Category: Politics

Miscarriage Should be Recognised as a Bereavement, Argues Psychiatrist

Photo by Joice Kelly on Unsplash

A miscarriage during the first 6 months of pregnancy should be recognised as a bereavement, rather than illness in UK law, argues psychiatrist Nathan Hodson in correspondence published online in the journal BMJ Sexual & Reproductive Health.

Some MPs in the UK government have called for following in the steps of New Zealand’s policy of giving bereavement leave at  any stage of pregnancy loss, though this has been met with opposition.

The Parental Bereavement (Leave and Pay) Act 2020 allows for two weeks’ statutory bereavement leave for a stillbirth after 24 weeks and for the loss of a child up to the age of 18 in the UK. In South Africa, the 2002 Basic Conditions of Employment Act allows for six weeks’ maternity leave for pregnancy loss after 28 weeks.

Dr Hodson pointed out that parents in these circumstances are also entitled to take maternity or shared parental leave planned before the stillbirth, giving them weeks or months to recover from their loss.

But those who miscarry before 24 weeks in the UK have no such rights, added to which the miscarriage is regarded as an illness, with entitlement to sick leave. And if this lasts longer than 7 days, a formal sick note from a doctor is required.

“This policy creates an arbitrary cliff edge at 24 weeks,” with few women who miscarry being aware of their employment rights, Dr Hodson insisted.

Presently it is not known how many miscarriages occur in the UK annually nor how much sick leave is taken for them. He acknowledges this could open up private companies to unknown costs for employee miscarriage at any stage.

A single week of statutory bereavement leave when miscarriage occurs after the 12 week scan could reduce these costs. “Miscarriage risk after 12 weeks is less than 1% so this policy would be highly targeted with a less uncertain price tag,” he explained.

And within 2 or 3 years there should be sufficient data from New Zealand to estimate the impact of the policy, which was introduced in March this year. This allows women and partners 3 days of paid leave, irrespective of how long the woman had been pregnant, but excluding abortions.

But in any case, “miscarriage should as far as possible be recognised as bereavement, not sickness, and many parents will need time off work afterwards,” wrote Dr Hodson.

“Leave following first-trimester miscarriage should be prioritised when New Zealand has published data. But whatever approach is taken with regard to early miscarriages, the cliff edge at 24 weeks is a stark injustice demanding remedy.”

Source: EurekAlert!

NHI Implementation on the Financial Rocks – For Now

Photo by Michael Longmire on Unsplash

South Africa’s National Health Insurance (NHI) implementation continues to flounder, as the National Treasury notes its expenditure will not be a significant cost in the medium term. This scheme, which seeks to address the country’s huge gulf in healthcare inequality, has still made barely any progress since its inception over a decade ago.

In its Medium Term Budget Policy Statement published on Thursday (MTBPS), the Treasury said that the national health insurance policy was estimated to cost R40 billion per year in additional funding in the first five years, and perhaps considerably more over time. Therefore, it dismissed the possibility of any substantial work on it, saying that presently, “there is insufficient capacity in the health sector to work substantively on national health insurance. The national health insurance indirect grant has been underspent, the National Health Insurance Fund has not yet been established, and the National Health Insurance Bill still needs to be passed by Parliament.

“It is therefore unlikely that national health insurance will be a significant cost pressure in the medium term,” it said.

While the Department of Health has time and again reiterated its commitment to the NHI system, several studies highlight the system’s deep unpopularity among healthcare professionals. 

“To fund this, we need taxpayers,” said senior researcher Morné Malan at Solidarity Research Institute, when former Health Minister Dr Zweli Mkhize tabled the NHI Bill in Parliament in August 2019.

“To be a taxpayer you must be employed… only 12% of South Africans pay tax.”

In August 2021, trade union Solidarity published a report drawing on three surveys from 2018 to 2021, with 20.8% of respondents already preparing to leave.

Across the studies, the overarching response from healthcare professionals is one of uncertainty and mistrust around the NHI, with general sentiment towards the system being overwhelmingly negative.

“Almost all the respondents have serious concerns regarding the state’s ability to manage and administer the NHI,” Solidarity said. “The total administration and management of funds and decision-making will be in the hands of the state.

“Most are seriously concerned about the fact that the state can determine and enforce tariffs, place of work, type of diagnostic tests and type of medication and treatment.”

The opinions of those surveyed are likely shaped by the observed mismanagement and maladministration at state institutions such as Eskom, Solidarity noted. The NHI will be considerably larger and more complicated, and will have to manage and execute many contracts, it said.

Source: Businesstech

Rare Diseases in South Africa: A Neglected Topic

Source: Pixabay/CC0

An article in Spotlight examines the challenges faced by South Africans with rare diseases.

A rare disease is a health condition affecting a small number of people compared with other diseases commonly identified in the population. According to the World Health Organization (WHO), there are between 5000 and 8000 known rare diseases worldwide, affecting an estimated 400 million people.

According to the advocacy group Rare Disease South Africa (RDSA), about 3.6 million people in SA have a rare disease. In South Africa, the ability to diagnose a rare disease is hindered by a lack of capacity and resources, according to research, putting the time to diagnosis for rare diseases in general higher than the estimated 5.5 to 7.5 years in high-income countries.
“There is still low recognition of genetic disorders among specialists. And when they are recognised, testing remains expensive and requires sophisticated levels of training which are relatively limited,” says Prof Karen Fieggen, a medical geneticist at the University of Cape Town (UCT).

According to her, costs, skills, training, and human resource factors are all barriers to effective testing and diagnosis. But she says the rationale to build an effective system is solid.

“We have capable people and expertise to build this system, but until you invest in it, it won’t be big enough to be self-sustaining,” she says.

Prof Fieggen acknowledges that resources are stretched in the public sector, where specialists who carry out genetic testing for rare diseases must meet the needs of a larger part of the population. However, she notes, “there’s no guarantee you’re better off in the private sector”.

“There are very few genetic referral options, and none of the medical geneticists are kept in work full time,” she says. In Cape Town, for example, she says that all patients seeking genetic testing had to come to the private sector until recently. “We have the capacity to train seven specialists a year, but posts aren’t available for them to take,” she says.

At one per 4.5 million population, available medical geneticists in the public healthcare sector fall far short of the 21 per 2 million recommended by the WHO. These services are also spread unevenly through the country. The country’s heavy burden of HIV and TB is partly responsible for this lack of coverage.

While healthcare training must focus on these public health needs, Prof Fieggen says rare diseases need a sensible approach. “It doesn’t help to throw huge resources at something that will have minimal management impact,” she says. “But the way in which rare diseases have been relatively ignored isn’t constructive.”

Helping the recognition of rare diseases and referral pathways in physician training may make a difference. “One thing that could be instilled in training is to recognise that if things are atypical in their presentation, there should be a discussion with a referral centre,” says Associate Professor Ian Ross, a senior consultant endocrinologist at UCT and Groote Schuur Hospital.

Only 2.5-5% of rare diseases have approved treatments, some of which are prohibitively expensive.

The most expensive drug in the world is Zolgensma (generic name onasemnogene abeparvovec), a once-off treatment costing a mind-blowing USD $2.1 million (R 30m). Used to treat inherited spinal muscular atrophy, where infants with the condition are unlikely to see their second birthday. However, even this is available through the UK’s National Health Service, which struck a deal to bring prices down.

Du Plessis says these drugs are not on the essential medicines list because of the small group of patients they would serve. “The essential medicines list is dedicated to treatments that are procured in large numbers. Rare diseases will never be mass-market drugs.”

Such drugs can be purchased by hospital pharmacists so they can be available at a certain hospital, making for a haphazard situation.
To help address this inequality, RDSA held a Rare Disease Symposium on 25 August, inviting feedback on a draft policy framework from various medical sector and political stakeholders.

The framework has a definition for rare disease in SA, namely a condition affecting one in 2000 people or fewer. It also recommends including rare diseases in the NHI benefit package. The NHI bill also includes a Benefits Advisory Committee, which will determine what diseases get coverage,

However, Dr Nicolas Crisp, Acting Director General for Health, said that the NHI would not ring-fence funding. As medical insurance will be done away with, it will be crucial to secure funding for those extremely expensive drugs unaffordable to the private sector.

Source: Spotlight

A Look Back at Mkhize’s Tenure as Health Minister

Image by Hush Naidoo from Unsplash
Image by Hush Naidoo from Unsplash

With Dr Joseph Phaahla being promoted from his position as Deputy Health Minister to replace the embattle, Dr Zweli Mkhize, Spotlight reviews Dr Mkhize’s tenure, writing that the very reason he was brought in to that post — to roll out National Health Insurance — would likely suffer a considerable setback as a result of his exit.

His appointment as South Africa’s Minister of Health in May 2019 came as a surprise for some. As one of the ANC’s top officials, the health portfolio seemed a meagre choice in the pre-COVID days.

However, Mkhize’s seniority signalled that health was being given high priority in the new administration. Theoretically, his greater political clout meant he would have a better chance of bringing much-needed reforms to provincial healthcare systems. Spotlight were also “cautiously hopeful that Mkhize’s firmer hand would help better organise and direct the National Health Department and the various national health entities.”

A string of procurement scandals during his time as KwaZulu-Natal’s Premier was cause for concern but was not direct evidence that he was corrupt.

The Digital Vibes scandal had the side effect of making Mkhize anathema to the very project he was originally brought in for, implementing National Health Insurance.

Even with Mkhize gone, the ANC will have a hard time convincing the public that we will not see more such looting once NHI is implemented. There has, after all, been little willingness from ANC members in Parliament to engage seriously with people’s concerns about the proposed NHI structure and governance arrangements set out in the NHI Bill.

Mkhize tackled COVID from a scientific standpoint, which is fortunate for the nation considering the anti-scientific stance of the former Minister of Health Dr Manto Tshabalala-Msimang. However, the decision not to use AstraZeneca vaccines remains contentious. Meanwhile, a purge of scientists, starting with Professor Glenda Gray, let Mkhize surround himself with allies, according to Spotlight.

However, entering the third wave with vaccinations lagging so far behind was a governance disaster possibly even worse than the Digital Vibes scandal.

From an outside perspective, the past two years have not seen great progress in the department, despite some competent individuals, with infighting, under-capacity and most seriously, poor management. The procurement department

Source: Spotlight

EU Demands AstraZeneca Vaccine Produced by UK Plants

In another twist to the EU’s seemingly never-ending vaccine procurement problems, the EU health minister has demanded that vaccine production from AstraZeneca’s UK operations be sent to EU countries to make up for the company’s shortfall at its two European plants. 

EU health commissioner Stella Kyriakides dismissed AstraZeneca’s argument that it the UK take precedence.

“We reject the logic of first come, first served,” the commissioner declared. “That may work at the neighbourhood butcher’s [shop] but not in contracts and not in our advanced purchase agreements. There’s no priority clause in the purchase agreements.”

The Anglo-Swedish company had triggered fury in Brussels when it was revealed that it would only be able to deliver 25% of the agreed vaccine doses when they received approval as expected this Friday. However, AstraZeneca assured the UK government that it would meet its commitment of supplying 2 million doses a week. UK government sources insisted that only once AstraZeneca had fulfilled its order to provide the UK with 100 million doses would its vaccine production be allowed to be released to serve other countries.

The EU meanwhile is flagging far behind, with only 2% of its adult population vaccinated compared to 10% of the UK’s. Kyriakides pointed out that in its contract with AstraZeneca, four European plants were listed as suppliers and two of those were located in the UK, and she expected them to work for EU citizens.

An AstraZeneca spokesperson said: “Each supply chain was developed with input and investment from specific countries or international organisations based on the supply agreements, including our agreement with the European commission.

“As each supply chain has been set up to meet the needs of a specific agreement, the vaccine produced from any supply chain is dedicated to the relevant countries or regions and makes use of local manufacturing wherever possible.”

Kyriakides said the argument was unacceptable, emphasising that the company had a moral duty to treat the EU similarly to the UK, adding that there was no “priority clause” that would justify UK residents benefiting first from doses made there.

Germany meanwhile has said that it is facing 10 weeks of vaccine shortage.
However, there is encouraging news as Israel reported a 92% effectiveness with the Pfizer/BioNTech vaccine outside trials. Only 31 of 163 000 Israelis caught COVID within ten days of the innoculation reaching its full strength. None were hospitalised.

Source: The Guardian

UNAIDS Calls for Renewed Action and Sets 2025 Targets

In a press release, UNAIDS reflects on the current state of the fight against HIV and AIDS, and notes that while there are numerous setbacks, it is possible to renew the fight.

It notes that the global response to HIV was already flagging before the advent of the COVID pandemic, and this has only pushed back the effort further. According to the agency, projections show 123 000 to 293 000 additional new HIV infections, along with 69 000 to 148 000 additional AIDS-related deaths between 2020 and 2022.

The agency strongly criticised the lack of political commitment which has led to this combined blow.  Winnie Byanyima, Executive Director of UNAIDS  said, “The collective failure to invest sufficiently in comprehensive, rights-based, people-centred HIV responses has come at a terrible price. Implementing just the most politically palatable programmes will not turn the tide against COVID-19 or end AIDS. To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive.” 

By proposing bold new targets for 2025, UNAIDS believes that the world can successfully meet its goal of ending HIV as a public health threat by 2030. The goals include reducing discrimination against HIV sufferers, removing punitive laws and combating gender inequality and gender-based violence. However, not all is negative: countries such as Botswana and eSwatini have already exceeded their 2020 targets. There are other positive spots, such as the infrastructure used to fight HIV/AIDS being leveraged in the fight against COVID.

Source: UNAIDS