Category: Healthcare Politics and Regulations

SAHPRA Recalls Two Batches Of Benylin Paediatric Syrup

Photo by cottonbro studio

On 10 April 2024, the South African Health Products Regulatory Authority (SAHPRA) received a report from the Nigerian National Agency for Food and Drug Administration and Control (NAFDAC) regarding the detection of high levels of diethylene glycol in a batch of Benylin Paediatric Syrup. SAHPRA immediately contacted the South African manufacturer, Kenvue (formerly Johnson and Johnson) for a response. Following engagements with the manufacturer and in the best interest of the public, it was resolved that affected batches would immediately be recalled while an investigation is ongoing.

SAHPRA, in collaboration with Kenvue, have identified the affected batch numbers as 329304 and 329303. These affected batches have been distributed to the following countries: South Africa, Eswatini, Rwanda, Kenya, Tanzania and Nigeria.

Benylin Paediatric presents as a clear, bright red syrup having a raspberry odour and taste, packed in amber glass bottles containing 100 mL with a plastic measuring cup. It is indicated for the relief of cough and its congestive symptoms and for the treatment of hay fever and other allergic conditions affecting the upper respiratory tract.

SAHPRA wishes to inform the public not to panic as the matter is being handled with priority. Batch recalls are batch-specific and do not necessarily apply to other batches/similar products. The manufacturer is a SAHPRA-licenced manufacturer and complies with Good Manufacturing Practices. The public is reminded that the recall is limited to two batches and should not panic regarding the range of products bearing the same name.

SAHPRA is alerting healthcare professionals and the public to discontinue the use of the two batches mentioned, remove them from their inventory and return them to their normal distribution channel(s) with immediate effect.

Classification of the recalls

The recall is classified as a Class 1, Type A recall, which is associated with a serious product quality concern that may have severe consequences. This is a country-wide recall. The product is being recalled from hospitals, retail outlets, healthcare professionals, authorised prescribers and individual customers or patients.

What the public should know

Diethylene glycol is toxic to humans when consumed and can prove fatal. Toxic effects can include abdominal pain, vomiting, diarrhoea, inability to pass urine, headaches, altered mental state, and acute kidney injury which may lead to death.

Members of the public who have consumed these two batches who experience any adverse reaction or witness it in children should consult their healthcare professional and report this using the Med Safety App or send an email to: adr@sahpra.org.za.

The recall is limited to batch numbers 329304 and 329303 of Benylin Paediatric Syrup.

“As a national regulatory authority, the recalling of medical products is a crucial measure to address safety concerns or quality issues so that we protect the health of the public. SAHPRA is recalling these two batches from the market due to reported high levels of diethylene glycol, with the potential to cause serious adverse events,” indicates SAHPRA CEO, Dr Boitumelo Semete-Makokotlela.

Source: SAHPRA

SAHPRA Signs MoU with Rwanda Food and Drug Authority

Photo courtesy of Rwanda FDA

The South African Health Products Regulatory Authority (SAHPRA) has signed a Memorandum of Understanding (MoU) with the Rwanda Food and Drug Authority (Rwanda FDA).

The MOU between SAHPRA and Rwanda FDA will allow the regulators to develop a cooperative partnership towards ensuring access to safe, quality, and effective health products in the respective countries.

Areas of cooperation

SAHPRA and Rwanda FDA will cooperate in joint products reviews and inspections to enable efficient access to health products. The World Health Organization (WHO) has set up an initiative for establishing a mRNA technology transfer hub, together with six spokes, in Africa as a strategy to increase mRNA vaccine production capacity in under-served regions and thus promote regional health security. Rwanda is one of the spokes and South Africa being the hub. Thus, building on this model, SAHPRA and Rwanda FDA will collaborate in the area of mRNA vaccines regulatory oversight.  

“The forging of partnerships with fellow African National Regulatory Authorities, namely the Rwanda Food and Drug Authority allows SAHPRA to further our drive in enhancing and building capacity on the continent,” says SAHPRA CEO, Dr Boitumelo Semete-Makokotlela.

“The signing of this MoU underscores the profound potential of collaboration among African NRAs, affirming that the solutions to our shared challenges lie within our continent. Rwanda FDA staunchly believes in the power of collaboration and strategic partnerships. This MoU symbolises the culmination of dedicated efforts and signifies our unwavering commitment to facilitating mutual exchange and enhancing regulatory oversight.  Through collaborative efforts with SAHPRA, we aim to strengthen our regulatory capacity and promote public health. As we embark on this journey together, let us harness the collective strength of our agencies to advance the pharmaceutical sector in Rwanda and beyond,” shares Rwanda FDA Director-General, Professor Emile Bienvenu.

Source: SAHPRA

A Year after a Damning Report, Some Green Shoots at Rahima Moosa Hospital

Spotlight visits Rahima Moosa Mother and Child Hospital and sees progress for the struggling hospital but also the reality that there’s a long road ahead to undo what a health ombud report suggests has been years of neglect and poor management.

Rahima Moosa Mother and Child Hospital serves up to 2 300 people admitted per month as well as 10 000 outpatients each month. (Photo: Denvor de Wee/Spotlight)

By Ufrieda Ho for Spotlight

It’s been a year since a damning Health Ombud’s report on the Rahima Moosa Mother and Child Hospital (RMMCH) was released. This month also marks the end of the last deadline the Gauteng Department of Health had to act on recommendations in the report.

At 80 years old, RMMCH is an iconic landmark on the western edge of Johannesburg. But it has gone from a one-time outlier for excellence to being in steady decline, marked by what the Ombud’s report criticised as incompetent leadership, neglect and crumbling infrastructure.

In May 2022, the hospital suffered a public low point when paediatric gastroenterologist, Dr Tim de Maayer, penned an open letter, slamming multiple failings at the facility. Public outcry from the letter, complaints from hospital users, and a widely circulated video of pregnant mothers sleeping on hospital corridor floors prompted the ombud’s investigation.

When Spotlight visited the hospital at the end of February (2024), there were positive outward signs that recent maintenance work had been completed, per the Ombud’s recommendations. Some areas have been painted and surfaces where underground sewer pipes had to be unblocked have also been tarred. The stench from overflowing sewage appears to be a thing of the past. Renovations to the antenatal care ward, shown in the video that went viral, are also near completion and the ward is expected to be operational again by the middle of March.

More signs that RMMCH is blipping on radars again include a new granite plaque at the entrance ready to be unveiled to commemorate the hospital in its 80th year. On noticeboards were flyers that advertised a community fun-walk for the end of February. It was an event intended to “reconnect” hospital staff with the immediate community it serves.

The hospital is also part of the roll-out of the provincial health information system (HIS) and admin staff were seen enrolling new patients on the system. The HIS is a long-awaited system to modernise patient file storage and make patient files accessible at facilities province-wide. Spotlight previously reported on the system.

These encouraging advances since the Ombud’s investigation get the thumbs up from hospital insiders. But they flag that even though the Gauteng Department of Health has announced a six-year renewal plan for the hospital and R53 million was approved in December 2023 for the next phase of renovations, the department is playing catch-up and still dragging its feet.

CT scan empty promises

For Dr Z, the biggest of her current concerns is that the hospital’s CT scan has not been in operation for the past 14 months. Dr Z asked not to be named because of the risk of victimisation.

“We have to beg other hospitals to do our scans. So even when you have a patient who actually needs a CT scan, you think twice – you ask yourself do they really, really need it or should you just watch them for another couple of months. It’s very demoralising and we keep hearing empty promises from management,” Dr Z says.

A shortage of clerical staff means clerks are shared between departments, resulting in inevitable administrative glitches and delays, Dr Z says.

There is also a growing need for child mental health services but the hospital doesn’t have in-patient psychiatry services and only has sessional psychological services.

“We serve an ever bigger community that has changing needs but our infrastructure has stayed the same and our staff numbers have not increased,” says Dr Z. The doctor has worked at RMMCH for nearly two decades – “my second home” she calls it.

The hospital has around 1200 staff members. They serve up to 2300 people admitted per month as well as 10 000 outpatients each month.

Dr Z tries to stay hopeful, saying “we look to the positive things and we do what we can”, but RMMCH can be a daunting place to work. Safety and security has resurfaced as a concern this February. This comes on the back of a car hijacking that took place in the hospital’s parking area at the beginning of the month. The Ombud’s report also looked into the hijacking of an intern’s car that took place in its investigation period.

Parking too is a daily frustration – there are only 300 parking spots for staff on the hospital campus but at least 400 vehicles that need a place to park at peak times. Visitors are told to park on the streets.

‘Mr Fixer’

Acting CEO of the hospital Dr Arthur Manning met with Spotlight to answer questions put to him and to the Gauteng Department of Health.

Manning took up the job in September 2022 as part of the Ombud’s recommendation to redeploy the previous CEO, Dr Nozuko Mkabayi, whom the government oversight body found to be a dismal failure.

Manning calls himself “a fixer”.  His role, he recognises, has been to help stop the slide for RMMCH, also to boost staff morale, restore communication channels and regain the community’s trust in the facility.

“We are a system under pressure and we know there is burnout and low morale but we have improved counselling support and we try to recognise and thank people. We held a nurse’s awards dinner last year exactly for these reasons,” he says.

Manning says the hospital organogram was last updated in 2006, but he has submitted a revised one to the Gauteng Department of Health. It makes the case for more admin and support staff, more junior and training doctor posts and bolstering psychiatric and psychological services. These, he says, are especially necessary because services for children are particularly neglected.

The broken CT scanner at Rahima Moosa Mother and Child Hospital. (Photo: Denvor de Wee/Spotlight)

On the matter of the CT scanner, he says “procurement is underway”. It’s a planning failure that the machine is five years beyond its expected lifespan and was not replaced sooner, resulting in the current gap. Manning says the Gauteng Department of Health is now piggybacking on Limpopo’s procurement contract. Piggybacking refers to provisions in the Public Finance Management Act, that under certain conditions, allow a department in one province to procure goods and services via a contract that a department in another province has concluded with a service provider.

According to Manning, the Gauteng province is currently concluding an X-ray equipment tender that has delayed the procurement of the CT scanner for RMMCH.  “Without a tender in place, procurement is more difficult,” he says. Approval to use Limpopo’s tender contract cuts out some red tape and means the CT scanner and maintenance contract has been secured at the price of R30 million. By May, he says, the hospital will also have an MRI-scanning facility.

Staff helps to spruce up waiting area

Manning has been credited by some for shifting morale and competently overseeing the interventions set out by the Ombud’s report. On a hospital walkthrough with Spotlight, he engages casually with staff and patients. He’s also evidently proud of staff-driven initiatives to improve the hospital experience for patients. He points out a freshly painted waiting area in one of the departments where children are playing with new toys and crawling on bright green astro turf. More than half the money for this project came from doctors and nurses raising funds cycling and running in race events in the city.

Keeping staff motivated means their concerns and working conditions – including the parking problem and safety and security – have to be priorities, he says.

Cars are double and triple-parked in the overcrowded staff parking area. Currently, informal management of this is done via Whatsapp groups. People on the groups are notified to move their cars as spots free up. Manning says the hospital is working to secure nearby grounds for additional parking. On safety and security, he says the hospital has stepped up collaboration with local police and the community policing forums to increase patrolling around the hospital especially around shift changes. He adds: “We have expanded our CCTV camera coverage, requested for armed security control and we’re exploring panic button systems.”

A bigger budget and a permanent CEO

There are two key outstanding issues from the Ombud’s report. The first is reclassification of the hospital that is also an academic and training hospital, from a regional facility to a tertiary hospital.

“This is something that involves national, but when reclassification is done it will means RMMCH’s budgets and grants will be adjusted and we will be able to do so much more,” says Manning.

The second issue is the appointment of a permanent CEO, which Manning says is “being handled by central office”. He side-steps a question on whether his name is in the mix. It’s expected that an announcement on the new CEO will take place in April.

Professor Ashraf Coovadia is academic head of Paediatrics and Child Health at Wits University and heads up this department at RMMCH. He says Manning has “been good for RMMCH” but he says above the level of CEO, it’s the Gauteng Department of Health that needs to get its house in order . He says there has been a lack of communication, consultation, transparency and decisive action from the Gauteng Department of Health for years.

“A CEO can do only so much. When we have having acting heads in so many departments who are in acting positions for forever, it’s a joke. It means decisions don’t get made or decisions don’t get made for the long run and this compromises how the hospital is run and the care we give patients,” he says.

He adds that when there is less “hospital floor” consultation and more bureaucratic centralisation from the department it alienates doctors and nurses. “It becomes more and more difficult to try to motivate especially junior doctors who start off wanting to give back to the public health service but become so frustrated they don’t stay.”

Back to the 1900s

Like Dr Z, Coovadia highlights the CT scan issue, as well as the long delays and the excuses for the delays.

“Working without a scanner takes us back to the 1900s; we are not practising modern medicine and we are not able to diagnose patients early enough,” he says.

Coovadia adds that even though water and electricity supply issues at RMMCH have improved, infrastructure fixes remain patchy. “There are fewer issues of burst pipes and flooding, but it’s still happening.”

Coovadia has been with the hospital for 26 years, he knows better than most the precariousness of the situation and why the hospital is not yet out of the woods. He says: “The negative attention on the hospital did bring about some positive change. But it can make you cry when you see the slide over the last ten years… The hospital is not collapsing, but there are daily collapses.”

NOTE: Coovadia is on the board of SECTION27. Spotlight is published by SECTION27, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

Republished from Spotlight under a Creative Commons licence.

Source: Spotlight

Health Budget 2024: Tangible Investment Needed to Alleviate Poverty-related Health Issues and Build Trust for NHI

Finance Minister Enoch Godongwana tables his 2024 Budget during a joint seating of the National Assembly in the Cape Town City Hall. (Photo: National Treasury)

By Wanga Zembe, Donela Besada, Funeka Bango, Tanya Doherty, Catherine Egbe, Charles Parry, Darshini Govindasamy, Renee Street, Caradee Wright and Tamara Kredo

The 2024 national budget offers some glimmers but allocations for direct health benefits fall short of making a difference to people’s health and wellbeing. These include a ring-fenced allocation to crack down on corruption in health to inspire trust for the National Health Insurance, taxing accessories for e-cigarettes, a jacked up child-support grant, clarity on plans dealing with climate change and its impacts on human health, and finally greater investment to enhance women’s capabilities alongside the Covid-19 grant, researchers from the South African Medical Research Council write exclusively for Spotlight.

The 2024 national budget presented last week by Finance Minister Enoch Godongwana contained several key elements that have an impact on systems, services and wellbeing from a health perspective.

Importantly, not only direct health spend, but budget allocated to social protection and climate infrastructure has implications for health outcomes such as nutrition, growth and food security. Health taxes, to address illness caused by alcohol, cigarettes and e-cigarettes amongst others, are also key revenue streams with taxation intended to deter use.

As researchers at the South African Medical Research Council we are dedicated to improving the health of people in South Africa through research and innovation. We wish to share some insights into positive areas in the budget and to point out areas where there are gaps with potentially dire consequences for the health of our nation.

In real terms, the health budget is shrinking.

Health has been allocated a total of R848-billion over the medium-term expenditure framework. This includes R11.6-billion to address the 2023 wage agreement, R27.3-billion for infrastructure and R1.4-billion for the National Health Insurance (NHI) grant.  Compared to the medium-term budget policy statement in October last year, government is now adding R57.6-billion to pay salaries of teachers, nurses and doctors, among other critical services.

In real terms, the health budget is shrinking. The allocation to cover last year’s higher-than-anticipated wage settlement is a positive step to try to fill posts for essential health workers. But this allocation falls short of fully funding the centrally agreed wage deal, meaning that provincial health departments will be unable to fill all essential posts.

Treasury’s Chief Director for Health and Social Development, Mark Blecher, was quoted as saying that the “extra money would not be sufficient to hire all the recently qualified doctors who have been unable to secure jobs with the state, and provincial Health Departments will need to determine which posts should be prioritised”. He added: “There will be less downsizing, and more posts will be filled, but it is unlikely they all will be.”

South Africa has a ratio of only 7.9 physicians per 100 000 people in the public health system, while it has been estimated that there are more than 800 unemployed newly qualified doctors. Considering the health-workforce shortfalls, the amount of money allocated appears optimistic for service coverage for the increasing population.

The World Health Organization (WHO) considers building a health workforce a highly cost-effective strategy. Salaries continue to consume the largest share of provincial health budgets, estimated at 64% since 2018. The Human Resources for Health strategy lacks clarity on the implementation of workforce-planning approaches with significant implications for how provinces prioritise workforce cadres to keep up with the increasing needs – particularly in light of NHI.

Nutrition support on the decline

The Minister described protecting the budgets of critical programmes such as school-nutrition programmes, which includes almost 20 000 schools. He noted that the early childhood development (ECD) grant will be allocated R1.6-billion rising to R2-billion over the medium term.

Ensuring nutrition support to children under-five for optimal physical and cognitive growth is vital. The 2023 National Food and Nutrition Security Survey by the Human Sciences Research Council found that 29% of children under five in South Africa are stunted (short for their age). The proportion of children experiencing both acute and chronic under-nutrition has increased over the past decade. Stunted children are more likely to earn less and have a higher risk of obesity and non-communicable diseases such as diabetes and heart disease as adults.

Currently, only registered or conditionally registered Early Learning Programmes (ELPs) serving poor children (determined by income-means testing) are eligible to receive the ECD subsidy. This is not aligned with inflation and the real value of the R17 per child per day subsidy and the contribution to nutrition costs  have decreased over time. The subsidy is not enough to cover the costs of running quality programmes, let alone the costs of providing nutritious meals. The World Bank suggests a minimum of R31 per child per day.

There is also concern about the children missed who attend informal or unregistered programmes. According to the 2021 Early Childhood Development Census, only 41% of ELPs are registered and only 33%, registered or not, receive the subsidy. Unregistered ELPs are more likely to be based in vulnerable communities and attended by children from vulnerable households. Further, although about 1.7 million children are enrolled in ELPs, enrolment rates vary across provinces from 40% in Gauteng to 26% in the Eastern Cape. This means many young children are not enrolled, and, of those enrolled, most do not benefit from the subsidy.

Child grants increase not keeping up with inflation

Child grants appear in the budget every year, but the increases do not keep up with inflation, and particularly not with the basket of goods needed for a growing child. In real terms grant amounts are decreasing – visible in the way hunger is increasing throughout the country, particularly in the Eastern Cape where uptake of social grants is very high.

A recent Department of Social Development report – Reducing Child Poverty: A review of child poverty and the value of the Child Support Grant – recommended, as a minimum, an immediate increase of the child-support grant to the food poverty level (R760 last year), as more than 8 million children receiving it were found to be going hungry/missing a meal at least once a day. The R20 increase falls far short of that recommendation.

The Social Relief of Distress Grant and women’s economic empowerment

As part of pandemic recovery efforts, we commend government for the roll-out of the Social Relief of Distress (SRD) grant and its plans to extend this beyond March 2025. While SRD continues to suffer implementation challenges related to the amount and roll-out; it  presents an opportunity for renewed attention to a comprehensive and inclusive approach to women’s economic empowerment.

The recent Stats SA labour survey reported a higher unemployment rate among women (35.7%) versus men (30.7%). Our research also finds that women caregivers of children and adolescents living with HIV are particularly vulnerable to poor health and economic outcomes. Greater investment in programmes that enhance women’s opportunities alongside the SRD could promote the sustainability of pandemic-recovery efforts.

The NHI, health-system reforms and dealing with corruption in health

The Minister indicated that the allocation for NHI – government’s policy for implementing universal health coverage – demonstrates commitment to this policy. He also noted that there are a range of system-strengthening activities, that are key enablers of an improved public healthcare system, including strengthening the health-information system; upgrading facilities; enhancing management at district and facility level; and developing reference pricing and provider payment mechanisms for hospitals. He recognised that these require further development before NHI can be rolled out at scale.

The NHI allocation must show a tangible commitment to health-system reforms. Funding needs to be allocated for the creation of organisational infrastructure that ensures transparent, trustworthy decisions will be made about the benefits package and programmes to be funded. Specifically, funding for conducting Health Technology Assessments with credible processes that manage interests and ensure coverage decisions are informed by independent appraisal of the best-available evidence, measures of affordability, and with public input. Some areas of government already undertake such work, for example the National Essential Medicine Committee, but how these processes will expand beyond medicine to include decisions about health-systems arrangements and public-health interventions remain unclear, and apparently unfunded.

Undoubtedly, facilities need to be upgraded. It’s positive to see this as a named activity. It is however unclear how the upgrade of health facilities and quality of care will be ensured, given that tertiary infrastructure grants have been reduced due to underspending of conditional grants. Currently, health facilities’ quality is assessed by the Office of Health Standards Compliance whose role is to inspect and certify facilities. This is a prerequisite for accreditation under NHI. This means the watchdog agency will need adequate budget. Implementation research is also required to test out the different NHI public-private contracting models. Furthermore, a ring-fenced allocation to deal with corruption in health, would be welcomed and inspire trust for NHI.

‘Sin’ taxes vs ’health taxes’

The Minister proposed excise duties and above-inflation increases of between 6.7 and 7.2% for 2024/25 for alcohol products and indicated that tobacco-excise duties will be increased by 4.7% for cigarettes and cigarette tobacco and by 8.2% for pipe tobacco and cigars. And, based on inputs from citizens, the Minister also tabled an increase in excise duties on electronic nicotine and non-nicotine delivery systems (vapes).

While there may be a concern that increasing taxes on products consumed by the poor is regressive, there are ways to direct revenue gained back to those sub-populations and it’s not fair to deny them the benefits of consuming less alcohol products.

It is notable that excise taxes on wine have been increased to a greater percentage than spirits, but the health effects of alcohol come from the ethanol not the type of liquor product so it would make more sense to make the excise tax rate per litre of absolute alcohol equal across all products. The budget has not moved this forward in any meaningful way.

The proposed tax on tobacco products is not in line with WHO recommendations and is below inflation. This should be at least 70% of the retail price to have a positive impact on public health by reducing tobacco use, especially in a country with one of the highest tobacco-use rates in the region. In South Africa, the tax is currently between 50 – 60%. Although the tax on electronic cigarettes has increased, it is still below inflation. We hope that this increase will deter more young people from starting to use e-cigarettes and encourage current users to quit. We also hope that this increase is not just once-off and that future increases are made with the goal of reducing e-cigarette use.

Overall, the taxes on tobacco products and electronic nicotine and non-nicotine delivery systems are below inflation. This means that manufacturers can absorb the increases, and consumers may not be deterred from using them. This is a missed opportunity, as there is a clear link between these products and the development of non-communicable diseases, like hypertension, and the worsening of communicable diseases, like tuberculosis.

The impact of climate change on lives and livelihoods

Climate and health are closely related, with more attention being paid by the global research community  to potential impacts of climate change and natural disasters on lives and livelihoods. The Minister noted a multi-layered risk-based approach to manage some of the fiscal risks associated with climate change. These include a Climate Change Response Fund; disaster-response grants; support and funding from multilateral development banks and international funders to support climate adaptation, mitigation, energy transition and sustainability initiatives; and, municipal-level adaptation and mitigation initiatives.

There are numerous health co-benefits to these strategies. For example, investing in renewable energy sources can improve air quality, leading to reduced respiratory illness. There is a need to highlight these co-benefits and to foster intersectoral collaboration.

Overall, from the perspective of health researchers, we note the mention of NHI plans, social protection, nutrition, health workforce, health taxes and climate. However, we all agree that the allocations for direct health benefits and to address social determinants of health, such as education and poverty-alleviation, fall short of what is recommended, from global and national research evidence, to make a difference to people’s health and wellbeing.

*SAMRC researchers: Wanga Zembe, Donela Besada, Funeka Bango, Tanya Doherty, Catherine Egbe, Charles Parry, Darshini Govindasamy, Renee Street, Caradee Wright and Tamara Kredo.

Republished from Spotlight under a Creative Commons licence.

Source: Spotlight

Unemployed Doctors March to Union Buildings

They are calling for the president to intervene and make sure medical professionals are employed

By Silver Sibiya for GroundUp

Scores of unemployed doctors, nurses and other health workers marched to the Union Buildings in Pretoria on Monday, calling for the Presidency to intervene in the ongoing financial problems facing the health sector.

One of their main demands is for the health budget to be increased to absorb about 800 medical professionals.

Joining the march, Mandla Matshabe, said he never imagined being unemployed when he completed his community service at Sefako Makgatho University in December last year after studying in Cuba.

“Now I’m sitting at home with a medical qualification when there is a dire need. It’s appalling to think there are medical professionals at home,” he said.

Matshabe, who lives in Hazyview in Mpumalanga, said many unemployed health workers were becoming depressed at home. He said hiring qualified doctors could help alleviate some of the burnout among doctors in the public sector.

“Doctors in communities are overburdened because we don’t have enough medical professionals, including physiotherapists and dieticians or everyone in the hospital,” he said.

University of Cape Town graduate Lerato Jaca said it was discouraging to be an unemployed doctor. “I come from KwaNzimakwe in Port Shepstone where there were literally no doctors when I was growing up.”

Jaca was raised by an unemployed single mother who relied on the money she made during Jaca’s three-year community service employment at Ermelo Hospital.

She said they now rely on her brother’s disability grant and his children’s child support grants to buy food.

Deputy President of the South African Medical Association, Dr Nkateko Minisi, said: “Other health professionals in the allied sectors, including pharmacy, are here with us to hand over a memorandum to build up the health system. But to do so, we feel that human capital must be optimised by hiring all these unemployed professionals. Not tomorrow, not next week but now!” she said.

Mnisi said more than 80% of the population depends on public health services. “Healthcare is not a privilege that should be enjoyed by some; it is a basic human right that every single person deserves.”

Communications Manager at The Presidency, Phil Mahlangu accepted the group’s memorandum.

He said that the presidency was “immensely worried as the presidency about the negative issues affecting the medical industry”. He promised the protestors a response within a week.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

More Practical Solutions for SA’s Health Future 

Health funding options towards Universal Health Coverage

Photo by Kindel Media

The funding required to initiate and sustain the National Health Insurance (NHI) project, aimed at achieving Universal Health Coverage for South Africa, has healthcare industry experts and some of the country’s leading economists raising fundamental questions about its financial viability as outlined in the NHI Bill.

“South Africa needs actionable solutions now to broaden healthcare access and improve affordability however, with the current debt to GDP ratio and many demands on the public purse, it is difficult to see how the State could afford to finance the NHI alone, as outlined in the NHI Bill,” said Craig Comrie, chairperson of the Health Funders Association (HFA).

“The existing regulatory framework could offer a more viable springboard to achieve the aims of Universal Health Coverage sooner through collaborative healthcare initiatives that improve healthcare access for all South Africans.”

He points out the substantial financial commitment demanded by the NHI, noting that an initial allocation of more than R20 billion has already been disbursed. “This allocation, which is merely the tip of the iceberg, accentuates the magnitude of the financial hurdle that lies ahead for the country and its people if the NHI Bill is enacted in its current form,” Comrie says.

“In the current economic climate marked by reduced GDP and tax collections, financing the NHI presents an impossible task for National Treasury, particularly with the exclusion of private health funding collaboration.

“We are therefore urging the Presidency to prioritise the exploration of alternative pathways towards realising Universal Health Coverage in South Africa. There is a critical, urgent need to reassess and redirect vital resources towards more pressing national priorities than the NHI’s potentially unsustainable framework.

“This is a heavy financial burden for the South African taxpayer to shoulder, particularly at this time, with cost projections ranging from R200 billion to a staggering R500 to R800 billion annually if fully implemented. This exorbitant sum, dwarfing recent and future government bailouts, presents an insurmountable challenge given our economic downturn and diminished tax revenue,” asserts Comrie.

The HFA, a professional body representing the majority of medical schemes in South Africa, proposes leveraging the existing regulatory framework to expedite Universal Health Coverage through collaborative healthcare initiatives, emphasising the urgency of exploring viable alternatives.

Comrie also addresses the limitations of tax increases as a revenue solution, emphasising the strain it not only places on families but on the broader economy.

“While NHI implementation may be decades away, we recognise that immediate action is imperative to enhance affordability and access to quality healthcare. We, therefore, must prioritise exploring sustainable solutions rooted in economic viability,” he urges.

“At this stage, realistic timelines for NHI implementation will be decades away, and in the meantime, there is much we could be doing to improve affordability and access to quality healthcare for more South Africans. A good starting place would be to finalise the Low Cost Benefit Options framework and ensure regular reviews of Prescribed Minimum Benefits [PMBs].

Highlighting the current ambiguity surrounding NHI services and the staggering cost projections, Comrie stresses the critical need for clarity from the Minister of Finance.

He emphasises that the HFA’s stance is firmly rooted in a deep commitment to quality healthcare and the implementation of sustainable solutions that can definitively grow accessibility. This mission necessitates prudent financial planning and a steadfast commitment to transparency in healthcare financing.

“With Treasury facing an impossible task to finance the NHI in its current proposed form, all alternatives must be considered. As a country, we cannot afford to gamble on a project lacking clear direction and financial viability.

“We advocate for a recalibration of priorities, urging policymakers to explore collaborative healthcare initiatives to deliver healthcare funding solutions within well-researched reforms including those indicated in the Health Market Inquiry.

“Now almost five years later, the reforms suggested by the Competition Commission have yet to be actioned. South Africans cannot wait decades for NHI implementation, and the real question is, can we afford to embark on this unproven and unrealistic model,” he asks.

“NHI is not the sole path to Universal Health Coverage, nor is it the most expedient. We must pursue reforms rooted in economic viability to safeguard healthcare assets and extend access. As the HFA continues to champion sustainable healthcare solutions, we affirm our commitment to preserve South Africa’s healthcare landscape for the benefit of all citizens,” he concludes.

Worst of Hiring Freeze Over, Western Cape Health Department Assures Health Workers

By Daniel Steyn for GroundUp

Dr Keith Cloete, head of the Western Cape Department of Health and Wellness, has told health workers in the province that the “severe and drastic measures” taken to “constrain the filling of posts” in the past three months has brought the department back within budget.

Cloete was speaking in a video update circulated to the department’s employees on Thursday. Health workers in the province have raised concerns over a “near-complete” freezing of vacant posts to curb budget cuts imposed by National Treasury.

Initial cuts to provincial budgets and conditional grants that fund hospitals were made at the start of 2023/24 and were further exacerbated by in-year cuts.

Provincial governments also had to absorb within their existing budgets a mandatory public sector wage increase. National Treasury recommended in November that provincial departments freeze hiring.

Since November, posts in the Western Cape could only be filled on approval by head office, but Cloete said in his video that those decisions will now be “decentralised” again.

Line managers may again fill vacant posts on condition that they “apply their minds” and work within “a tight framework”, said Cloete. He added that he was mindful of the impact the hiring constraints have had on services.

In January, GroundUp reported on significant staff shortages at Groote Schuur Hospital and Red Cross War Memorial Hospital. Senior hospital managers in the province complained that there had been a lack of communication from the department’s management on how long budget cuts would last and what would be done to mitigate their impact.

On 4 February, more than 1200 doctors wrote an open letter to Western Cape Premier Alan Winde, Western Cape Finance Minister Mireille Wenger and national Finance Minister Enoch Godongwana, calling for an end to “catastrophic budget cuts”.

The health workers warned that the cuts will cause surgical operations to be cancelled or postponed; patients in need of specialist medical care to wait longer; cancer treatment to be delayed and cancers diagnosed at later stages with less chance of successful treatment; and gains in neonatal, infant and paediatric care would be “reversed”, among many other issues.

In Thursday’s video update, Cloete said that the budget for the 2024/25 financial year has not yet been finalised. The final budget allocation will be tabled in the provincial legislature in early March.

Budget cuts are expected to continue into the foreseeable future. Over the next three years, the Western Cape government faces cuts amounting to R6.7-billion. According to premier Alan Winde, 37% of the province’s budget goes to healthcare.

Cloete announced that a meeting will be held with managers, clinicians and support staff “to have a discussion of how do we redesign our healthcare services across the entire system in the Western Cape” on 21 February.

“I understand anxieties that everyone will experience in this specific area. I call on everyone to please attempt to get a slightly bigger view …. And for us to do this together. Together, we can actually navigate this successfully.”

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Call to Stop ‘Catastrophic’ Health Care Budget Cuts

By Daniel Steyn for GroundUp

More than 1,200 doctors, nurses and other health workers in the Western Cape have signed an open letter to Finance Minister Enoch Godongwana, Premier Alan Winde and Finance MEC Mireille Wenger, calling for an end to “catastrophic” budget cuts in the provincial department.

The National Treasury cut health budgets at the start of the 2023/24 financial year and introduced further cuts halfway through the year, recommending a hiring freeze on new posts. Provincial departments were also told to absorb the cost of an unfunded public sector wage increase.

On Monday, Deputy Minister of the National Department of Health Sibongiseni Dhlomo told protesting unemployed doctors in Pietermaritzburg that the department will be taking the issue of budget cuts to Parliament this week and ask that healthcare be exempted.

In January, GroundUp also reported how two of the Western Cape’s biggest hospitals, Groote Schuur and Red Cross Children’s Hospital, are facing significant staff shortages.

According to the open letter sent by Western Cape health workers, the provincial health system has been “destabilised by indiscriminate freezing of virtually all clinical and non-clinical posts and a freeze on nursing overtime and agency budgets”.

“A reduction in posts mean that today, and tomorrow into the foreseeable future, there are fewer nurses, doctors, general assistants, clerks, physiotherapists, radiographers, porters, occupational therapists, dentists and specialists to deliver desperately needed healthcare to the population.”

The hiring freeze has also meant that critical medical posts remain vacant due to resignations or doctors completing their training.

The health workers wrote that the cuts will cause a reduction of surgical theatre lists, causing a postponement or cancellation of operations; patients in need of specialist medical care to wait longer due to fewer available hospital beds; oncology (cancer treatment) services to be delayed, meaning that cancers are diagnosed at later stages with less chance of successful treatment; and gains in neonatal, infant and paediatric care to be “reversed”, among many other issues.

Currently employed health workers will be required to work harder and longer to fill the gaps, which may lead to “sleep deprivation, burnout and fatigue-induced errors”, according to the letter.

Premier Alan Winde and MEC Wenger responded to the open letter in a joint statement on 7 February.

In the statement, Wenger and Winde agreed that the “nationally imposed” budget cuts are “devastating” and that they go beyond health services and “have hit education and social development services”.

“This is exactly what the Western Cape Government warned of and which it is now fighting to stop and reverse,” the statement read.

Over the next three years, the Western Cape Government faces cuts amounting to R6.7-billion. According to Winde and Wenger, these cuts are more than the total combined budgets of the provincial departments of community safety, economic development, and cultural affairs and sport.

In November, the provincial government declared an intergovernmental dispute (IGD) with the national government over the cuts. Mediation in this matter remains ongoing.

Asked to respond to the open letter, the National Treasury told GroundUp that the budget for 2024/25, which will be tabled on 21 February, will provide some guidance.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Unemployed Doctors March to Department of Health

They demand permanent jobs and no budget cuts to healthcare

Doctors marched to the Department of Health offices in Pietermaritzburg on Monday to demand jobs. Photo: Joseph Bracken.

Over 80 unemployed doctors marched from UNISA campus on Longmarket Road to the KwaZulu-Natal Department of Health’s offices in Langalibele Street, Pietermaritzburg, on Monday.

They went to hand over their CVs and a memorandum demanding that the healthcare budget be increased to accommodate over 700 qualifying medical practitioners. The department was given 14 days to respond.

Eighty-four unemployed doctors also signed a register handed to the department.

The doctors were met by Deputy Health Minister Sibongiseni Dhlomo who said health minister Joe Phaahla had another engagement. Dhlomo said the department was working to address the issue of unemployed doctors, and that the minister would raise it this week in Parliament and ask that healthcare be exempt from budget cuts.

Dr Siya Shozi, part of a “small committee” of unemployed doctors with no political affiliation mandated to liaise with the department, said the march was coordinated through a WhatsApp group. Shozi was happy with the turnout but said it did not represent the large number of unemployed doctors in KZN and its rural areas.

Busiziwe Mancotywa, a grade one medical officer who has been unemployed since completing her training at the end of last year, said, “You apply for some positions where you meet the minimum requirements but for whatever reason you are never contacted”.

Mancotywa was joined by her brother, Nqaba, who is finishing his internship at Greys Hospital. He said if action is not taken now, he won’t find a job in the future.

Nomfundo Mbanjwa, also a grade one medical officer, complained about the cost of applying for jobs, including printing applications and transport to interviews. Mbanjwa says she had to sell her car to cover these costs.

Representatives from the South African Medical Association Trade Union (SAMATU) and the Public Servants Association of South Africa (PSA) joined the march and pledged support for the doctors.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Patient-centred Health Care: The NHI Revolution You Deserve

A patient-centred health system will remain an illusion under the NHI unless the public health system is ramped up to better serve users and a clear path is outlined for public-private partnerships, argue Bernard Mutsago and Haseena Majid.


By Bernard Mutsago and Haseena Majid

National Health Insurance (NHI) is South Africa’s chosen financing vehicle for Universal Health Coverage (UHC). The plan is a step closer to being a reality after the NHI bill was passed by Parliament’s National Council of Provinces on 6 December 2023. The legislation aims for a single NHI fund that will buy services from public and private providers, it will be free at the point of delivery, and will prevent medical schemes from covering services that the NHI provides. The bill is likely to soon be signed into law by President Cyril Ramaphosa, although it may take years before all sections of the bill will come into force.

However, achieving a universal, affordable, high-quality, comprehensive, and patient-focused health system under the NHI will remain an illusion unless shortcomings of the public health system is fixed to meet the needs of the public. This can be achieved through a structured system that enables efficient and equitable pooling and distribution of resources across the public, private, and civil society sectors to improve service delivery.

As it stands, the absence of a clear framework for public-private partnerships in health service delivery is a barrier to progressive planning.

South Africa, over the last decade, has seen a significant decline in the state of its health sector. Despite initiatives such as the primary healthcare (PHC) re-engineering programme, and outreach services to improve service access, the health system faces a myriad of challenges. Budget constraints have crippled our human resource capacity. Corruption, maladministration, and neglect have resulted in the decay of facilities and their inability to withstand the increasing demands for basic and complex health services.

Most importantly, the data management system, public administration processes, and the referral pathways require significant intervention to align with the digital age and the potential role of artificial intelligence to improve health service delivery. The result is a poorly representative and possibly outdated set of data indicators to inform health service delivery needs that are contextual to geographic and institutional needs.

Applying a blanket approach to health interventions, in the absence of a significantly strengthened data collection and assessment pathway has led to questionable methods to achieving universal healthcare via NHI. The implementation of NHI pilot sites in the build-up to delivering the NHI has failed to show how the health system will move from the current curative approach to a more patient-centred approach. Failing to establish the patient-centred pathway at the onset from the public administration and health service delivery system, will result in the ongoing reality of some people being unable to access the health services closest to them at the lowest cost. It also has an extended impact on preventive strategies for better health outcomes.

South Africa has a fragmented, two-tiered and inequitable health system in which about only 17% of the population in 2018 had medical aid coverage, while more than 80% of the population are largely dependent on the public health sector. This is according to the Competition Commission’s final Health Market Inquiry report, released in November 2019.

The pathway to universal healthcare should entail crucial actions like maintaining and strengthening healthcare infrastructure and implementing strategic initiatives to bolster the workforce through robust recruitment, retention drives, and public-private collaborations.

But attention to these vital steps have been diverted by the government’s emphasis on a specific funding model -the NHI – The plan has faced considerable pushback with criticism, , largely rooted in the government’s inability to deliver essential services, theft due to corruption and cadre deployment, to the detriment of health users. These concerns  have been ignored. Instead, the determination to move ahead with the NHI amid outcries from the health sector, academics, and civil society is likely driven by politics.

Lessons from Ghana

Ghana’s failed NHI experiment is a luminous example for many countries attempting different financing models for delivering UHC. Ghana’s attempted NHI approach was taken off the national policy agenda due to public political opposition, weak civil society mobilisation, and low trust in the political leadership. This begs the question of whether due diligence was taken by the crafters of the NHI to establish the viability and sustainability of this model within the South African context.

Government needs fertile collaboration to materialise any policy goals. Whereas the NHI Bill has already been passed by the legislature, the successful implementation of the policy is dependent on people beyond the political realm. Engagements to structure and implement the operational plan for the NHI requires that government take on an approach that shows its willingness and commitment to take input from across all sectors, embrace the criticism, and find an approach that unifies all actors within the health sector and financing space.

Public-private partnership 

A well-designed public-private partnership model, with strong monitoring and evaluation processes could offer an opportunity to create the foundation for a medium-term solution. This could improve resource capacity in the public health sector to address the current health service backlogs, improve health infrastructure and technology, and create a functional system between the public and private health sectors to harvest  accurate health data. A strengthened data collection system that is inclusive and reflective of all users of the health system is after all essential to craft a responsive health system rather than a reactive one, thus placing the patient central to the health system.

Additionally, structures for community participation to inform healthcare service delivery, such as clinic committees and hospital boards, need to be bolstered as they are currently poorly functioning or non-existent. Including all voices, especially those of the public and clinicians, is critical for establishing  a capable health system that offers equitable health access for all people. This is only achievable through amplified voices and a united call for government to urgently re-evaluate its current approach toward NHI implementation.

*Mutsago is a health policy analyst, health equity activist, and primary healthcare enthusiast and Majid is a Global Atlantic Fellow for Health Equity in South Africa and director of public health programmes at civil society organisation Usawa.

Republished from Spotlight under a Creative Commons licence.

Source: Spotlight