Category: Hospitals

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

South Korean Trainee Doctors Walk Out en Masse

Photo by Hush Naidoo on Unsplash

Physicians argue that trying to combat dwindling numbers with increased medical school places ignores the real problem: gruelling hours and low pay

At several major South Korean hospitals, thousands of doctors walked out on Tuesday, causing widespread disruption in a protest at the government’s plan to increase the numbers of medical school students, The New York Times reports.

On Monday, over 6000 doctors had submitted resignations at Seoul’s five hospitals and left at 6am on Tuesday, the Health Department reported. One of the hospitals had up a sign saying that its emergency department was only handling cardiac arrest cases; the other four were on “red alert”.

Government sources state that 7813 doctors had walked off the job, Reuters reports.

South Korea may have one of the most advanced healthcare systems in the world, but it is plagued by a critical shortage of doctors. The protestors, interns and residents, say that this shortage is confined to certain areas such as emergency medicine, which are poorly compensated by the government and insurance providers. Cosmetic medicine on the other hand, is highly profitable.

One survey found that doctors in training regularly work shifts longer than 24 hours and many work for more than 80 hours a week. (In South Africa, a 2012 study found that interns regularly put in 150–200 hours of overtime per month, working out to 80–90 hours a week.)

Other factors such as an ageing population are putting more and more strain on doctors.

Early this month, the government announced a plan to increase South Korea’s medical school admissions quota from 3000 to 5000. The Ministry of Health and Welfare regulates the licences to practice medicine. Doctors were immediately critical of the plan, protesting with placards saying things like “end of health care.”

Officials Raise Alarm over Hiring Freeze at Western Cape’s Largest Hospitals

By Daniel Steyn for GroundUp

Health workers at Groote Schuur Hospital and Red Cross Children’s Hospital in Cape Town are starting to feel the effects of an ongoing freeze on the hiring of critical medical staff.

According to senior officials at these hospitals, speaking to GroundUp anonymously, the situation has reached a point where managers are struggling to fill shift rosters. An impact on patient care and waiting times is inevitable, the officials say.

A senior hospital manager at Groote Schuur told GroundUp that almost half of medical officer (doctor) posts in the medicine department are vacant, in addition to hundreds of other nursing and operational posts. 

Another senior official at Red Cross Children’s Hospital told GroundUp that “critical medical posts” are being left vacant, including medical officer, registrar (doctors in training for a speciality), and specialist posts.

Groote Schuur Hospital is one of the largest government hospitals in the Western Cape and Red Cross Children’s Hospital is the largest children’s hospital in Sub-Saharan Africa. The Daily Maverick reported in November that the budget shortfall for these two hospitals amounts to more than R300-million for 2023/2024.

In addition to hiring freezes at Groote Schuur and Red Cross, the Western Cape Department of Health decided to de-escalate services at the hospitals for a period of four weeks over December and January. Hospital managers were also told to reduce spending on consumables by 50%, according to the Daily Maverick.

At the start of 2023, large cuts were made to the conditional grants that fund these hospitals. And then in the middle of the year, National Treasury announced significant austerity measures including a R21-billion reduction in national government spending for 2023/24.

In August last year, a letter by National Treasury to provincial governments recommended several “cost containment” measures for the 2023/24 financial year and suggested a freeze on hiring of new employees.

It appears that each province’s health department is dealing with the “cost containment” measures in different ways. In the Eastern Cape, for example, hiring freezes have been implemented but not for clinical staff, Sizwe Kupelo, spokesperson for that province’s health department, told GroundUp.

In the Western Cape, as of May 2022, the vacancy rate of medical posts was 5%, compared to 14% in the Eastern Cape, 20% in Gauteng and 28% in KwaZulu-Natal. Health experts are concerned that budget cuts and hiring freezes will have a devastating impact on these provinces.

Hospital officials at Groote Schuur and Red Cross told GroundUp that there has been a lack of clarity from the provincial department on how long hiring freezes will last and whether there will be a permanent reduction in medical posts.

Senior officials fear that the hiring freeze is undoing decades of investment by the government in the capacity of state hospitals. Newly graduated doctors looking to specialise need to take up a registrar post in a state facility, but with registrar posts frozen in the Western Cape, this is almost impossible for them to do.

Hospital managers told GroundUp that some medical officers have resigned from Western Cape hospitals to take up registrar posts in other provinces or even other countries.

Officials are also concerned that if hiring freezes are implemented in primary and secondary care facilities, referrals to hospitals will increase, putting further pressure on an already overburdened tertiary health system.

Dwayne Evans, spokesperson for the Western Cape Department of Health, told GroundUp that the department is unable to respond to specific questions on budget shortfalls or the number of posts frozen, as the 2024/25 budgets are being finalised.

Evans told GroundUp that as part of the hiring freeze, the filling of vacant posts now needs to be authorised by the provincial department to attain “provincial consensus”. 820 vacant nursing posts and 441 doctor positions have been “earmarked to be filled soon”, Evans said.

“We are doing everything we can to reduce the impact on our patients. No patients will be refused emergency and basic medical care and treatment,” he said.

The National Department of Health did not respond to GroundUp’s questions despite several follow-up attempts. National Treasury said that guidance will be given during the upcoming budget speech by Finance Minister Enoch Godongwana.

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

Source: GroundUp

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

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.

Analysis: Where We Are with NIMART 13 Years Later

Photo by Hush Naidoo Jade Photography on Unsplash

By Tiyese Jeranji for Spotlight

Like many countries, South Africa has a shortage of healthcare workers – particularly of doctors. One response to such shortages is task-shifting – in short, to let doctors focus on the things only they can do, and to shift some other less specialised tasks to other healthcare workers like nurses or pharmacists.

Task-shifting can take many forms. Earlier this year Spotlight reported on a court case that gave the green light to specially trained pharmacists to dispense antiretroviral treatment without a script (the judgement is being appealed). Similarly taking pressure off public sector clinics, the Department of Health has for several years now allowed some people to pick up their medicines at participating private sector pharmacies or other pickup points. Less well implemented, was the introduction of clinical associates in 2008 as a new type of mid-level healthcare worker that can take some of the pressure off of doctors and stand-in for them in some situations.

Probably the most impactful example of task-shifting in South Africa, however, was the introduction of Nurse Initiated and Managed Antiretroviral treatment (NIMART) in 2010.

What is NIMART?

Dr Silingene Ngcobo, a lecturer at the School of Nursing and Public Health at the University of KwaZulu-Natal and a Board Member of the Southern African HIV Clinicians Society, says NIMART is a clinical management program for people living with HIV which is driven by registered nurses. This means that registered nurses can independently manage a person living with HIV, starting from screening and diagnosis, all the way to treating, and monitoring throughout the HIV care continuum in the absence of a medical doctor.

As explained by Mmotsi Moloi, Training Programme Manager at the Aurum Institute (an NGO), prior to the introduction of NIMART in 2010 only doctors were authorised to prescribe antiretroviral therapy.

The rollout of antiretrovirals in South Africa technically started in 2004, but it only gathered momentum after the end of state-backed AIDS denialism in 2008. It soon after became clear that South Africa would not have enough doctors to handle the demand for HIV treatment and nurses would have to be roped in.

“The waiting lists became long, and the doctors could not meet the increasing demand of clients in need of antiretroviral treatment, this led to the death of clients while awaiting to be initiated,” says Moloi. “There was an urgent need to remedy the situation which was to decentralise management of HIV to Primary health care facilities and professional nurses to be trained and authorised to manage HIV infected clients.”

Ngcobo says nurses are often the only healthcare providers available to provide HIV prevention, care, and treatment services. She says the South African healthcare delivery system approach has changed from hospital-centred care to promotion of health and prevention of disease through primary healthcare and the introduction of NIMART fits this shift.

Hard to quantify

According to estimates from Thembisa, the leading mathematical model of HIV in the country, the number of people taking HIV treatment in South Africa increased from 1.2 million in 2010 to 5.7 million in 2022. How big a part NIMART played in this remarkable scale-up of treatment is hard to quantify, but that it played a pivotal role seems clear.

review study published in 2021 that looked back at 10 years of NIMART in South Africa, found that adequate NIMART training “results in improved knowledge of HIV management, greater confidence and clinical competence, particularly if accompanied by mentoring”.

The review summarised results from several smaller studies conducted in different provinces on NIMART – which show, on a small scale at least, what potential impact NIMART has had. Among other things, the training of nurses to initiate and manage HIV treatment led to feelings of empowerment, and when coupled with appropriate training and support can “lead to increased quality of patient care, confidence and professional development”.

Studies conducted in Johannesburg cited by the review found that NIMART training increased access to HIV treatment, reduced workloads at referral facilities, and reduced referrals to tertiary hospitals. Nurses also saw an “improvement in the quality of life of their patients and the retention of patients in care, which they felt reflected the success of NIMART”.

When asked how many NIMART-qualified nurses we have in the country, Foster Mohale, spokesperson for the National Department of Health, says he can’t provide an exact number since they no longer collect data on NIMART since it has been incorporated in broader HIV training. He also says that provinces are the custodians of data for all trained healthcare workers and points out that the numbers change all the time due to attrition.

What NIMART nurses do

Ngcobo says NIMART nurses assess and screen people living with HIV for treatment eligibility, initiate antiretroviral therapy, provide adherence counselling and monitoring, screen for opportunistic infections, offer various preventative therapies, psychological support, as well as appropriate referrals to other members of the disciplinary team, and oversee repeat visits throughout the healthcare user’s life while managing any other health condition that the person might have.

Nurses also have to support people with tuberculosis and non-communicable diseases (such as diabetes and hypertension) to take treatment as prescribed.

“For effective management of other diseases, NIMART nurses should actually work with all other conditions because a person living with HIV still can gets various other conditions which still need to be managed. Therefore, the role of [the] NIMART nurse is to wholistically manage the patient and provide all the necessary healthcare services that the healthcare user in front of them will be requiring,” says Ngcobo.

Training requirements

The NIMART programme has changed somewhat since its launch back in 2010. Mohale says the programme now also covers the majority of healthcare professionals like medical doctors, pharmacists, registered or professional nurses, and other healthcare professionals who are authorised by their statutory bodies to assess, diagnose, prescribe, and dispense medications. He says in 2017 NIMART was changed to “Basic HIV for Health Care Professionals”, but the name NIMART is still in wide use.

The essence of the programme however remains that a professional nurse, or other qualifying healthcare professional, must complete special training (see this online course for example) before they are authorised to prescribe HIV treatment and manage the treatment and care of people living with HIV. Training typically requires both an exam and some practical work, ideally with the support of a mentor.

All prescribing by nurses in the public sector relies on section 56(6) of the Nursing Act, which allows an exception to the Medicines Act and other health-related laws, explains Andy Gray, Senior Lecturer  in pharmaceutical sciences at the University of KwaZulu-Natal. “They therefore do not need section 22A(15) permits or section 22C(1)(a) dispensing licences in terms of the Medicines Act,” he says.

The legalities of how nurse prescribing works in South Africa is set out in a 2016 policy document issued by the National Department of Health. Amongst others, the document states that, “a nurse may only perform the functions authorised by Section 56(6) in public sector facilities in the district or municipality where the authorisation was granted to him/her”. In other words, nurses who move to jobs at other facilities or in other districts will often require new authorisation before they may prescribe medicines such as antiretrovirals.

Some concerns

But there are signs that training and mentorship is not functioning optimally across the board.

“There is non-standardised training and inadequate mentoring as the country doesn’t have enough trainers,” says Mohale. “There are human resource constraints for both trainers and nurses to be trained. Some districts rely on their district support partners to carry out trainings on their behalf.”

“Staff shortage from the facilities also leads to some nurses not being able to be trained due to demand for other health services at their service delivery points. Some challenges include failure to identify and manage drug-drug and drug-food interactions which are important in making sure that the patients are suppressing their viral loads,” he adds.

Mohale’s comments echo several barriers to the success of NIMART that were identified in the 2021 review study, including: “non-standardised training, inadequate mentoring, human resource constraints, health system challenges, lack of support and empowerment, and challenges with legislation, policy and guidelines”.

Republished from Spotlight under a Creative Commons licence.

Source: Spotlight

The World’s First Precision Institute to Redefine the Healthcare Industry as We Know It

Blending 4IR technology and holistic approaches to health, the future of personalised and predictive ‘Wellcare’ comes to Cape Town and Johannesburg

InUversal Group, a health and biotech market disruptor in Africa and the Middle East that is transforming the way we think about healthcare, medicine and hospitals, is set to open next-gen medical and wellness hubs in Cape Town this December 2023 and a monumental R1 Billion Development in Sandton, Johannesburg, to follow in 2024. These visionary, state-of-the-art health and wellness facilities are designed to embrace the holistic nature of individuals’ wellbeing, emphasising the intricate interplay of biological, social and psychological facets.

Comprising a team of esteemed medical experts working collaboratively to transform disease treatment through innovative and holistic strategies, the InUversal Group is committed to alleviating South Africa and Africa’s healthcare challenges through the application of 4IR technology that is set to improve healthcare accessibility and standards for individuals across the continent. As an increasing number of international visitors travel the globe in search of medical treatments, the InUversal Group is committed to making South Africa’s major metropolises, including Johannesburg, Cape Town, and Durban, the go-to destinations for personalised Wellcare – a term coined by the group that is anticipatory in nature and requires a holistic approach to health.

Wellcare harnesses proven strategies to attain an optimal and healthy balance between individuals’ health, time, and finances, ensuring that they can lead healthier, happier and more fulfilling lives. This ambitious endeavour aligns with South Africa’s reputation as a hub for medical tourism, offering world-class medical services, competitive pricing, and a rich cultural and immersive experience.

The Institute of Universal Wellcare (InUWell) will be based in the heart of Cape Town at the prestigious V&A Waterfront Mall and is the first of its kind – a digitally-immersed, multidisciplinary institute of holistic health and wellbeing in a warm and welcoming retail environment. InUWell’s versatile multifunctional design, and forward-thinking commitment to radical sustainability, offers an unparalleled experience that is a seamless blend of physical and digital realms. The Institute is set over 2000 square metres and is considered to be the heart of “Wellcare.”

This festive season, InUWell is opening its doors to immersive health and wellness experiences where individuals are invited to learn more about health and well-being, while exploring and having fun in an engaging, euphoric, multi-sensory environment as they connect and share memorable moments with friends and family.

InUWell provides a diverse range of services including DNA genetic testing, comprehensive health screenings and diagnostics, specialised treatments and therapies, Wellcare lifestyle products and services, active health studios, multisensory immersive experiences and a digital health bank with evidence-based healthcare insights.

“The InUversal Group is an ecosystem shifting and stretching boundaries, creating connections, taking complex intricate life decisions and making them SIMPLE,” says Dr Kamlen Pillay, Founder and CEO of the InUversal Group and Plastic Surgeon. “InUWell, under the InUversal Group, is a single destination for all your health and wellness needs. It is the perfect place to learn about your body and how to take care of it, to access the latest technology and treatments and therapies, and to connect with other people who are on the same journey,” says Dr Pillay.

“The InUversal Group’s WellCare Programmes empower individuals of all generations to take precise, proactive, and preventative measures, not only to extend the quantity of years in our lives but also to infuse more vitality and quality into those years,” says Dr Pillay.

The Group is launching several innovative health technology products which will enter the market early next year, including the Johannesburg facility called SIM Sandton, that is unique in Africa and will host a 5* hotel, InUWell Precinct, Step-Down Facility as well as a multi-disciplinary Surgical Theatre Complex with more than 20 of Johannesburg’s top specialists. 

Working with esteemed medical specialists, leading MedTech equipment and companies, and lifestyle and wellness retail brand partners, the InUversal Group invites potential collaborators to join the vanguard of companies and brands helping to shape the future of health and Wellcare practices in Africa and globally, with the shared mission of enhancing the well-being of countless individuals.

“Imagine a world where every man, woman and child has the agency over three valuable assets – their health, time and money. A world where every person has the dignity of choice where they live, work and play. A world where hospitals are not places we go to when we are sick but rather to stay healthy. Imagine a world where hospitals are for profits but not for profiteering. A world where each day, each and every one of us, uses our energy collectively to leave the world in a slightly better place than we found it, the day before,” concludes Dr Pillay.

To get involved or find out more information, visit: inuwell.global or contact experience@inuwell.global to book an appointment. InUWell Cape Town will officially be opening its doors on 19 December 2023.

Cape Town’s Newest Hospital Recognised for Exemplary Water Conservation  

Netcare Christiaan Barnard Memorial Hospital has earned a prestigious five-star rating from the City of Cape Town’s Water and Sanitation Directorate, joining the esteemed ranks of organisations dedicated to water sustainability. The accolade underscores NCBMH’s commitment to responsible water management and aligns with the hospital’s ongoing efforts to champion prudent and sustainable management of natural resources, supporting water-sensitive urban living.

Netcare Christiaan Barnard Memorial Hospital (NCBMH) has earned a prestigious five-star rating from the City of Cape Town’s Water and Sanitation Directorate, joining the esteemed ranks of organisations dedicated to water sustainability. The accolade underscores NCBMH’s commitment to responsible water management.

The City of Cape Town’s Water Star Rating Certification Awards acknowledged NCBMH’s dedication to best water use, supply, conservation and discharge practices. This recognition aligns with the hospital’s ongoing efforts to champion prudent and sustainable management of natural resources, supporting water-sensitive urban living.

“We are proud to be part of a community leading the charge in climate-smart healthcare transformation and are committed to playing a proactive role in averting a potential water crisis in Cape Town and across South Africa,” said André Nortje, Netcare’s environmental sustainability manager.

Nortje emphasised Netcare’s dedication to minimising environmental impact: “Our commitment extends beyond accolades. Efforts to conserve water, reduce waste and save electricity should be high on every South African’s agenda, and we are committed to doing our part to drive sustainability.”

NCBMH’s water conservation initiatives include a sophisticated greywater harvesting system, as well as a desalination plant capable of providing the entire facility’s water needs. These initiatives, as well as the installation of low-flow showerheads and aerator-equipped taps throughout the hospital, can achieve water savings of approximately 60 000 kilolitres for the facility per annum. The hospital’s desalination plant, installed in 2019, also has the filtration capacity to support all Netcare facilities in the City of Cape Town in a disaster situation.

Netcare achieved a 23% reduction in water consumption at Group level between 2014 and 2020. Nortje outlined the 2030 aim to further reduce the company’s impact on the natural potable water sources by implementing grey- and black-water recycling projects within selected facilities.

The company’s sustainability strategy, initiated in 2013, addresses electricity use, waste reduction, and water management. The Group aims to further reduce its impact on water sources by an additional 20% from the 2020 baseline. The strategy includes efficient equipment deployment, the evaluation of greywater and blackwater treatment for potable water and an operational efficiency drive.

“We believe every business should be a good corporate citizen contributing to our country’s future. At Netcare, we want to show South Africa and the world that sustainability is possible and that YOU can make a difference. The certification allows us to showcase our efforts to inspire businesses around us to join in the fight against wastage,” concluded Nortje.

Chlorine Disinfectant no Better than Water at Eliminating C. Diff

Clostridioides difficile. Credit: CDC

One of the primary chlorine disinfectants currently used for hospital infection control does not kill off spores of the notorious cause of hospital-acquired infection Clostridioides difficile, according to a new study published in the journal Microbiology.

Research by the University of Plymouth has shown that C. Diff spores are completely unaffected despite being treated with high concentrations of bleach used in many hospitals.

In fact, the chlorine chemicals are no more effective at damaging the spores when used as a surface disinfectant – than using water with no additives.

The study’s authors say susceptible people working and being treated in clinical settings might be unknowingly placed at risk of contracting the superbug.

As a result, and with incidence of biocide overuse only serving to fuel rises in antimicrobial resistance (AMR) worldwide, they have called for urgent research to find alternative strategies to disinfect C. diff spores in order to break the chain of transmission in clinical environments.

Dr Tina Joshi, Associate Professor in Molecular Microbiology at the University of Plymouth, carried out the study with Humaira Ahmed, a fourth year Medicine student from the University’s Peninsula Medical School.

Dr Joshi, said: “With incidence of anti-microbial resistance on the rise, the threat posed by superbugs to human health is increasing. But far from demonstrating that our clinical environments are clean and safe for staff and patients, this study highlights the ability of C. diff spores to tolerate disinfection at in-use and recommended active chlorine concentrations. It shows we need disinfectants, and guidelines, that are fit for purpose and work in line with bacterial evolution, and the research should have significant impact on current disinfection protocols in the medical field globally.”

C. diff causes diarrhoea, colitis and other bowel complications, causing around 29 000 deaths per year in the USA, and almost 8500 in Europe, with the most recent data showing that, in the UK, incidence of C. diff infection was increasing prior to the start of the COVID pandemic.

Previously, Dr Joshi and colleagues had demonstrated the ability of C. diff spores to survive exposure to recommended concentrations of sodium dichloroisocyanurate in liquid form and within personal protective fabrics such as surgical gowns.

The new study examined spore response of three different strains of C. diff to three clinical in-use concentrations of sodium hypochlorite. The spores were then spiked onto surgical scrubs and patient gowns, examined using scanning electron microscopes to establish if there were any morphological changes to the outer spore coat.

Dr Joshi, who is on the Microbiology Society Council and Co-Chairs their Impact & Influence Committee, added: “Understanding how these spores and disinfectants interact is integral to practical management of C. diff infection and reducing the burden of infection in healthcare settings. However, there are still unanswered questions regarding the extent of biocide tolerance within C. diff and whether it is affected by antibiotic co-tolerance. With AMR increasing globally, the need to find those answers – both for C. diff and other superbugs – has never been more pressing.”

Source: University of Plymouth

Netcare Reports Strong Growth in its 2023 Earnings Report

For the year ended 30 September 2023, the Netcare Group’s profit after tax and exceptional items increased by 27.2% to R1 336 million (FY 2022: R1 050 million) and adjusted HEPS increased by 27.0% to 105.7 cents (FY 2022: 83.2 cents). A sustained improvement in activity, off a largely organic base, supported revenue growth of 9.5%. Coupled with tight cost control notwithstanding the high inflationary environment, this has resulted in excellent operating leverage, reflected in the 23.9% growth in operating profit.

Group chief executive officer, Dr Richard Friedland commented, “We are encouraged by the ongoing normalisation and resilient demand for private healthcare services, allowing the Group to continue on the solid trajectory reported during the first half of this past financial year.”

Total paid patient days (PPDs), inclusive of acute and mental health, increased by 6.7% with improved occupancies of 64.4% for FY 2023 (FY 2022: 60.1%).

Dr Friedland continued, “It is also very pleasing that we have made excellent progress in implementing our key strategic projects. The CareOn digitisation project is nearing completion and has been successfully rolled out at 38 acute hospitals to date, covering 90% of beds. The project is delivering tangible benefits for patients across the Netcare ecosystem, and the gross financial benefits of R104 million in FY 2023 have exceeded expectations.”

Similarly, Netcare’s environmental sustainability strategy continued to deliver financial savings and plays a pivotal role in reducing exposure to the impacts of the instability of the national electricity grid. In line with the 2030 sustainability strategy, the Group concluded an agreement for a renewable energy (RE) supply arrangement with NOA Group Trading, a renewable energy trader. This agreement will increase the proportion of Netcare’s total energy consumption derived from RE sources to c26% and represents an important step towards Netcare’s goal of achieving 100% reliance on RE sources by 2030. Netcare is currently exploring further grid-wheeling opportunities that will potentially increase RE-derived energy to c.40%. 

In order to address the growing demand for mental healthcare services in South Africa, Netcare successfully commissioned Netcare Akeso Gqeberha (72 beds) in May 2023. Sales of NetcarePlus products to the retail and corporate segments continue to gain traction, contributing to the Netcare ecosystem through increased access to private healthcare beyond traditional medical schemes and the increased use of its services. Netcare Diagnostics progressed with the rollout of validated and quality assured point of care devices across Netcare’s intensive and high care units, theatres and emergency departments as well as Medicross medical and dental centres.

Dr Friedland said, “We remain committed to our Consistency of Care strategy, broadening the measurement of clinical outcomes and patient experience to ensure we deliver on our core purpose of providing the best and safest care to our patients.”

Cash generated from operations was strong, increasing to R4 135 million (FY 2022: R3 950 million), and the cash conversion ratio amounted to 100.5% (FY 2022: 113.0%). In line with the capital allocation strategy of returning excess cash to shareholders, the Group executed a share buyback programme that, collectively, entailed the repurchase of 33.7 million shares at a cost of R444 million.

Similarly, in line with the dividend policy, which aims to provide shareholders with a sustainable dividend of 50% – 70% of earnings, the Board declared a final dividend of 35.0 cents per share. This, together with an interim dividend of 30.0 cents per share represents 61.5 % of adjusted HEPS and an increase of 30.0% over FY 2022.

Netcare is encouraged by the ongoing improvement in the Group’s financial performance as demand continues to normalise from the impact of the COVID-19 pandemic. The higher activity levels, coupled with ongoing efficiencies, resulted in strong operating leverage and an improvement in Group EBITDA margins of 120 basis points to 17.4%, from 16.2% in FY 2022.

Total capex, including strategic projects, amounted to R1.5 billion for the year, of which R136 million related to expansionary projects, including the completion of construction of the new Netcare Akeso Gqeberha facility and R82 million invested in the hospital digitisation project.

The Group incurred operational costs relating to strategic projects of R258 million (FY 2022: R249 million).

Netcare experienced an average of Stage 3.6 loadshedding across its facilities during the year, resulting in a sharp increase in generator diesel costs to R124 million from R37 million in FY 2022.

At 30 September 2023, the Group‘s cash resources and available undrawn committed facilities amounted to R3.7 billion.

DIVISIONAL REVIEW

Hospital and emergency services

The segment delivered a steady performance for FY 2023, driven by continued recovery in demand and further normalisation of the post COVID-19 operating environment.

Revenue for the segment increased by 9.6% to R23 050 million (FY 2022: R21 024 million) and total patient days increased by 6.7% to 2 447 494 days in FY 2023 (FY 2022: 2 293 344 days). The steady increase in activity contributed to higher occupancy levels with total occupancy of 64.4% (FY 2022: 60.1%).

Notwithstanding the changes in various networks that were effective from January 2023, a milder flu season and extended vacations by specialists, acute hospital patient days increased by a solid 6.1% against FY 2022, equating to 95.1% of FY 2019 with ICU and high care PPDs being 10.1% higher than pre-pandemic levels.

In line with the trend reported in H1 2023, year-to-date growth in medical PPDs of 8.5% continued to outpace surgical PPD growth of 3.9%. Medical PPDs have recovered to 99.0% of 2019 levels, while surgical PPDs continue to be impacted by sector trends, inter alia, declining maternity cases, as well as an outmigration of lower margin day cases, and have recovered to 91.7% of pre-pandemic levels. Total surgical cases comprised 51.5% of patient days (FY 2022: 52.6%; pre-pandemic levels: 53.4%) and medical cases 48.5% (FY 2022: 47.4%; pre-pandemic levels: 46.6%). Surgical cases continue to contribute more than 70% of revenue.

Demand for mental healthcare remains strong with mental health patient days increasing by 12.7% compared to FY 2022. The newly opened Netcare Akeso Gqeberha facility contributed 2.3% of this growth. Activity has surpassed pre-pandemic levels by 5.4% (same store) and 11.6% inclusive of the 36-bed Netcare Akeso Richards Bay facility (commissioned in May 2022) and the 72-bed Netcare Akeso Gqeberha facility (commissioned in May 2023).

The strong increase in mental healthcare activity has resulted in occupancies improving to 72.7% (73.5% excluding Netcare Akeso Gqeberha) in FY 2023 from 68.1% in FY 2022 (FY 2019: 71.6%).

In 2023, Netcare Christiaan Barnard Memorial Hospital received Level 1 trauma accreditation from the Trauma Society of South Africa, which is aligned to the American Trauma Society accreditation principles. There are only four hospitals in South Africa that have achieved this status, all of which are in the Netcare Group.

Netcare’s geographic footprint, electronic medical records (EMR) offering, and highly accredited facilities, allow the Group to continue attracting specialists and a net 124 doctors were granted admission rights at acute and mental healthcare facilities during FY 2023.

Primary care

Total GP and dental visits decreased by 3.1% in FY 2023 compared to FY 2022. The decline in visits is predominantly attributable to the higher base in FY 2022, which was boosted by increased COVID-19 GP visits during the Omicron-driven fourth wave. Revenue increased by 4.6% to R663 million. EBITDA margins were adversely impacted by diesel fuel costs.

Strategic update

Netcare has made excellent progress in the implementation of its key strategic projects and is now well placed to benefit from the rapidly changing dynamics driving demand in the healthcare sector.

Digitisation: Significant progress has been made in the implementation of the CareOn hospital EMR offering, which is a major focus of the digitisation strategy. This new way of care has been successfully implemented at 38 of the 45 Netcare hospitals to date, comprising 8 645 beds (90% of registered beds). In addition, over 28 000 healthcare professionals, comprising nurses, doctors, allied health professionals and pharmacists are actively using the system. Rollout to the final seven hospitals (943 beds) will be completed by April 2024. Dr Friedland said, “We remain confident that this investment will create a sustainable competitive advantage for the Group and will prove pivotal in laying the foundations in achieving our strategy of person centred health and care that is digitally enabled and data driven.” Digitisation has now been completed across all ancillary businesses in the Netcare ecosystem spanning across Netcare Akeso, Netcare Medicross, Netcare 911, National Renal Care and Netcare Cancer Care radiotherapy.

Netcare App: Netcare successfully launched its App in July 2023, which represents the next phase of the strategy to enable digital engagement with patients and clients. There has been a robust take-up of this App, which allows online pre-admissions, doctor appointments, the ability for Netcare 911 to geolocate someone in an emergency, access to a Summary of Care, and the ability to purchase NetcarePlus policies, with further services to be added in future.

Promoting access to healthcare: NetcarePlus has a portfolio of innovative healthcare products and funding solutions that promote access to affordable, quality healthcare in South Africa. In FY 2023, Netcare launched additional pre-paid procedures, completed enhancements to NetcarePlus GapCare and NetcarePlus Accident Cover, and also launched a new primary care offering.

Netcare Diagnostics: Netcare Diagnostics, which supports a Black female owned pathology service provider, Dr Esihle Nomlomo Inc., is gaining traction and made a positive contribution to EBITDA. The first stage rollout of 122 blood gas analysers at Netcare’s intensive care and high care units has been completed, with a further 70 point of care devices commissioned at ten emergency departments. Additionally, the service has been rolled out at ten Medicross facilities to date and will be extended to further sites in FY 2024.

Environmental sustainability: The first phase of the Group’s environmental sustainability strategy commenced in 2013. Since then, energy intensity per bed has reduced by 39%, exceeding the initial 10-year target. Similarly, the Group has exceeded its 2023 financial targets, achieving cumulative operational savings and benefits of more than R1.5 billion to date, yielding an IRR of 40%. In FY 2021, Netcare embarked on the second phase of its strategy, with a primary target of reducing Scope 2 emissions to zero by 2030 and Scope 1 and 3 emissions by a combined 84%. The Group’s 2030 strategy aims to achieve 100% utilisation from renewable sources, with zero waste to landfill and an additional 20% reduction of impact on water sources.

Outlook and guidance

Although the macro environment remains impacted by national power grid load shedding, global supply chain limitations, constrained consumers, and high levels of unemployment, Netcare has a number of measures in place to mitigate these challenges and remains focused on optimising the progress made in FY 2023. Furthermore, the environmental sustainability projects will continue to mitigate the significant escalation in costs associated with increased reliance on diesel powered generators resulting from the instability of the national electricity grid.

Although there has been limited growth in medical scheme membership, the pool of covered lives remains resilient and underscores the sustainable demand for quality private healthcare, which is exacerbated by the growing disease burden and ageing insured population.

For FY 2024, the Group expects revenue growth of between 7.5% and 9.5%. Total patient days are expected to grow by between 2.5% and 3.5% off a largely normalised base. The increased activity will drive further EBITDA margin expansion, improved earnings and a higher ROIC.

Netcare will continue to maintain an optimal capital structure, and the strength of the statement of financial position and the ongoing improvement in operational performance in the underlying businesses will continue to support dividend payments in line with the Group’s dividend policy.  Netcare will also continue to return excess cash to shareholders by way of share buybacks or special dividends.

Dr Friedland concluded, “We are confident that our strategy remains relevant, and we are firmly committed to realising growth opportunities, improving returns and the successful execution and completion of our key strategic projects. Notwithstanding the fluid economic environment, we expect ongoing improvements in the operational and financial performance of the business in FY 2024 and beyond.”

Cracking the Whip on Fraud, Waste and Abuse at This Week’s BHF Forensic Unit Indaba

Photo by Jp Valery on Unsplash

A realistic update on the amount of funds lost to fraud, waste and abuse in the South African healthcare environment as well as a special address dedicated to the value and protection of whistle blowers will lead discussions during the annual Board of Healthcare Funders (BHF) Healthcare Forensic Management Unit (HFMU) Fraud, Waste and Abuse (FWA) Indaba at The Houghton in Johannesburg on Wednesday, 22 November.

Convened to coincide with International Fraud Awareness Week and to be moderated by BHF Forensic Unit chair, Dr Hleli Nhlapo, the Indaba spotlight will be on “Strengthening a Culture of Integrity and Accountability – New Strategies for a Corruption Resistant Future “ – subject of the keynote address.

The event will once again endorse the BHF’s representative role as a guardian of the interests of medical schemes, administrators and managed care organisations not only in South Africa but also Lesotho, Zimbabwe, Namibia, Botswana, Mozambique, Malawi and eSwatini.

To this end an unprecedented feature this year will be a panel discussion by Southern African Development Community (SADC) members on strengthening anti-corruption efforts in the SADC Region with cross-border co-operation.

“Promoting the culture of whistle blowing and the protection of whistle blowers” will be a significant key point on the Indaba agenda with the promise of a lively discussion on the encouragement of whistle blowing with the non-negotiable proviso that specific mechanisms should be put in place for corruption reporting without repercussions. 

Until last year fraud, waste and abuse losses in South Africa were generally estimated at just under the R30-billion mark, but as pointed out by the Special Investigating Unit’s Advocate Andy Mothibi at the BHF Conference earlier this year, this figure was likely to be a lot higher.

Fraudulent activities relating to false claims was still a major contributing factor to these losses, he explained, alluding to an observation that anything between 5% and 15% of all medical aid claims could include elements of FWA.

Spurious activities in this regard will no doubt emerge in some of the answers to the Indaba agenda question “Is there ‘Rent Seeking’ in our Healthcare System?” – “rent seeking” being an economic term for an individual who or an entity which seeks to increase their own wealth without creating any benefits or wealth by activities which aim to obtain financial gains and benefits through the manipulation of the distribution of economic resources.

In the same vein, the discussion on “Cracking the Code: Uncovering and Combating Organized Crime Networks in Healthcare”, should shed light on current FWA challenges followed by collaborative measures to counter these such as the use of the HMFU FWA portal introduced four years ago with the prime objective of combating healthcare fraud, waste, and abuse.

Another important element of FWA which has risen to the fore particularly since the successes of the SIU, has been the recovery of lost funds. This will be the focal point of a presentation “Navigating the Road to Restitution: Strategies for Successful Civil Claims Recovery in Healthcare” during which a series of steps to recover losses from wrongdoing or fraud in healthcare are scheduled to be presented.

Going by previous deliberations on the topic, these are likely to emphasise the need for a dedicated legal team with healthcare law and fraud recovery expertise and a commitment to justice for fraud and misconduct victims.

The day’s proceedings will conclude with the SADC member panel discussion on “Cross border Co-operation: Strengthening Anti-Corruption Efforts in the SADC Region”.

Members are expected to deal with important issues such as, not least, the protection of whistle blowers, as well as encouraging healthcare workers in their specific countries to report corruption risk-free with the promotion of law enforcement capabilities and related awareness campaigns.