global comparisons on life expectancy and avertable mortality.

Global comparisons of life expectancy: 1970 – 2020

Source: United Nations World Population Prospects (2022) processed by Our World in Data. Accessed May 2024.

Now that the NHI Bill has become the NHI Act, it is time to move on from debates about whether we need NHI or not, and rather focus on how we can make the NHI work for us.

Our public sector will be the backbone of our future NHI and so we should seek to continue to strengthen this system. It would also be wise to put in place measures to strengthen our private system given that private providers are intended to play a key role in the NHI. We should be pragmatic.

The NHI includes many exciting opportunities for leveraging big data and artificial intelligence in health systems strengthening, but at this stage we hardly have any electronic health data. A clear step forward would be the further implementation of the National Digital Health Strategy (2019-2024) which includes the establishment of a patient electronic health record, amongst other needed developments.

In addition, the NHI places emphasis on the achievement of a purchaser provider split via establishing ‘Contracting Units for Primary Health Care’ (CUPS). These new entities will contract with both public and private providers within a defined geographic area, on behalf of a particular population. The establishment of CUP ‘proof of concept’ sites is therefore a priority, but must be done in a way that generates learning and enables adaptation to different contexts.

Let’s continue to push forward on many of these complex undertakings. It is going to take time, but it is needed, irrespective of the name that we choose to give to our health system.

*Cleary is professor of health economics and the head of the School of Public Health at the University of Cape Town.

Note: The views expressed in this opinion piece are not necessarily shared by the Spotlight editors. Spotlight is committed to publishing a variety of views and facilitating informed discussion that deepens public understanding of health issues.

Republished from Spotlight under a Creative Commons licence.

Source: Spotlight

Categories : Expert Opinion HospitalsTags :

Our Nurses, Our future: Addressing the Critical Issue of Sustainability in SA’s Healthcare Sector

On By ModernMedia
Photo by Hush Naidoo on Unsplash

With only 22 090 nurses to serve the country’s public health sector of more than 50 million citizens1, urgent intervention is required to bolster their numbers and protect the wellbeing of our nation. After all, without their tireless dedication, who will be there to guide you through the corridors back to health? writes Bada Pharasi, CEO of the Innovative Pharmaceutical Association of South Africa (IPASA)

As the global healthcare industry commemorates International Nurses Day on 12 May, it is an opportune moment to reflect on the role of nurses as the heartbeat of healthcare systems globally. Amid turmoil and triumph, nurses stand as the unsung heroes and compassionate caretakers who embody empathy, endurance and expertise. 

In South Africa, where healthcare challenges often loom large and resources are stretched thin, nurses serve as the frontline warriors, bridging the gap between suffering and healing. Yet, despite the invaluable role they play, a concerning trend looms.

Minister of Health, Joe Phaahla, recently revealed a pressing concern – the anticipation of a staggering 30% of South African nurses retiring within the next decade, and 38% retiring the decade thereafter. Compounding the issue, 5060 vacancies remain unfilled on the back of crippling budget constraints1. 

Representing over 90% of global healthcare workers2, nurses are indispensable in the healthcare ecosystem, and addressing this impending crisis of their reducing numbers demands comprehensive and multifaceted solutions that approach the challenge from every angle.

The nurse shortage crisis in South Africa stems from multiple factors. Firstly, the escalating healthcare needs of a growing population, compounded by the burden of infectious diseases such as HIV/AIDS, have strained the healthcare system to breaking point.

Another factor is the restricted capacity of the private sector to train nurses comprehensively due to existing regulations. Moreover, poor working conditions, particularly in the public sector, and comparatively low salaries have led to high turnover rates, prompting nurses to explore alternative career paths or seek employment opportunities abroad3. 

While there are many challenges to defusing the proverbial ticking time bomb which is the declining number of qualified nurses in South Africa, increased investment across the board is critical to strengthening their ranks. 

Despite financial investment being central in realising this, addressing the problem demands a focus on improving the working conditions of nurses. Healthcare facilities must prioritise nurses’ well-being by offering competitive salaries, manageable workloads, and opportunities for career growth. By creating a supportive work environment, South Africa can retain more nurses and deter them from seeking opportunities abroad3.

Furthermore, granting private hospitals full participation in nurse training programmes is crucial. Private sector entities, such as Netcare, have the capacity to train as many as 3,500 nurses annually. However, limited accreditation from the government hampers their potential contribution to resolving the nurse shortage. Expanding private sector involvement in nurse training could substantially increase the number of trained nurses in the country3.

In addition to these measures, collaborative efforts between the government, healthcare institutions, and nursing organisations are essential. Such partnerships can identify and implement strategies to alleviate the shortage, including targeted recruitment drives, mentorship programmes, and initiatives to improve nurses’ job satisfaction and work-life balance3.

Innovative approaches to addressing the nurse shortage in South Africa extend beyond traditional solutions. Telemedicine platforms are emerging as a promising tool, allowing nurses to deliver care remotely and reach patients in underserved areas. 

Additionally, community health worker programmes are being expanded to complement nursing services and extend healthcare access to marginalised communities. Furthermore, initiatives to empower and support nurse entrepreneurs are gaining traction, encouraging the development of innovative care models and healthcare solutions. 

These diverse approaches reflect a multifaceted response to the nurse shortage crisis, leveraging technology, community engagement, and entrepreneurship to strengthen the healthcare workforce and improve access to care for all South Africans.

References:

1. Only 22 000 nurses for 50 million South Africans [Internet]. Democratic Alliance. [cited 2024 May 2]. Available from: https://www.da.org.za/2023/06/only-22-000-nurses-for-50-million-south-africans

2. Experiences of nurses and midwives in policy development in low- and middle-income countries: Qualitative systematic review. International Journal of Nursing Studies Advances. 2023 Dec 1;5:100116.

3. [Opinion] Nurse shortage crisis in South Africa [Internet]. Centre for Risk Analysis. 2023 [cited 2024 May 2]. Available from: https://cra-sa.com/media/opinion-nurse-shortage-crisis-in-south-africa

Categories : Expert OpinionTags :

Opinion Piece: Addressing Sanitation Challenges – A Call for Prioritising Basic Needs in South Africa’s Upcoming Elections

On By ModernMedia

By Robert Erasmus, Managing Director at Sanitech

Photo by Hush Naidoo Jade Photography on Unsplash

In South Africa, and across many developing nations, the discourse leading up to elections often centre on fundamental issues that directly impact the daily lives of citizens, such as the cost of living and access to clean water and sanitation. As the world witnesses a significant portion of its population gearing up to vote in 2024, it becomes evident that the voting criteria in developing countries vastly differ from those in developed ones.

While developed nations may debate topics like climate change and immigration, citizens in developing countries like South Africa are primarily concerned with securing basic necessities for survival and dignity. The disparity in voting patterns reflects the stark contrast in the challenges faced by people living in different parts of the world.

Elevating the discussion on South Africa’s paradox

South Africa, despite being regarded relatively highly in terms of election fairness, grapples with persistent challenges in providing access to clean water and adequate sanitation facilities. Our democratic process works, but it needs to be leveraged correctly for the benefit of our people. Many communities across the country continue to suffer due to the absence of proper sanitation infrastructure, perpetuating cycles of poverty and disease. The lack of clean water exacerbates these challenges, posing significant obstacles to health, dignity, and economic progress.

The interconnectedness of health, dignity, and economic progress

It is worth noting that the voting populace in South Africa has shifted its focus from ideological differences to practical concerns about the delivery of basic human rights. This shift underscores the importance of addressing the immediate needs of citizens before delving into broader policy discussions. Without access to clean water and sanitation, individuals and communities struggle to break free from the cycle of poverty and disease, hindering their ability to participate fully in economic and social life.

The impact of inadequate sanitation and clean water access extends beyond health and dignity – it also affects economic progress. Families burdened with preventable illnesses spend precious resources on healthcare instead of investing in education and livelihoods. Children often sacrifice their education to care for sick family members, further perpetuating the cycle of poverty. To address these challenges, practical solutions must be prioritised that ensure equitable access to clean water and sanitation for all citizens to break the cycle of poverty and disease and pave the way for economic growth.

Solving South Africa’s challenges starts with sanitation

These solutions include investing in infrastructure that can provide clean water and adequate sanitation facilities to all communities, especially those in rural and underserved areas, while at the same time investing in the repair and maintenance of existing infrastructure.

Implementing technologies such as water purification systems and innovative sanitation solutions tailored to local needs can help bridge the gap in access. Additionally, community engagement and education programs are essential to promote hygiene practices and ensure the long-term sustainability of water and sanitation initiatives. By prioritising these solutions, South Africa can make significant strides towards ensuring equitable access to clean water and sanitation for all its citizens.

Advocating for real change beyond election promises

Citizens have a central role to play in advocating for real commitment from political candidates. By elevating the discussion around sanitation and clean water access, voters are better informed to hold leaders accountable for delivering on their promises. Political parties must recognise the importance of addressing basic needs and commit to implementing sustainable solutions that uplift communities and promote dignity. For political parties this will be one of the most effective ways to win and retain the vote.

As we get closer to election date, it is essential to correctly prioritise the basic needs of citizens, including access to clean water and sanitation. This is not a critique of the government but a call to action – a recognition of the fundamental rights that must be upheld for all individuals to thrive. By addressing sanitation challenges, South Africa can pave the way for a future where every citizen has the opportunity to live a healthy, dignified life and contribute to the nation’s prosperity.

Categories : Expert Opinion IT in HealthcareTags :

The Digital Nurse: Redefining the Future of Healthcare in South Africa

On By ModernMedia
Sandra Sampson, Director at Allmed

By Sandra Sampson, Director at Allmed

The South African healthcare landscape is undergoing a transformative shift, driven by the rapid advancement of technology. At the forefront of this change is the rise of the “digital nurse,” a testament to the increasing integration of technology into the nursing profession. This transformation is not only streamlining processes; it is addressing critical challenges like the nation’s nurse shortage while ultimately improving patient care.

Embracing convenience and accessibility

Virtual platforms have become commonplace in the nursing world, facilitating efficient and accessible professional development for nurses through online meetings, networking opportunities, and educational resources. This fosters a more connected and knowledgeable nursing community, better equipped to serve patients.

Telehealth consultations, another facet of digital nursing currently revolutionising patient care, provide convenient and accessible medical consultations from the comfort of one’s home, eliminating long wait times and unnecessary travel.

Mitigating nurse shortages and ensuring quality care

South Africa grapples with a significant nurse shortage, placing a strain on the healthcare system to which digital nursing offers a practical potential solution. By leveraging technology, nurses can effectively manage larger patient volumes, reducing the burden on the existing workforce and optimising resource allocation. Remote monitoring systems and AI-powered tools further empower nurses by providing real-time patient data and facilitating early intervention, ultimately improving the quality of care delivered.

Additionally, embracing technology ensures that patients, even in underserved areas, receive quality care. The efficiency gained through virtual platforms allows nurses to allocate their time effectively, addressing minor health concerns remotely and reducing the strain on healthcare facilities for non-emergency cases.

However, it must be pointed out that although leveraging technology allows nurses to effectively manage larger patient volumes, which can alleviate the strain on the current system, this doesn’t necessarily mean fewer nurses are needed, but rather that technology empowers existing numbers to reach a wider patient base to deliver more efficient, personalised care.

Evolving alongside technology: the digital nurse of tomorrow

As the healthcare industry embraces digital technologies, the role of the nurse will continue to expand. While traditional nursing skills will remain essential, the “digital nurse” of the future must possess additional competencies.  Acquiring proficiency in digital tools and equipment, along with the capability to interpret and analyse digital data, will be crucial for delivering effective patient care. However, the most critical attribute for the digital nurse will be the willingness to adapt and embrace constant technological advancements. This will require a mindset shift that comes with acknowledging that traditional methods might not be sufficient in the face of evolving patient needs.

The challenges and opportunities in change

While the adoption of digital nursing brings numerous benefits, challenges remain. Resistance from individuals accustomed to traditional healthcare practices is one hurdle. However, with the younger generation being more adaptable, the shift towards digital nursing is expected to gain wider acceptance as technology advances. To ensure the success of this digital-first healthcare, it will be necessary to focus our attention on upskilling, which means recognising that continuous training and development programs are vital for nurses to remain proficient in the face of change.

On the flip side, a change in perspective from nursing professionals themselves will be necessary. This means embracing a growth mindset and being open towards new technologies to adapt and thrive in the digital age. Lastly, healthcare professionals as a whole need to bear in mind that transformation is essential to meet the evolving needs of patients, which includes catering to a growing preference for digital healthcare solutions. Continuing to meet the needs of patients is the only guaranteed way for nursing professionals to ensure their relevance in the future. By embracing technology and fostering a culture of continuous learning, South Africa can empower its nurses to become the digital healthcare leaders of tomorrow.

Categories : Expert Opinion General InterestTags :

We Need to Fight for Sleep Equity in SA, Say Leading Researchers

On By ModernMedia

By Ufrieda Ho for Spotlight

Photo by Andrea Piacquadio

Research into the link between disordered sleep and disease show an outsized burden on the most vulnerable. It’s sounding alarms for sleep equity to have a place on the public health agenda, reports Ufrieda Ho.

Scientists are increasingly connecting the dots on how a lack of sleep places a disproportionate health burden on at-risk population groups, including people living with HIV, women, informal workers, the elderly and the poor.

This year’s World Sleep Day on 15 March focuses on sleep equity. Researchers say that tackling sleep inequity and raising awareness for the importance of sleep as a pillar of good health could help stave off several looming public health pressures.

The lack of healthy sleep is linked to cardiovascular disease, obesity, hypertension, diabetes, mental health conditions and dementia. In South Africa, understanding the connection between sleep and HIV is also key to managing the health of the large ageing population of people living with the disease.

Karine Scheuermaier is associate professor at the Wits University Brain Function Research Group. The country’s oldest sleep laboratory founded in 1982 is based at the university’s medical school in Parktown, Johannesburg.

“Society understands the role of exercise and diet in good health but somehow sleep has not had the same kind of awareness or priority, even if sleep is linked to how well your body functions and your chances of developing disease,” she says. “We do everything else at the expense of sleep. Sleep is somehow a symbol of laziness in a work-driven society and we need to change this thinking.”

Sleep inequity in SA

Sleep inequity is linked to socio-economic realities, she says. Sleep inequity might affect the person who lives in an environment where safety and security is neglected or where there is a high threat of gender-based violence. It could also be having to navigate apartheid city planning that forced black people to live far from job hubs. This legacy means today many workers still wake up early to face long work commutes daily. There could also be inequity in division of labour in households, when one person wakes up to take care of children or elderly family members in the home.

Living in overcrowded informal settlements also presents disturbances for good sleep, including high levels of noise and bright floodlights as street lighting. Those who work in unregulated or informal sectors, including shift work or digital platform workers, like e-hailing drivers, are prone to lose out on quality sleep.

clinic that does clinical work, research, and training. Chandiwana says homing in on the intersection of HIV and sleep is critical in a South African context.

“The average person living with HIV who has started antiretroviral treatment on time should live as long as a person who doesn’t have HIV. But what we know is that the person with HIV is on average, living 16 years less of good health. They are more likely to develop type II diabetes, mental health issues, obesity, and heart disease – and we know poor sleep is linked to this,” she says.

Chandiwana says sleep science is still a relatively new field of medicine and the nascent research is still looking to better understand how sleep deprivation triggers immune pathways and chronic inflammation in people living with HIV, even those who are healthy and respond positively on treatment.

A current study at the clinic is looking into the intersection of obesity, sleep apnoea, and women living with HIV. Chandiwana says because so much is unknown, the issue of sleep equity extends to support and funding for more locally appropriate sleep research. Medical school curricula needs to change and more avenues to train people in sleep research needs to be established, she says.

“We have very little African data on sleep disorders and disordered sleep,” she says. She argues we need better data on things like how many people are affected by poor sleep, a better understanding of what is causing it and what it means, and then we need to present these findings to public health authorities to look at it as a public health issue.

“We do have specific challenges in our country. If you are trying to explain to someone, who isn’t South African, how the impact of load-shedding affects sleep or how living in a shack affects sleep, it’s not always easy to do,” she says.

Chandiwana says countries in the global North are already counting insufficient quality sleep as an economic cost measured in loss of productivity, efficiency, safety and society’s well-being. They are also changing public health policies accordingly. South Africa and the rest of the continent stand to be left behind, she says.

How to get better sleep in SA

Chandiwana says: “There is no lab in South Africa that does sleep studies for people in the public sector and no place in the public sector for people to even be diagnosed for a sleep disorder – so services are extremely limited. With something like sleep apnoea, we can’t offer patients in the public sector the gold standard intervention of CPAP [continuous positive airway pressure, which is a device of a face mask, a nose piece, and a hose that delivers a steady flow of air pressure to keep airways open while someone sleeps] because this is financially out of reach. Instead, we have to work with patients to help them lose weight and do positional therapy like training them to sleep on their backs.”

Other ways to get better sleep without costly intervention or sleeping tablets, the two scientists say, include getting exercise, not having food, stimulants or alcohol two to three hours before bedtime, limiting screen time of all kinds in the hour around bedtime, getting exposure to the early morning sunlight each day, keeping sleeping areas dark, quiet and at a comfortable temperature, and developing fixed sleep routines and sleep time rituals – like brushing your teeth, putting on pyjamas, reading for a short period and then going to sleep.

Ultimately, Chandiwana suggests it all comes back to building awareness that healthy sleep is part of health rights.

“We have to fight for sleep equity and we need people to know that sleep is not elitist – it’s not just reserved for some,” she says, “and we should not be accepting poor sleep as the norm”.

Republished from Spotlight under a Creative Commons licence.

Source: Spotlight

Categories : Expert Opinion Substance UseTags :

Proposed Update to Schedule 6 of the Medicines and Related Substances Act

On By ModernMedia
Photo by Kindel Media on Unsplash

By Rodney Africa, Partner, Adriano Esterhuizen, Partner & Daveraj Sauls, Associate at Webber Wentzel

The Minister of Health (the Minister) in terms of section 22A(2) of the Medicines and Related Substances Act 101 of 1965 (the Medicines Act), and on the recommendation of the South African Health Products Regulatory Authority, has invited interested persons to submit substantiated comments or representations on the proposed update of Schedule 6 to the Medicines Act.

The proposed update to Schedule 6 of the Medicines Act intends to exclude certain cannabis products containing Tetrahydrocannabinol (THC), the psychoactive compound in cannabis, from the operation of the Schedules to the Medicines Act and will, inter alia, permit the manufacturing of cannabis consumer items and products, with no limitation on the percentage of THC content, provided that the items and products have no pharmacological action or medicinal purpose. This will also allow adults to cultivate and possess cannabis in private for personal consumption, with no limitation on the percentage of THC content.

This proposed update appears to be a move away from utilising THC content as a threshold to distinguish between consumable and industrial cannabis. This shift seemingly comes in response to the growing South African market for cannabis products and aims to augment the Cannabis for Private Purposes Bill 2023 [B19 – 2020] recently passed by the National Council of Provinces and submitted to the President for his assent and signature.

Interested persons have until Thursday, 14 March 2024 to submit any substantiated comments or representations by emailing mihloti.mushwana@health.gov.za or paul.tsebe@health.gov.za.

Categories : Expert Opinion Medical IndustryTags :

Can Digital Technology Improve Accessibility to Healthcare in SA?

On By ModernMedia

Technology is reshaping and closing the gap between patients, healthcare providers, and the healthcare system. By embracing this digital shift, South Africa’s healthcare sector can benefit both now and in the long term, resulting in a healthier and more prosperous society, writes Bada Pharasi, Chief Executive Officer of The Innovative Pharmaceutical Association South Africa (IPASA).

As technologies such as Artificial Intelligence (AI) and big data disrupt multiple industries, it has proven its worth in simplifying, analysing and speeding up processes, and the healthcare sector is no different. 

Technology in the sector has come a long way since the inception of the stethoscope and X-rays. Today, it is becoming the cornerstone of modern healthcare in developed countries across the globe and is growing at an unprecedented rate. So much so that studies suggest that while the global digital health market was valued at over US$330 billion in 2022, this number is expected to skyrocket to a staggering US$650 billion by 20251.  

While the likes of the United States and the United Kingdom lead the charge in the adoption of digital health, South Africa is quickly growing its share of the pie as well. Insights suggest that in South Africa revenue in the digital health market is projected to reach US$831.20 million this year. Moreover, it is envisioned to grow by an annual growth rate of as much as 7.57%, resulting in a projected market volume of US$1,113.00 million by 20282. 

From revolutionising patient access to cutting-edge medicine and AI-driven diagnostics tools to virtual consultations with healthcare specialists and genomic breakthroughs, the capabilities of digital health technologies are far-reaching.

The advent of technology such as AI and big data brings with it the capacity to interpret analytics and enhance patient care through faster diagnosis than was ever thought possible. Google’s DeepMind AI system, for example, recognises eye diseases with a correct diagnosis of up to 94.5%, while teledermatology companies have developed apps that utilise smartphone and computer cameras to aid patients in finding out the cause of lesions or certain conditions3.  

Moreover, technologies such as the Phillips Lumify Portable Ultrasound allow for an examination anywhere, be it a refugee camp or an accident scene, while IBM Watson has leveraged the power of AI to accelerate the early detection of oncological diseases and analyse data to compile treatment programmes for those with cancer3. 

It is a dynamic realm that enables better collaboration around patient-centred care, and one that promises a future where healthcare can be delivered to patients quickly and more effectively than ever before.

This is particularly relevant in the South African context, where as many as 45 million people, or 82 out of every 100 South Africans, fall outside of the medical aid cohort4. This is compounded by the fact that nearly 32% of the population resides in rural areas5 where access to healthcare is limited, meaning the adoption of digital healthcare has the potential to address many of the health issues that plague the country and create a healthier and more productive society. 

And the shift has already begun, with provincial departments such as the Free State Health Department heeding the digital call. In late 2023, the department announced its intention to utilise digital innovations to streamline healthcare services and improve patient and healthcare outcomes in the province6. 

The department’s first project in the province is focused on telemedicine, where patients and specialists consult online from the comfort of their local clinic, regardless of their different locations. The second sees the mountain of paper patient records being done away with in favour of a streamlined, digital system where patient records can be accessible electronically, thus greatly improving efficiency, reducing errors, and ensuring continuity of care6.   

Importantly, amidst the promising potential that these technologies yield, it is critical for healthcare workers to remain steadfast in their digital fluency and technological relevance. 

Gone are the days of specialists only being adept in their professions. Professionals of the future need an understanding of the technologies at their disposal, how they work and how they will better serve their patients. In this way, they will remain at the forefront of the latest innovations specific to their fields of expertise, thus propelling the advancements forward.

In doing so, this ongoing upskilling ensures not only the advancement of their professions but will also benefit patient outcomes for decades to come. 

References:

1. Digital health – Statistics & Facts [Internet]. Statista. [cited 2024 Jan 16]. Available from: https://www.statista.com/topics/2409/digital-health/

2. Digital Health – South Africa [Internet]. Statista. [cited 2024 Jan 16]. Available from: https://www.statista.com/outlook/hmo/digital-health/south-africa

3. Digital healthcare: the evolution of better medicine [Internet]. [cited 2024 Jan 16]. Available from: https://www.discovery.co.za/

4. [No title] [Internet]. [cited 2024 Jan 16]. Available from: https://www.statssa.gov.za/?p=10548#

5. South Africa Rural population, percent – data, chart [Internet]. TheGlobalEconomy.com. [cited 2024 Jan 16]. Available from: https://www.theglobaleconomy.com/South-Africa/rural_population_percent/

6. Sompane M. FS Health goes digital to improve services [Internet]. Health-e News. 2023 [cited 2024 Jan 16]. Available from: https://health-e.org.za/2023/12/19/fs-health-goes-digital-to-improve-services

Categories : Dentistry Expert OpinionTags :

Opinion: We can’t Simply Close Dental Facilities during the Festive Period

On By ModernMedia
Photo by Tima Miroshnichenko on Pexels

By Bulela Vava for Spotlight

On the 2nd of January 2024, Simphiwe*, needing emergency oral healthcare, turned to the Cala District Hospital in the Eastern Cape. However, she was confronted with a note on the door that read, “Dear Community Members, starting from the 18th of December 2023 to the 12th of January 2024 there is no dentist. The dentist will start working on the 15th of January 2024.”

Many such notices hang in front of oral health clinic doors, mostly where dentists work alone to respond to the myriad of emergency oral health needs within their catchment area. Having previously worked alone at a provincial government funded hospital in the rural Eastern Cape, similar notices would be placed on the door to the oral health clinic I operated, until such time as a colleague joined me at the facility.

Oral diseases affect more than 3 billion people globally, while in Africa, it affects an estimated 400 million people.

Oral diseases and conditions that affect people include trauma-related oral injuries, oral cancers, dental decay, and periodontal disease amongst others.

While dental decay remains the most common form of oral disease, untreated, it can lead to life-threatening complications. The closure of dental services at any oral health clinic may subject people to the risk of developing conditions such as Ludwig’s angina, a life-threatening condition that is linked to delayed access to care.

Fewer than 200 dentists

The Eastern Cape is predominantly a rural province, with most of the province’s 7.2 million people largely depending on public healthcare services for the majority, if not all their healthcare needs. The province employs fewer than 200 dentists, a majority of whom are concentrated in the more urban/peri-urban centres.

Cala, a rural town in the province’s Sakhisizwe Local Municipality, is home to an estimated 63 000 people and Cala District Hospital provides access to oral health services to this population. The hospital’s closed dental clinic over the festive period deprived the people of Cala of much-needed care.

It is well known that the festive period results in an increased need for emergency healthcare, including oral healthcare services. People often present with jaw fractures, tooth fractures -often a result of violence or accidents associated with an increase in alcohol consumption -, oral pain and sepsis. While the festive period may result in the increased need for managing these conditions, these are the usual conditions, amongst others, that are managed in many public oral health clinics in most provinces.

Oral health professionals, in particular dentists, are trained to manage the complete spectrum of general oral diseases and often refer to dental specialists for complex and specialised management. In a province like the Eastern Cape, characterised by a dire shortage of dental specialists, dentists are the last defence for many of the people in the province.

A significant portion of dentists in the province work alone, with limited options to manage their leave, often leaving clinics closed in their absence.

However, the closure of dental clinics without a detailed and well-communicated plan is unacceptable and places the lives of populations in danger. At times, people have been known to resort to harmful and dangerous home practices to relieve themselves of their anguish.

We need a plan

A comprehensive plan must be put in place for efficient management and referral of emergency oral healthcare cases during the festive period so that we avoid a repeat of this year’s unacceptable situation at Cala District Hospital 12 months down the line. People in need of oral health services must be made aware of where they can access such services without any delay.

Beyond this, there is a need to invest in building adequate human resource capacity for oral health in the province, to ensure that services are readily available. A mix of oral health professionals and the prioritisation of “lone dentist” clinics for community service placements should help alleviate some of the problems in the system.

It is concerning that the challenges faced in the Eastern Cape is very similar to those in other parts of the country. Fewer than 3000 dentists are working in the public healthcare sector nationwide. With such numbers it is unlikely that what happened to Simphiwe was an isolated incident. Her experience should serve as an important case study, highlighting the significant problems faced by communities and oral health professionals.

Those responsible for managing oral healthcare services in South Africa must take note and recognise that the continued deprioritisation and neglect of the population’s oral health cannot be allowed to continue.  We must work together to ensure that oral health is given the attention it deserves as a critical aspect of general health and well-being.

*Dr Vava is the President of the Public Oral Health Forum, a network of public oral health professionals striving for oral health equity, dignity and well-being for all.

Republished from Spotlight under a Creative Commons licence.

Source: Spotlight

Categories : Expert Opinion HospitalsTags :

Opinion piece: Specialist TES Providers Optimising Healthcare Operations – a Prescription for Patient Care Success

On By ModernMedia

By Sandra Sampson, Director at Allmed

The healthcare sector in South Africa is beset with numerous challenges, ranging from high turnover rates to skilled staffing shortages and complex regulations in addition to stressful working environments, and communication barriers. Despite these formidable obstacles, patients have the right to expect top-tier care from their medical facilities. Here, specialised Temporary Employment Services (TES) providers can become indispensable partners, adeptly assisting medical facilities to navigate these challenges in their quest to ensure a seamless continuum of care.

Streamlining healthcare staffing to counter shortages

Specialist TES providers offer a multifaceted remedy to the relentless staffing challenges in healthcare. Capable of promptly supplying temporary staff to bridge immediate gaps, TES providers ensure that all resources have already been rigorously screened, recruiting qualified professionals to function as a buffer against high turnover and staffing scarcities. Through tailored training, specialist providers ensure that their temporary staff placements align seamlessly with organisational expectations to consistently uphold care standards. Furthermore, specialist TES providers alleviate the burden of complex healthcare regulations on management and staff by taking on the responsibility of handling the entire employment relationship, from end to end, including managing human resources and labour relations components, as well as payroll. This provides significant relief for healthcare facilities giving them the staffing resources that they need, without the additional administrative complexities involved with recruiting, on-boarding and managing such resources.

Addressing skills gaps to raise the bar on healthcare resources

Maintaining consistent levels of patient care without compromising quality is challenging in the face of staffing shortages and high turnover rates. With so many specialised healthcare staff, including ICU personnel, leaving for better opportunities abroad due to financial considerations, such an exodus necessitates urgent strategies to retain and fill gaps within healthcare facilities. Specialist TES providers are already playing a critical role in addressing these concerns by focusing on nurse competencies and facilitating targeted courses to upskill their resources. These courses address critical gaps in patient safety and empower nurses to provide better care. Through the development of these essential courses, such as ECG interpretation and cannulation, TES providers are taking significant steps to ensure nurses possess the necessary skills and knowledge. This proactive approach not only enhances patient care at a facility level, but also contributes to nurse competence and job satisfaction, ultimately benefiting the healthcare ecosystem.

The strategic advantages of enhancing workforce dynamics

In addition to operational bolstering and sector-specific upskilling, specialist healthcare TES providers present strategic benefits for healthcare facilities. Access to a diverse, extensive talent pool makes it simpler for medical organisations to find the ideal fit for each role, effectively mitigating the risk of hiring mismatches usually associated with permanent placements. Medical facilities also benefit from the cost-effectiveness of the TES operating model, which aligns with the dynamic nature of healthcare to optimise resource allocation. This is particularly important in hospitals where patient occupancy levels fluctuate daily. Many healthcare organisations now operate with a 50/50 ratio of permanent placements and temporary resources, which gives them the flexibility to accommodate the ever-shifting demands of patient care staffing, while safeguarding the delivery of quality care. By efficiently managing both permanent and agency staff, TES providers optimise recruitment efforts and ensure that the right candidates are placed in suitable roles, benefiting the healthcare organisation’s operations and patient care. TES providers uphold patient confidentiality and provide comprehensive training, ensuring staff are cognisant of privacy protocols and handle sensitive information appropriately.

Boosting patient care excellence: the vital role of specialist TES providers

In an era where healthcare value is intricately tied to workforce excellence, TES providers play a pivotal role in elevating the sector by helping medical facilities conquer their industry-specific challenges, enabling the fundamental mission of enhancing patient well-being. Ultimately, Specialist TES providers represent a crucial element in the healthcare sector’s quest for excellence, as their strategic approach to staffing not only addresses immediate needs but also upholds patient care standards, while easing administrative burdens, and enhancing workforce competencies. As such, collaboration with specialist TES providers is a progressive strategy that medical organisations should prioritise to effectively navigate the intricate challenges of the healthcare landscape today while significantly enhancing patient care outcomes.