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QUALIT Y

healthcare

A long and healthy life for all South Africans


primary healthcare

hospital illness accident trauma disability cover

dread disease illness top-up

Unbeatable health cover from R265 per month.


DAY TO DAY BENEFITS from R265 per month HOSPITAL PLAN from R380 per month COMPREHENSIVE COVER from R645 per month

emergency medical

employee wellness GAP cover

SENIOR PLAN from R295 per month

maternity cover

funeral cover

We create healthy, happy families.


This year presents us with an exciting and unique moment; we have the tools to control the HIV epidemic, even without yet having an HIV vaccine or cure. The United States fully supports the South African government’s bold commitment to provide life-saving HIV treatment to 2 million additional South Africans by 2020.

U.S. Chargé d’Affaires Jessica Lapenn with Grassroot Soccer participants The American people remain deeply committed to the South African people, and through the U.S. President ’s Emergenc y Plan for AIDS Relief (U.S. PEPFAR), we have been proud par tners in South Africa’s HIV/AIDS response and achievement since 2004. Our commitment helps provide testing and counseling, life-saving antiretroviral therapy (ART ) for more than 4 million people, suppor t for orphans and children made vulnerable by the epidemic, and increases in health system capacity to suppor t these individuals through care and treatment. Our more than 70 billion rand investment is focused for impac t to control the HIV/AIDS epidemic and aligned with the National Strategic Plan for HIV, TB and STIs 2017-2022 (NSP), and NDoH’s Treatment and Retention Acceleration Plan. In 2018, we continue our emphasis on epidemic control in the 27 NSP focus distric ts and nationally, to increase testing, treatment, care, and prevention. We continue to work with our South African par tners to enhance access to treatment ser vices, suppor t

DREAMS program for young women

U.S. Health Attaché during transition of the KZN nursing training program

We are confident that together, we can create a healthier and brighter future for South Africa! the health workforce, facilitate easier access to HIV medicines, and harness innovation and technology for greater impac t. Our U.S. PEPFAR programs operate in accordance with core American values of compassion, empowerment, innovation, transparenc y, accountability, and par tnership.

U.S. PEPFAR Community Grants recipients


64 STEPS IN THE RIGHT DIRECTION Investing in progressive policies to transform the national health system

A long and healthy life for all South Africans

05 FOREWORD Minister of Health Dr Aaron Motsoaledi on SA’s healthcare system 08 OVERVIEW How the Department of Health is reforming SA’s healthcare system 18 MINISTER INTERVIEW NHI: Quality healthcare for all 26 DDG: PRIMARY HEALTHCARE INTERVIEW Jeanette Hunter on strengthening the public health system 29 KEY ACHIEVEMENTS Highlights from the DOH’s 2016/17 financial year 38 HEALTHCARE POWERED BY TECH MomConnect and NurseConnect mobile programmes 44 mHEALTH Taking healthcare into the 21st century 58 PHARMACY Good practice makes better

68 CANCER PREVENTION AND CONTROL The DOH’s early detection and prevention initiatives 76 MENTAL HEALTH Road to resilience – the Mental Health Policy Framework and Strategic Plan 2013 – 2020

INSIDE

QUALIT Y

healthcare

84 EMERGENCY SERVICES Assessing emergency care education and training 96 HIV, TB & STIs NSP 2017 – 2022: Where to from here? 103 SANAC CEO INTERVIEW Understanding the NSP 111 HEALTH STATISTICS Annual compilation of health statistics for the 194 WHO member states 120 DDG: MATERNAL, CHILD & WOMEN’S HEALTH INTERVIEW Dr Yogan Pillay on delivering quality MNCWH healthcare services in the public sector 125 WOMEN, CHILDREN & NUTRITION Improving the health of women and children

No. 9, 3rd Avenue, Rivonia, Johannesburg PO Box 92026, Norwood 2117, South Africa t +27 (0)11 233 2600 f +27 (0)11 234 7274/75 www.3smedia.co.za Publisher Elizabeth Shorten Managing Director Candice Landie Head of Design Beren Bauermeister Chief Sub-editor Tristan Snijders Sub-editor Morgan Carter Production Manager Antois-Leigh Botma Financial Manager Andrew Lobban Distribution Manager Nomsa Masina Distribution Coordinator Asha Pursotham Please Note: Quality Healthcare statistics have been taken from publically available documents that may or may not reflect the absolute correct numbers applicable at the time of going to print. NOTICE OF RIGHTS This publication, its form and contents vest in 3S Media. All rights reserved. No part of this book, including cover and interior designs, may be reproduced or transmitted in any form or by any means, without permission in writing from the publisher, nor be otherwise circulated in any form other than that in which it is published. The authors' views may not necessarily reflect those of the publisher. While every precaution has been taken in the preparation and compilation of this publication, the publisher assumes no responsibility for errors, omissions, completeness or accuracy of its contents, or for damages resulting from the use of the information contained herein. While every effort has been taken to ensure that no copyright or copyright issues is/are infringed, 3S Media, its directors, publisher, officers and employees cannot be held responsible and consequently disclaim any liability for any loss, liability damage, direct or consequential of whatsoever nature and howsoever arising.


Minister’s Foreword

A healthcare system

we can all be proud of

W

ith the National Health Insurance (NHI) on the horizon for South Africa, quality, affordable healthcare can be a realisation for all our people. The devastating economic global downturn has forced hundreds of thousands into unemployment, and making financial provision for medical aid is no longer possible. This is the time when our country’s poor need protection more than ever before. We can no longer ignore the burden on the State’s healthcare facilities, the delayed response to quality improvements, and inadequate staffing levels. The people of South Africa deserve better. Each and every person deserves access to above-adequate healthcare facilities and services. It is their Constitutional right.

HIV, TB and STIs While NHI is a major agenda for the DOH, we cannot forget about the challenges we face regarding the alarming rate of new HIV, STI and TB infections, as well as the stigma attached to these diseases. In 2016, TB had overtaken AIDS as the biggest killer among infectious diseases. A National Coalition against TB was launched on 18 July 2016 in Durban, KwaZulu-Natal, which has the highest concentration of TB patients in South Africa. The Coalition is a partnership with government and is led by the DOH, which has partnered with the National Religious Association for Social Development, the South African National TB Association, and the South African Red Cross.

South Africa’s National Strategic Plan (NSP) on HIV, TB and STIs 2017 – 2022 serves as a roadmap for the next stage of our journey towards a future where these three diseases are no longer public health problems. This plan sets out the destinations – or goals – of our shared journey and establishes landmarks in the form of specific measurable objectives. The new NSP rests on scaling up and improving the implementation of tried and tested strategies for preventing and treating HIV and TB, as well as improving the identification and management of STIs. The plan gives new impetus to aspects that have been underpowered in the past. The focus on high-burden districts and particular populations has already been highlighted.

Universal health coverage The National Department of Health (DOH) is not oblivious to the fact that universal health coverage (UHC) through the NHI is perceived as a plan to abolish private healthcare in South Africa. This could not be farther from the truth. The concerns from government lie in the exorbitant costs of private hospitals, which are consequently accessible to just 17.4% of the population. We cannot run a healthcare system where there is a gross underservicing of the poor. Moving towards UHC is guided by several United Nations multilateral frameworks, such as the Sustainable Development Goals (SDGs) 2030 and, particularly, SDG 3, as well as the World Health Organization (WHO) frameworks on moving towards UHC. Achieving UHC will contribute significantly towards realising the vision of a long and healthy life for South Africans.

Minister of Health Dr Aaron Motsoaledi

DOH 2018

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B R A V E R Y

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Minister’s Foreword

We urge every role player to embrace this bold national plan and identify the parts that apply to them. The national HIV, TB and STI response is, in truth, the sum of many local, regional and sectoral responses. The targets we have set can only be achieved if each of us owns the targets that apply to our work and makes these the standards we strive for tirelessly in our day-today work.

Supporting mothers and children Currently, most new HIV infections occur in adolescent girls and young women aged 14 to 25. There are far too many girls who leave school early and are subjected to violence and coerced sex. As a result, they become victims of HIV infections and unplanned pregnancies. Children should not be having children. All healthcare workers must provide young people with the correct health services they require, without judgement. Bushbuckridge Local Municipality in Mpumalanga is one of the 22 sub-districts that the DOH prioritised for intensive engagements with young people. The interventions showed a 14% decrease in unplanned pregnancies among girls in 2016 when compared with the previous year. While clearly this is a start, we need to do much better. Furthermore, South Africa is committed to reducing mortality and morbidity among mothers and children. The delivery of comprehensive, quality MCWH (maternal child and women’s health) services is dependent on a well-functioning health system. The introduction of free healthcare services for mothers and children, together with the revitalisation and building of more primary healthcare (PHC) facilities, has improved access to healthcare services for many women and children, especially in rural areas.

MomConnect In keeping up with technological advances, the DOH initiated MomConnect, which aims to support maternal health through the use of mobile-based technologies that are integrated into MCWH services.

South Africa is committed to reducing mortality and morbidity among mothers and children.”

The services are free to the user, and messages are available in all 11 official languages. MomConnect is voluntary and users can opt out at any time. Over 1.7 million moms have registered on MomConnect since it was launched. The overall objective of MomConnect is threefold: 1. To introduce a mechanism for electronically registering all pregnancies in the PHC system as early as possible. 2. To send targeted health promotion messages to pregnant women to improve their health and that of their infants. 3. To provide pregnant women with an interactive mechanism to provide feedback on the service they received. In South Africa, most pregnant women have a cell phone or access to one. By using a system like MomConnect, a large number of maternal and child deaths can be avoided through the implementation of basic interventions. A number of successful pilot projects have been conducted in several countries where cell phone technology was used to improve interventions. MomConnect also helps with factors

linked to the improvement of government facilities. For the healthcare worker, there is NurseConnect – an extension of MomConnect and also initiated by the DOH. The system works in the same way as MomConnect and provides support to midwives and nurses working in MCWH and family planning across South Africa.

Women’s health Women’s healthcare features high on the DOH’s agenda. In August last year, we launched two critical cancer policies – namely, cervical and breast cancer policies – aimed at addressing the high mortality rates caused by these cancers, management of the condition, and improving the quality of life of women in our country. Breast and cervical cancers have been identified as being among the leading causes of deaths among South African women, especially those aged 30 years and older. The Cervical Cancer Prevention and Control Policy will assist in preventing the disease by promoting a healthy lifestyle and making provision for the human papillomavirus (HPV) vaccine, whereas the Breast Cancer Control Policy will focus on breast cancer awareness, early detection, treatment and care. Let’s work together to make South Africa a country that places its people at the frontline of effective healthcare services.

Minister of Health Dr Aaron Motsoaledi

DOH 2018

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InterSystems Overview | Department | Profile of health

Reforming SA’s healthcare system The Bill of Rights states unequivocally that healthcare is a right and no one may be refused emergency medical treatment. The State is mandated to achieve the progressive realisation of this and all other rights and the National Department of Health is one of the most crucial sectors of state in South Africa.

P

ost 1994, the health sector in South Africa invested in progressive policies to transform the health system into an integrated, comprehensive national health system; however, the sector still faces challenges, inclusive of the following: • a complex, quadruple burden of disease, which consists of communicable diseases such as HIV/AIDS and TB, an escalating incidence of non-communicable diseases, high maternal and child mortality rates, and a high incidence of violence, injuries and trauma • serious concerns about the quality of public healthcare • spiralling private healthcare costs. Since 2009, the current Department of Health (DOH) has embarked on a massive reform focused on strengthening health system effectiveness. This has been achieved by addressing health management and personnel challenges, financing challenges, and quality-of-care concerns. The effectiveness of the health system must be strengthened, as this forms the foundation for successful health interventions. Decreasing the burden of disease requires a well-functioning health system that is based on the principles of accessible, equitable,

The main source of revenue for the Department of Health was generated from registration fees of medicines, which yielded an increase of 15.1% in 2016/17 compared to 2015/16 and the inspection fees charged from Port Health Services. The tariffs charged by the Department in this regard are in terms of the provisions of the Medicines and Related Substances Act (No. 101 of 1965) as published in the Government Gazette on 7 November 2012

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DOH 2 0 1 8


Overview | Department of health

From a total allocation for the year under review amounting to R38.6 billion, the Department of Health spent R38.5 billion – 99.7% of the available budget

efficient, affordable, appropriate and quality health service provision.

Equal access According to the debate on the budget vote, 16 May 2017, delivered by Minister of Health Dr Aaron Motsoaledi, medical aids are designed for 16% of South Africa’s population, with an alarming 84% of the population having no right to access good-quality private healthcare as a result of medical aid offerings. The mission of the DOH is to improve the health status through the prevention of illnesses and the promotion of healthy lifestyles and to consistently improve the healthcare delivery system by focusing on access, equity, efficiency, quality and sustainability. This starts with access to affordable, quality healthcare services regardless of race, geographical location and household income.“The most important aspects of these [Bill of Rights in section 27 of the Constitution, subsections 2 and 3] provisions have not yet been operationalised,” said Motsoaledi during the budget vote debate. “The time has now eventually arrived for us to do so. In the second phase of our transition to democracy, the phase of radical economic transformation, we have no option but to do so. It is for this very reason that we have no option but to implement the United Nations programme of Universal Health Coverage, which we call the National Health Insurance (NHI) in South Africa.” NHI is a health financing system that pools funds to provide access to quality health services for all South Africans, based on their health needs and irrespective of their socio-economic

status. Working with the CSIR, the Department of Science and Technology, and the Department of Home Affairs, the DOH announced that its preparatory period has gone very well in this regard. The DOH now has a system that is being implemented that will be ready for NHI. As at 10 May 2017, this programme had reached 1 859 clinics, 1 270 of which are in the NHI pilots, and an impressive 6 355 759 South Africans have registered on this system in preparation for NHI. A unique patient identifier (UPI) is linked to your ID number at the Department of Home Affairs and is considered a cradleto-the-grave number. This means that as soon as you register, you will keep this UPI until you die. First-time registration takes just five minutes. After registration, it will take a healthcare facility only 45 seconds to retrieve a patient’s file in subsequent visits. Thanks to this system, six million South Africans are already enjoying that type of quick service.

Milestones

81%

The UNAIDS 90-90-90 targets require that 81% of people living with HIV receive antiretroviral therapy and that 73% of all people on treatment are virally suppressed

The National Health Insurance, Health Planning and Systems Enablement programme shows an expenditure amounting to R679 170 million (98.3%) in 2016/17, with an under expenditure of R11 423 million (1.7%), against a budget of R690 593 million

In spite of the offset between the private and public healthcare sectors and government’s concern over the increase in certain communicable and non-communicable diseases, the DOH enjoyed many milestones in the 2016/2017 financial year. For example, the recruitment of district clinical specialist teams (DCSTs) started in 2011 to improve the quality of care for mothers, newborns and children. The goal was to provide direct specialist support to districts. Teams have been implemented with varied successes. At the end of March 2017, 45 of 52 districts in nine provinces had functional DCSTs, with at least three members per team.

DOH 2018

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InterSystems Overview | Department | Profile of health

45 40 35

ZAR Billions

30 25 20 15 10 Estimated private sector for ART

5

Global Fund PEPFAR & additional USAID TB grant

-

2016/17

2017/18

2018/19

Two hundred specialised doctors and nurses are currently providing support to primary healthcare and district hospital services, with most districts in South Africa now having at least one specialised doctor. They have made a significant contribution in prioritising clinical care for critical target groups and in improving the skills level of staff. Furthermore, the municipal WardBased Primary Healthcare Outreach Team (WBPHCOT) programme expanded during the 2016/17 financial year. At the end of March 2017, there were 3 275 functional WBPHCOTs – an increase of 1 527 teams from a baseline of 1 748 in 2014/15. The DOH also performed well on TB. The new client treatment success rate reached 84.7%, and a client death rate of 3.9% was achieved against the set target of 4% for 2016/17.

of people living with HIV experienced some form of external stigma

36.3% of people living with TB reported experiencing TB-related stigma

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DOH 2 0 1 8

2019/20

2020/21

2021/22

With regard to the massive TB screening campaign, specific annual targets have been set for TB screening in correctional services and controlled mines. These services are implemented through a service-level agreement by sub-subrecipients (SSRs) of global funding. An estimated 47.1% of inmates were screened for TB on admission to correctional services. SSRs performed poorly due to uncertainty resulting from delays in the disbursement of funds experienced during previous quarters. A full 100% of controlled mines provided routine TB screening. On the vaccine front, the human papillomavirus (HPV) vaccine targeting girls in grade four was introduced to protect them against cervical cancer, which is a major cause of death, especially

Govt of SA: Other SSD funding Govt of SA: HIV/STI/TB funding

among African women. The programme was largely successful, reaching 420 356 targeted girls for the first dose HPV immunisation and 327 460 for the second dose. The fight against HIV and AIDS is an ongoing one. Prevention is the mainstay of efforts to combat this disease. Since the DOH introduced the HIV Counselling and Testing campaign in 2010, over 44 million people have been tested. A total of 14 233 123 people were tested for HIV, exceeding the annual target of 10 million for the 2016/17 financial year. Voluntary medical male circumcision (VMMC) is one of the Department’s combination HIV prevention interventions. During 2016/17, a total of 491 859 VMMCs were conducted (this included VMMC data obtained from partners).


AFFORDABLE &

PRACTICAL

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Lifestyles

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FAMILY OPTIONS

www.day1health.co.za 0876 100 600 DOH 2018

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InterSystems Day1 Health | |MAIN Profile Sponsor’s Message

A new era for

healthcare in South Africa

Richard M Blackman, CEO, Day1 Health

T

he end of 2017 ushered in a new era for healthcare in South Africa. The health demarcation debate that has persisted for almost two decades between the long- and short-term insurers and the Council for Medical Schemes (CMS) came to an end. Day1 Health was granted full exemption to continue providing low-cost hybrid (primary healthcare and hospital cover) health insurance products that it originally designed and introduced to the market many years ago, prior to the design of a Low-Cost Benefit Option medical scheme framework, which the CMS intends on introducing during the course of 2019, once certain changes have been made to the Medical Schemes Act (No. 131 of 1998), in the build-up to National Health Insurance (NHI). Contrary to scepticism, Day1 Health’s funding model has proven over the years that it is possible to deliver private healthcare cover, unlimited day-to-day benefits for as little as

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DOH 2 0 1 8

R8.70 per day and, for an additional R4.00 extra per day, adequate private hospital treatment may be included too, inclusive of VAT and reasonable broker commissions. With this in mind, and with the support of labour, which Day1 Health enjoys, it is our purpose to persuade employers in both the private and public sectors to fund or, at the very least, co-fund the minimal costs associated with our products, as alluded to above, thereby making healthcare a condition of employment. The aforementioned costs are fully tax-deductible in terms of Section 11A of the Income Tax Act (No. 58 of 1962) and are, in any event, negligible in comparison to the increased output and productivity levels that would naturally ensue as a result of a reduction in absenteeism from the workplace by implementing this measure. Furthermore, if it were mandatory for employers to contribute to the well-being of their staff members, an enormous burden would be removed from the State, in that the State’s primary responsibility would then only need to focus on the very vulnerable and unemployed sectors of society, bringing NHI within closer reach. Similarly, many grossly unfair labour practices still exist in certain sectors, such as in the municipal sector, where vested interests ensure that only high-income earners have access to medical cover, which, indirectly,

has put huge pressure on our State healthcare facilities. These practices should now be stopped, as they are at variance with not only Section 27 of the Constitution, but Section 18 of the Bill of Rights – that being, the right to freedom of association. From a practical perspective, South Africa has a long way to go before NHI may come into effect, given the current state of our economy. We must not, however, underestimate the resilience and resolution of the ruling party; with its new president-elect, the resurgence of our economy is still possible. The Department of Health has many challenges ahead but, once all bad elements have been taken care of, with determination and fortitude, State hospital facilities can be sanitised and rebuilt. When this transpires, citizens will begin to gain confidence in the State’s ability to deliver quality healthcare, which is an absolute prerequisite for its success. With regard to corruption, a zerotolerance policy needs to be adopted – as Botswana has successfully done. Following that, confidence in the economy will re-emerge, bringing with it sustainable GDP growth and paving the way for a more equitable distribution of health provision for the entire country, as is contemplated with the roll-out of NHI.

Richard M Blackman CEO, Day1 Health


Day1 Health InterSystems | main |sponsor Profile

The rising sun in healthcare

T

he year 2003 saw Day1 Health (Pty) Ltd pioneer the first hybrid medical insurance product, combining both primary healthcare and hospital plan benefits, which was made available to consumers as a more affordable alternative to traditional medical aid schemes. “We, at Day1 Health, are, and have always been, an affordable healthcare provider from the day we started 16 years ago. Day1 Health was up against the might of medical schemes simply because issues always existed around insurance-based schemes,

some of which, sadly, historically declined both the elderly and the sick,” shares Richard Blackman, CEO, Day1 Health. “Our good reputation is, however, the driving force behind our business. We ensure that all of our customers are treated fairly and I believe this was an important factor in Day1 Health recently being granted full demarcation exemption status from the Council for Medical Schemes (CMS).” Over the decades, access to quality private healthcare has become unobtainable, driven to a point where only the privileged few can afford conventional medical aid cover. An estimated 8.8 million South Africans are covered by medical aid – a figure that has remained static for some time because people cannot afford the cost associated thereto. A huge gap exists in the market to service the almost 7 million employed people

Day1 Health’s mission, as a low-cost benefit option product provider, is closely aligned with Section 27 of the South African Constitution, which states that it is everyone’s fundamental human right to be able to access quality healthcare.

who cannot afford medical aid. The country’s tax brackets are indicative of the fact that the majority of its citizens are relatively poor and since the cost of medical aid increases the higher an individual’s income, many would rather abstain from obtaining medical aid cover. Day1 Health’s solution, however, bucks the medical aid trends by demystifying the cost of delivering quality healthcare. The company’s premiums remain highly competitive and, in certain instances, have not increased in the last nine years, proving that, in spite of the hospital claims it

TABLE 1 Summary from the Healthcare Consumer Survey 2016 Reason for leaving medical scheme

Percentage

No longer affordable

41.0

I/my partner changed jobs

11.6

I/my partner became unemployed

11.2

Not good value for money

5.6

Was on my parents’ medical scheme but then left home

9.3

I wanted to stay but my medical scheme terminated my membership

3.0

Was a member through an employer, but contributions became unaffordable after changing employment

13.1

Have no dependants and, therefore, not concerned about healthcare needs

1.9

Was excluded from being a member due to health status

0.4

Other

3.0

Note: The 21% of survey respondents who were no longer a member of medical aid, even though they were at some point, were asked why they left. The results, as per above, reveal that 41% left their medical aid scheme because it was no longer affordable. This was followed by 13% who were members through an employer, but contributions became unaffordable after changing employment.

DOH 2018

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InterSystems Day1 Health | |main Profile sponsor

Good to know Some of the Day1 Health initiatives include:

1 2 3 4 Introducing a new Primary Healthcare and Indemnity Hospital product to specifically cater for the needs of the elderly.

negotiate with the likes of specialists and other important stakeholders in the private healthcare system. ” The day-to-day benefits of the Successfully contracting with plans, as outlined in Table 2, cover all Life Healthcare hospital prepaid preventative healthcare via facilities nationwide. 1Doctor Health (Pty) Ltd. On the Day1 Health plans, doctor consultations are unlimited, but managed, via Negotiating discounted the 1Doctor Health Network; acute rates with private and chronic medication is covered specialists to avoid according to the 1Doctor patient co-payments. The launching of Health formulary; basic the Day1 Health dentistry treatment, such as Clinic adjacent to preventative cleaning, pain Garden City. has had to pay, control, fillings, extractions Day1 Health still and one emergency root manages to make a marginal profit. canal treatment, is covered as per the 1Doctor Health dentistry protocols; Package offering basic diagnostic blood tests are Day1 Health offers the following covered on referral by a 1Doctor Health healthcare and assistance services: Network GP; basic radiology is covered primary healthcare cover, hospital according to the 1Doctor Health illness cover, illness top-up cover, formulary via a 1Doctor Network GP; maternity cover, accident/trauma and eye test and prescription glasses cover, dread disease cover, disability are covered as per the Spec-Savers cover, funeral cover, employee wellness agreed protocol range. programmes, emergency medical “During our journey, we developed services and GAP cover, with unlimited a marvellous relationship with private primary healthcare packages starting practitioners nationwide, recognising from as little as R265 per month (see the importance of controlling our own Table 2). “Our mission from day one has GP and dental network. We are happy been to overcome the segregation that to report that Day1 Health has a very exists between medical aids and the stable, established network of doctors everyday consumer. Medical aids are and dentists. By employing our own clearly not designed for the working GPs, we are able to control spiralling class; they’re not designed for the inflation and keep our prices to a poor,” Blackman continues. minimum, as far as is possible, “Day1 Health is different. As a result of so that the State can focus cross subsidisation, we are able to offer primarily on the very poor, one price for all patients, regardless of income bracket. While other companies have copied our approach, no one can offer what we do. Since achieving demarcation exemption from the CMS in November 2017, Day1 Health is on the launch pad! The exemption serves as a mandate from the CMS and, indeed, the National Department of Health, giving Day1 Health the rights to

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and very vulnerable, in terms of their healthcare needs,” reiterates Blackman. In the event that a Day1 Health patient cannot see a Network GP, he/she is allowed three out-of-area visits per family per annum to an alternative Network GP or a GP of his/her choice, subject to Day1 Health’s terms and conditions. While Day1 Health’s stated hospital benefits may not cover all 270 lifethreatening Prescribed Minimum Benefits (PMBs) at 100% of medical aid rates, the limits set in respect of these hospital benefits are such that they cover any individual for at least 70% of all health events. Blackman states, “In my humble opinion, it is important to continue to cover PMBs in terms of the MSA in order to ensure that our doctors and specialists remain in South Africa. It is also, however, imperative to formulate and implement a low-cost benefit option for those people on marginal incomes who cannot afford the ever-increasing costs associated with medical aid schemes.”

Wellness programme In addition to its healthcare packages, Day1 Health offers a wellness programme, available on request to employer groups only. A minimum of 35 members per annum are required to activate this option. Day1 Health has an association with Health IQ, which performs basic wellness screening for conditions such as diabetes, hypertension,


Day1 Health InterSystems | main |sponsor Profile

TABLE 2 The various Day1 Health products DESCRIPTION OF DAY1 HEALTH’S HEALTHCARE PRODUCTS

Day to Day Plan (R265 per month)

Primary healthcare benefits: • Unlimited but managed doctor visits (network GPs and out-of-area visits) • Medication (acute) • Medication (chronic) • Radiology (basic black and white X-rays) • Pathology (basic diagnostic blood tests) • Dentistry (basic) • Optometry • Specialists (R500 per annum) • Family funeral benefit (adult – R10 000; child – R5 000; R2 500 and R1 250)

Value Plus Plan (R385 per month)

Primary healthcare benefits: • As per Day to Day Plan Hospitalisation benefits: • In-hospital illness (day 1 – R10 000; day 2 – R10 000; day 3 – R10 000; subsequent days – R1 500; maximum benefit – R57 000) • Maternity cover (R20 000) • Accident/trauma benefit (R150 000 per member; R300 000 per family) • Death benefit (R10 000 per principal member) • Family funeral benefit (adult – R10 000; child – R5 000; R2 500 and R1 250) • 24-hour emergency services and hospital pre-authorisation

Platinum Plan (R645 per month)

Primary healthcare benefits: • As per Day to Day Plan Hospitalisation benefits: • In-hospital illness (day 1 – R10 000; day 2 – R10 000; day 3 – R10 000; subsequent days – R1 500; maximum benefit – R57 000) • Maternity cover (R20 000) • Accident/trauma benefit (R150 000 per member; R300 000 per family) • Dread disease (R250 000, limited to R50 000 prior to medical examination) • Accidental permanent total disability benefit (R250 000) • Death benefit (R10 000 per principal member) • Family funeral benefit (adult – R10 000; child – R5 000; R2 500 and R1 250), optional • 24-hour emergency services and hospital pre-authorisation

Executive Plan (R760 per month)

Primary healthcare benefits: • As per Day to Day Plan • Specialists (R1 000 per annum) Hospitalisation benefits: • In-hospital illness (day 1 – R10 000; day 2 – R10 000; day 3 – R10 000; subsequent days – R2 000; maximum benefit – R66 000) • Illness top-up (2 events per annum of R25 000 per incident per family) • Maternity cover (R20 000) • Accident/trauma benefit (R250 000 per member; R500 000 per family) • Dread disease (R250 000, limited to R50 000 prior to medical examination) • Accidental permanent total disability benefit (R250 000) • Death benefit (R20 000 each for principal member and spouse) • Family funeral benefit (adult – R10 000; child – R5 000; R2 500 and R1 250), optional • 24-hour emergency services and hospital pre-authorisation

Senior Comprehensive Plan (R525 per month)

Primary healthcare benefits: • As per Day to Day Plan • No specialist benefit Hospitalisation benefits: • In-hospital illness (day 1 – R10 000; day 2 – R10 000; day 3 – R10 000; subsequent days – R1 500; maximum benefit – R57 000) • Accident/trauma benefit (R75 000 per member; R150 000 per family) • Death benefit (R5 000 each for principal member and spouse) • 24-hour emergency services and hospital pre-authorisation

Insurance products are underwritten by African Unity Life Limited, an authorised financial services provider (FSP No. 8447), under the Long-Term Insurance Act, 1998.

DOH 2018

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InterSystems Day1 Health | |main Profile sponsor

1Doctor health network

General practitioners Eastern Cape

69

Free State

69

Gauteng

297

Kwazulu-Natal

177

Limpopo

52

Mpumalanga

60

North West

54

Northern Cape

21

Western Cape

139

Total

938

obesity, high cholesterol and metabolic syndrome. Members identified as suffering from one of the abovementioned conditions are then acutely monitored on a real-time basis via a revolutionary application, thus minimising the need to go to hospital.

Health clinics “The more Day1 Health can drive down healthcare costs – e.g. the cost of anaesthetists, hospital beds and so forth – the more it can control its operating costs, thereby enhancing the value of its healthcare benefits for its clients,” explains Jason Crisp, Risk and Legal Adviser, Day1 Health. “This approach is crucial in assisting the CMS in formulating a cost-

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effective, low-cost benefit option,” he adds. “Ultimately, our aim is to alleviate pressures on State facilities. If we have the proper funding in place, Day1 Health can explore the option of introducing mobile clinics into its stable further down the line.” The company’s main aim is development and growth: as it grows, Day1 Health will establish a series of clinics in each province, employ its own GPs, incentivise them to help run the clinics, and have the clinics become administration centres, thereby adopting a decentralised model. “Our first clinic opened in Mayfair, Johannesburg, and will become a healthcare centre of excellence,” says Crisp. Situated next to the Netcare Garden City Hospital in the heart of Mayfair, this pioneer Day1 Health Clinic stands proudly on the main road, allowing easy access for Day1 Health members.

The opening of this clinic allows Day1 Health to offer far more allied healthcare services than traditionally covered by the company’s Primary Healthcare Policy, including X-rays, ultrasounds, blood tests, in-house optometry, dentistry, a wound care clinic, unlimited GP visits, physiotherapy, psychology and specialist physician care. Additionally, the facility houses a weight-loss clinic that is available at significantly discounted rates to Day1 Health members who have higher than normal BMIs. Paul Desvaux de Marigny, CFO, Day1 Health, explains, “It is important to note that the entire administration platform for Day1 Health is enrolled on Day1 Health’s system – a practice management system that enables seamless integration between health management organisations, health insurance companies and service providers in their day-to-day efforts to manage patients and their clinical needs. The system keeps an electronic record of every single consultation with a particular healthcare practitioner and, in so doing, enhances the relationship between doctor and patient.” Day1 Health’s system is key to its monitoring needs as it helps mitigate risk. “If a patient goes over a certain number of GP visits, for example, the system will flag it. This allows us to monitor and find out the reason for a patient’s excess doctor visits. In the same way, we can monitor GP statistics and mitigate against fraud. Ultimately, this helps us keep prices low for the benefit of our members,” Desvaux de Marigny continues.


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Additionally, Crisp says that Day1 Health’s business model assists in curbing any potential market abuse in the healthcare insurance industry by paying the private healthcare facilities and other medical expenses directly to the various service providers. This is done via letters of authority signed by its members, as opposed to paying the members themselves, thereby defraying the latter’s actual medical expenses incurred.

Dentists Eastern Cape

23

Free State

29

Gauteng

209

Kwazulu-Natal

106

Limpopo

26

Mpumalanga

29

North West

24

Northern Cape

10

Western Cape

126

Total

582

National Health Insurance Day1 Health has it pinned down when it comes to providing low-cost medical options for the average South African, while mitigating risk against abuse. And, the company is also in support of the proposed National Health Insurance (NHI). NHI is government’s response to achieving universal health coverage for all South Africans, with specific reference to financial health coverage. It aims to provide equity and solidarity through the pooling of risks and funds, thereby creating a unified public health fund equipped with adequate resources to plan for, and effectively meet, the health needs of every citizen. “I was privy to seeing a George Washington University debate live on CNN in February 2017 between senators Bernie Sanders and Ted Cruz regarding the future of Obamacare and whether there are any merits to its implementation,” shares Blackman. “I noticed similarities between the concept of Obamacare in the USA and the proposed NHI system for South Africa. Even though the US is the largest and most powerful economy

in the world, it, too, experiences similar problems.” The aim of NHI is not to do away with private healthcare providers; they will just be required to operate under a different environment. Section 27(3) of the Constitution will be strictly applied under NHI, which states that nobody may be refused emergency medical treatment. Under NHI, for example, private providers (e.g. private hospitals) will not be allowed to charge patients a co-payment after NHI has paid them, as is currently the case. Furthermore, a healthcare provider will not be allowed to start treating a patient and then send him/her away after that patient’s medical savings have been depleted. NHI will cover services that are delivered on a people-centred integrated healthcare services platform to ensure a more responsive and accountable health system that takes into account socio-cultural and socioeconomic factors. This will contribute

towards improved human capital, labour productivity, economic growth, social stability and social cohesion. While private healthcare providers will continue to operate, the healthcare system under NHI will be reorganised to strengthen primary healthcare (PHC), including PHC re-engineering, hospital services and emergency medical services. “For years, the State has been struggling to take care of the health needs of over 42 million South Africans, placing strain on the public healthcare system. It is reassuring to note, however, that the labour market has shown a significant interest in the benefits that Day1 Health’s products provide. We, at Day1 Health, hope to use this support as a springboard to enrol as many medically uncovered lives as possible,” Blackman concludes.

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InterSystems Minister Interview | Profile | NHI

NHI: Quality healthcare for all Minister of Health Aaron Motsoaledi has introduced National Health Insurance (NHI). Through NHI, the Department of Health aims to make significant strides in moving towards universal health coverage (UHC), which speaks to the principle of the constitutional right of citizens to have access to quality healthcare services that are delivered equitably, affordably, efficiently, effectively and appropriately, regardless of a person’s economic status.

In summary, what is NHI? AM NHI is a health financing system that is designed to pool funds to provide access to quality affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status. It is exactly what medical aid schemes are doing but with two very notable differences: (i) The word ‘all’ does not apply in medical aid schemes. They are for a select few in society, whereas NHI will be for all South Africans in keeping with the fact that health is a right in the Constitution and, hence, cannot be for a selected few. (ii) In medical aid schemes, the level of health service you receive is determined by your socioeconomic status rather than your health needs. In NHI, your socio-economic status will not matter but your health needs will determine what form of service you get. The World Health Organization (WHO) and the UN call it universal health coverage (UHC) because nobody is left behind.

Minister of Health Dr Aaron Motsoaledi

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What are the main objectives of NHI? NHI aims to achieve UHC for all South Africans. This specifically refers to financial health coverage. It aims to provide equity and social solidarity through pooling of risks and funds. It will create one public health fund with adequate resources to plan for and effectively meet the health needs of the entire population and not just for a select few.


Minister Interview | NHI

Under the NHI regime, will there still be private medical aid schemes? Paragraph 400 of the White Paper on NHI states that “with the implementation of NHI, the role of medical aid schemes in the health system must change.” This matter is still being debated by various stakeholders but what I can tell you is that state medical schemes will definitely cease to exist because there will be NHI. NHI is also going to be a mandatory prepayment of health – i.e. your healthcare is paid for before you are sick and it is mandatory because once passed into law, every South African has to belong to it. This is unlike medical aid schemes, which are voluntary prepayment. Therefore, the debate here is whether you could be allowed to keep another private medical aid scheme while you are mandatorily belonging to NHI. What about private healthcare providers – will they continue to operate? If yes, what will be different? Let me first clarify two different concepts that usually confuse many people.

Under NHI, for instance, a healthcare provider will not be allowed to start treating you and then discard you and send you away after he/she has exhausted all your funds.”

Private healthcare has two very distinct and different arms, usually owned and operated by different groups: One arm is called healthcare funders: these are mostly medical aid schemes, but also include hospital plans and hospital cash plans. They pay for you when you are sick. The other arm is called healthcare providers: these are mostly private hospitals. But they also include private specialists and general practitioners as well as allied health professionals in private practice (optometrists, physiotherapists, occupational therapists, speech therapists, dental therapists, oral hygienists, etc.). They provide you with healthcare, which is paid for by your funder. The private healthcare providers will definitely continue to operate. Contrary to popular belief, NHI is not going to abolish or do away with private healthcare providers. However, they will operate within a completely different environment created by NHI. For instance, NHI will not allow them to charge the exorbitant fees they are charging today, especially the private hospitals. Certain practices will not be allowed under NHI. For instance, a healthcare provider will not be allowed to start treating you and then discard you and send you away after he/she has exhausted all your funds. Private ambulance providers will no longer be allowed to pick up only people who have medical aid, a credit card or cash at the scene of an accident and leave behind the poor. Section 27(3) of the Constitution will be strictly applied under NHI. It simply states that nobody may be refused emergency medical treatment. Under NHI, private providers will no longer be

allowed to charge you extra cash – called co-payment – after NHI has paid them. Under the present system, a private provider may charge you extra cash over and above what your medical aid has paid them. Critics of NHI say government wants to disrupt a private healthcare system that is working well and that government should leave private healthcare alone as this reduces the burden of providing healthcare from the state. What is your response? It is definitely not true that private healthcare is a system that is working well. This assertion is a dangerous simplification of facts. For starters, a system of health cannot be said to be working well when it serves only a tiny minority of the population (only 16% of South Africans) and excludes the

DOH 2018

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InterSystems Minister Interview | Profile | NHI

Medical aid schemes are actually collapsing under the weight of the high medical costs. In 2002, there were 141 medical aid schemes. Today, we are left with 83 and still counting down.” overwhelming majority (84% of South Africans). Second, the cost of private healthcare is spiralling out of control, with medical aid contributions (premiums) increasing more than the consumer price index, while the benefits to patients are

reducing at a very fast pace. Most members of medical aid schemes run out of benefits and are no longer covered from as early as June until the end of the year. You cannot, therefore, claim that a system is working well when that system can take you out of the ICU while you are still very sick, simply because your benefits have been exhausted. Lastly, medical aid schemes are actually collapsing under the weight of the high medical costs. In 2002, there were 141 medical aid schemes. Today, we are left with 83 and still counting down. GPs are being taken out of practice because they are simply not paid or paid very little by medical aid schemes compared to private hospitals. Actually, the National Development Plan (NDP) states that if we want to fix the health system, we need to deal with two problems. Firstly,

we need to deal with the exorbitant cost of private healthcare. Second, we need to deal with the problems of the quality of the public health system. As you can see, both systems need to be fixed, not only the public health system. It is for this reason that paragraph 2 of the NHI policy document states: “NHI represents a substantial policy shift that will necessitate a massive reorganisation of the current healthcare system, both public and private, and also derives its mandate from the NDP of the country.” As it stands, poor people can get free medical care in public hospitals. Why do you feel that we need an NHI to provide universal healthcare? Poor people may be getting free medical care in public hospitals, but you and I know that free care is very difficult to deliver without adequate resources (both financial and human). The cream

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Minister Interview | NHI

Both the WHO and OECD state that only 10% of South Africa’s population can afford the present private healthcare cost. Clearly, it is the present system that is not affordable, not NHI.”

of the South African society – i.e. those with huge financial resources and skills – have hived off from the rest of society to have their own health financing system (medical aid) and health provision system (private hospital). They have hived off with huge financial resources. Skills and professionals follow the financial resources. Hence, 80% of the specialists of the country serve the private population. The remaining 84% of the population is served by only 20% of specialists. Actually, our country is spending 4.4% of GDP on only 16% of the population and only 4.1% on the remaining 84%. The services may be free, but it is a struggle to deliver them with the meagre resources left in the public health sector. Some people argue that medical aid scheme money is private money and we have no business to meddle in it. This is a serious distortion of facts! The truth is that medical aid schemes are subsidised for a whopping R46.7 billion by the fiscus of the country. If it were not for this very heavy subsidy from the state, medical aid schemes would have ceased to exist. People who are not on medical aid do not have

access to this subsidy. In the words of the director-general of the World Health Organization (WHO), UHC is an equaliser between the rich and the poor. It is only NHI that can bring this UHC. Isn’t the elephant in the room the fact that public healthcare is collapsing due to factors such as underfunding, corruption, politics and incompetence and perhaps that, if we want to ensure quality service for the poor, we should deal with these problems and not throw the baby out with the bath water? It is true that public healthcare is underfunded, but it is definitely not collapsing. It is just dealing with a huge burden of disease and a larger population compared to private health care, which is over-subsidised but has very few people to deal with. As an example, let us start at the beginning of life. There are 1.2 million women who fall pregnant every year. The private health sector takes care of only 140 000 of them, with 80% of the specialist doctors. The public health system takes care of a whopping 1 060 000, with only 20% of the specialists.

As things stand, the biggest killer of South Africans is TB. There are more than 260 000 South Africans being treated for TB each year, all of whom, regardless of their socio-economic status, are treated by the public sector. The private sector is treating none. The TB cure rate improved from 67% in 2009 to 85% by 2016. The second biggest killer is HIV/AIDS. There are an estimated 7 million South Africans infected by this virus. The public sector is treating 3.9 million of them, whereas the private sector, despite the huge resources at its command, is treating only 300 000. There used to be 70 000 babies born HIV-positive as at 2004. Because of the very highly successful PMTCT (prevention of mother-to-child transmission) programme, the figure is now down to 6 000. How on earth can all this be achieved by a system that is collapsing? It beats me! Corruption cannot be allowed in any system. We need to fight it. It is not part of NHI. In the White Paper on NHI, Section 8.6.3, paragraphs 372-383 outline what is being proposed to deal with fraud and corruption under NHI. We cannot then associate NHI with corruption. NHI

women fall pregnant in South Africa every year. The private health sector takes care of only 140 000 of them, with 80% of the specialist doctors. The public health system takes care of a whopping 1 060 000, with only 20% of the specialists

DOH 2018

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InterSystems Minister Interview | Profile | NHI

abhors corruption because there can never be development where there is corruption. What do you say to people who say NHI is a Rolls-Royce solution when we cannot even afford a Toyota Tazz? I will tell them that, in fact, a RollsRoyce is the present system, whereby only 16% of the population spends a whopping 4.4% of the GDP on their health, leaving 84% of the population with a measly 4.1% of the GDP. Which one is a Rolls-Royce in this situation? In 2002, expenditure on private healthcare was at R41 billion, but by 2014, it was already R141 billion, but that is spent on only 16% of the population. It is for this reason that the WHO and the OECD (Organisation of Economic Co-operation and Development) has declared that South Africa is an outlier because we are the only country in the world that is PD half PG AD 2018.pdf

1

2018/01/29

3 000 The number of optometrists in South Africa. Only 250 of them are in the public sector

spending huge amounts of money on very few people. Now that is a Rolls-Royce. Rolls-Royces are huge, extremely expensive cars owned by very few people at the expense of the majority. NHI is not designed to be a Rolls-Royce or a Toyota Tazz. It is designed to be a transport system for all South Africans, which is appropriate

for all South Africans and which is affordable for the country. Chapter 2.3 of the NHI White Paper shows that affordability is one of the eight principles of NHI. The others are social solidarity, efficiency, effectiveness, etc. For NHI to succeed, many qualified health professionals would be required. Given the current shortage of skilled professionals such as doctors and nurses, where will we get professionals? As it is at the moment, all countries in the world, with the exception of Cuba, have a shortage of health professionals. subSaharan Africa has been declared a crisis point. The Secretary-General of the UN has even come up with a global solution for this issue. But the shortage of health workers is not a reason not to implement UHC. Actually, UHC will help a country like South Africa to effectively share the small pool of health professionals that

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Minister Interview | NHI

we have. This shortage is exacerbated by not sharing what we already have. I can put it on record that one particular private hospital in Johannesburg has 30 specialist gynaecologists. Limpopo has only seven full-time South African gynaecologists to serve a total of 40 hospitals in the whole public sector, Mpumalanga has six to serve a total of 33 hospitals and North West has seven to serve a total of 22 hospitals. We had to get Cuban gynaecologists. If a teacher only has 16 pupils to teach, and another one has 84 to teach, comparing their performances without taking this into consideration is grossly unfair, resulting in distorted and outright unscientific facts. The solution to the gross inequalities I have just outlined above is NHI’s UHC, whereby the whole population will have access to all the gynaecologists that exist in our country, whether public or private. There are 3 000 optometrists in South Africa and only 250 of them are in the public sector. If we share under NHI, the shortage will be somewhat mitigated. I am on record that NHI is not a beauty contest between the public and the private health sectors, but is a system to make both sectors serve the whole population in cooperation rather than antagonism. One of the biggest problems faced by the public healthcare system is public servants who simply do not care about patients. How does the NHI propose to change this? We established the Office of Health Standards Compliance (OHSC) and the Office of the Health Ombud (South Africa’s first health ombud) to deal with some of these problems. We have even come up with a system of district specialist teams to supervise doctors and nurses in their duties. We also need strict application of the public service laws and the Labour Relations Act (No. 66 of 1995), as well as having good managers who manage without fear or favour like the health ombud. What do you say to people who say NHI is not affordable?

As I have already said, what is not affordable is the present system. I have given you the figures and numbers. People who believe that NHI is not going to be affordable wrongly think that, under NHI, we are going to allow the present high healthcare costs. Both the WHO and the OECD have already declared that South Africa is running one of the most expensive healthcare systems in the world. NHI is actually designed to fight these expenses. Both the WHO and OECD state that only 10% of South Africa’s population

can afford the present private healthcare cost. Clearly, it is the present system that is not affordable, not NHI. Do you think under NHI we are going to agree to pay R7 000 to R10 000 for a simple circumcision as is happening today in the present private health sector? No way will NHI allow that. The problem is that people wrongly believe that NHI is simply going to be a bigger version of the present system. It is not. It has been a few years since pilot projects to roll out NHI

DOH 2018

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Minister Interview | NHI

were launched. How are these going? What lessons have been learnt from these pilot projects? Yes, we launched pilots in order to learn what is feasible and what is not. We have learnt a lot. Under the pilots, we have screened three million schoolchildren for physical barriers to learning such poor eyesight, hearing and oral hygiene/speech. We now know how to tackle that. We have established district specialist teams to supervise doctors in each district. We now know where the gaps are. We have contracted GPs to work in public clinics and learnt that we also need to contract allied healthcare professionals like physiotherapists, speech therapists, oral hygienists, occupational therapists, psychologists, optometrists, etc. Primary health worker teams have visited no fewer than 4 million households to check their health status. We have finalised infrastructure needs for all 700 health facilities and have started the work of refurbishment and backlog maintenance. What are you doing to mobilise society to support NHI? Since the Green Paper was released for public participation, I have addressed several meetings with an estimated 60 000 people who attended cumulatively. I have addressed several forums of doctors through their professional associations. A total of six work streams have been formed where several stakeholders were consulted. I have addressed organised labour, some chapter nine institutions and even Nedlac. From 1 to 3 March, there will be a full day devoted to discuss NHI at the National Health Consultative Forum where stakeholders come together. Last year, at the same consultative forum (it is an annual event), the only agenda item was NHI. What other countries have implemented NHI-like systems? What have we learnt from these?

Primary health worker teams have visited no fewer than 4 million households to check their health status. We have finalised infrastructure needs for all 700 health facilities and have started the work of refurbishment and backlog maintenance.�

Many countries have started implementing UHC even before the UN adopted it as one of the 17 Sustainable Development Goals of the world. Countries call it by different names but the goal is the same, namely UHC, whereby every citizen has financial coverage for their healthcare needs instead of only a select few. The UK started its NHS in 1948. Japan started

in 1961. Mexico started in 2001 and calls it Seguro Popular. Brazil has it; all the Scandanavian countries have very good UHC systems. On the African continent, Ghana has started. Rwanda has also started. All 194 countries under the UN have become signatories to the notion of UHC, which means they are preparing to implement it, if they haven’t already.

Previously published in The Star, 21 February 2017. Re-published with permission from the Department of Health

DOH 2018

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InterSystems DDG: PHC Interview | Profile | Department Of Health

Building a solid healthcare foundation

Jeanette Hunter, Deputy Director-General for Primary Healthcare, National Department of Health

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DOH 2 0 1 8

It is now widely recognised that good health reduces poverty, improves educational performance, increases productivity and, as a result, stimulates economic growth. Jeanette Hunter, Deputy Director-General for Primary Healthcare at the National Department of Health, offers insight into plans to strengthen the public health system, training of healthcare professionals, and the importance of adequate healthcare for mentally ill patients.


DDG: PHC Interview | Department of health

In order to strengthen the health system, the Department of Health (DOH) needs to undertake a number of equally important initiatives. This includes the need to change health service delivery from a curative model to one that promotes cost-effective primary healthcare (PHC) as close to the community and households as possible. What drastic changes have come about in PHC, and what can we expect from the DOH over the next two years? JH To change health services from a curative to a primary healthcare model, the National DOH has, since 2014, steadily grown the district health system portion of the national health budget. This includes the budgets of the nine provinces. In South Africa, primary healthcare services are delivered with an organisational unit called the district health system (DHS). Increasing the resources for the DHS will facilitate improved primary healthcare services. The DOH has also increased resources and activities linked to health promotion and disease prevention messages and activities. We are constantly strengthening relationships and activities with other government departments, nongovernmental organisations, academia and the private sector to combat the social determinants of health. Together with other government departments and sectors, the National DOH is pursuing a Health in All Policies (HiAP) approach. HiAP is an approach to public policies across all sectors that systematically takes into account and steers clear of negative consequences for health and health systems. It is in the areas of “conditions” and “opportunities” that a HiAP approach should make an impact. A successful HiAP approach should make a positive difference with regard to those elements that determine an individual, a family and a community’s conditions and opportunities. These conditions and opportunities refer to South Africans’ access to housing, food security, water and sanitation, education, employment, security, physical activity, recreation and social and community networks. This illustrates that it takes

We are constantly strengthening relationships and activities with other government departments, nongovernmental organisations, academia and the private sector to combat the social determinants of health.”

much more than just the health sector to keep South Africans healthy and to return those who have fallen ill to health again. Access to suitably qualified healthcare professionals at PHC level, especially at community level, is still an issue. How is South Africa focusing on improving access to an expanded range of services especially at PHC level? Ensuring that key vacancies are filled is a priority. We have already determined specific needs in this regard. The DOH will also ensure access for South Africans to the primary healthcare package through appropriate partnerships with NGOs and private sector. For example, a clinic that does not have a government employed oral health practitioner could contract the services of a private sector oral health practitioner where available. The DOH, with the help of key partners, will develop and implement a model for delivering PHC services that give incentives for health promotion and disease prevention at the household and community level. Who are these key partners and what will their involvement be? Key partners include NGO sector, civil society, faith-based organisations, the private sector, academia and other government departments. Their role may be advisory and/or as implementation partners. Can we expect an increase in education campaigns for patients at PHC level, especially in the case of communicable diseases?

Is the DOH finding that increased awareness and educational campaigns are proving to be more effective with the general public? Can this be quantified? Targeted campaigns, aimed at keeping South Africans healthy and preventing both communicable and noncommunicable diseases have already started. Over and above the standard media such as billboards, radio and television messages, we are investing in methods that have proved to be successful in bringing about behaviour change such as peer education. Obesity is a major risk for NonCommunicable Diseases (NCDs). Overweight or obesity increases risk for NCDs such as diabetes, cardiovascular disease (hypertension, heart attacks and stroke), and cancer by 4 – 8 times. Therefore, obesity prevention is a key intervention for reducing the prevalence of NCDs. The rates of overweight

The DOH will also ensure access for South Africans to the primary healthcare package through appropriate partnerships with NGOs and private sector.”

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InterSystems DDG: PHC Interview | Profile | Department Of Health

and obesity in South Africa (SA) are increasing. According to the SADHS 2016 key indicator report, 68% of women are overweight or obese: overweight 27%, obesity 41%, with 20% falling in the severe obesity category. There is an overall increase of 4% and a much higher increase in obesity when comparing the SANHANES 2012 where 64% of women were overweight or obese: overweight 39%, obesity 25%. Thirtyone percent of men are overweight or obese: overweight 20%, obesity 11%, with only 3% falling in the severe obesity category, no significant change from SANHANES 2012. The causes of obesity are multifactorial; therefore, a multisectoral, multidimensional and life-course approach has been adopted in order to address obesity in SA. The four main

key drivers of obesity are poor diet, physical inactivity, poor early childhood feeding and lack of nutrition knowledge. Increasing education campaigns is one of the interventions for the prevention and control of NDCs and obesity in South Africa. Other interventions that are implemented in SA to address NCDs and obesity include: Fiscal measures (health promotion levy – i.e. sugar tax), product reformulation, workplace and early childhood development (ECD) based interventions (increasing access to health foods), regulation for salt reduction in various foodstuffs and media campaigns. It is important to note that a multiple-intervention approach is essential to see substantially larger health gains, rather than individual interventions. Interventions are not only implemented at PHC level but also in various setting – e.g. workplace, early childhood development programmes and to the general public. Health professionals, through a specifically designed health promotion handbook, are receiving focused orientation to capacitate them to provide targeted health education to clients in PHC facilities to South Africans to make healthy choices and take responsibility for their own health. The issue of adequate healthcare services for

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mentally ill patients has come under fire recently in the mainstream media. What are the DOH’s plans to ensure that people battling mental disorders are properly cared for at PHC level? Many of our primary healthcare facilities throughout the country already have well-managed mental healthcare services. Weaknesses identified in certain areas are receiving attention. One of the improvement interventions is to appoint specialist mental health teams at district level to assure the quality of mental healthcare services at primary healthcare level. Which populations/parts of the country will receive priority in terms of increased access to healthcare at PHC levels, and why? While the health of all South Africans is important for the development of our country, the vulnerable, namely children and older people in all geographic areas of the country, both urban and rural, will be prioritised. To assist all South African children to reach their full capacity, children with sight and hearing problems will be prioritised. Disability in the elderly, caused by cataracts is another example of focusing on the problems of the vulnerable members of our communities.

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Fast facts | Department of health

Key

The Department of Health made inroads in many aspects of healthcare during the 2016/17 financial year. These were some of the highlights.

achievements

917 053

1 252 000 The number of patients receiving their prescribed medicines through the DOH’s Centralised Chronic Medicines Dispensing and Distribution (CCMDD) programme

22

Since the launch of the ‘She Conquers’ campaign, adolescent girls and young women have received HIV testing and care services, postviolence care, life skills and sexuality education in 22 priority districts

3 121 The number of clinics that implemented the department’s Stock Visibility System (SVS). Additionally, national surveillance systems were established whereby information on medicine availability at clinics and hospitals is received and analysed to manage stock challenges

The total number of pregnant women who registered for the DOH MomConnect programme. MomConnect is designed to improve access to early antenatal services and empower pregnant women

85.6%

In the 2016/17 financial year, a national TB treatment success rate of 85.6% and TB death rate of 4.5% were achieved against targets of 84% and 6%, respectively

8 075 392 The total number of patients who were screened for diabetes at health facilities

786

100

South Africa is pursuing universal health coverage (UHC) through the implementation of National Health Insurance (NHI) alongside 100 other countries globally

6 355 759 The number of South Africans registered in the Health Patient Registration System (HPRS)

The total number of primary healthcare (PHC) facilities that have been renovated via the DOH’s Ideal Clinic (IC) initiative, and qualified as ready for NHI implementation

9 366 331

The total number of patients who were screened for hypertension at health facilities

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ANOVA | Profile

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to healthcare The Anova Health Institute has an excellent understanding of public health needs and challenges. Anova identifies opportunities and innovative solutions to empower people and change lives.

A

nova’s significant support to the Department of Health’s HIV/TB programme contributes to achieving the objectives of the National Strategic Plan for HIV and TB. Its expert technical assistance has greatly contributed to strengthening the public health system and direct service delivery to provide quality HIV services in over 450 facilities across all nine provinces. Anova’s innovative skills development activities have built public sector capacity, enabling a threefold increase in the number of people on treatment over the last five years. This work has also enabled expanded community outreach to focus health sector efforts to reach UNAIDS 90-90-90 targets and achieve HIV epidemic control. Some of the key successes resulting from Anova’s support include: • Consistently low mother-to-child HIV transmission rates of below 1% in the last five years • NIMART (nurse-initiated management of antiretroviral treatment) training and mentoring of over 1 500 Department of Health nurses has increased the number of clients on HIV treatment. In Anova-supported sites in the Johannesburg district, the number of people on antiretrovirals increased from 68 000 to over 180 000 between 2012 and 2017, and similarly in the Mopani district, from 31 700 to 86 000 • Strengthening of TB/HIV integrated services and improving quality of care. In Johannesburg, this proportion of co-infected clients initiating antiretrovirals improved from 50% to an impressive 89% between 2012 and

2017. In Limpopo’s Mopani District, the increase in ART was dramatic: from 26% to 96% • Implementation of pioneering and successful Key Population programmes aimed at reaching communities and people who are most vulnerable to HIV infection. Since 2008, Anova’s Health4Men Initiative has worked in partnership with the Department of Health to increase capacity of medical staff to provide competent and well-informed health services to gay men and other men who have sex with men (MSM), and transgender communities. Health4Men has sensitised 17 500 facility staff, trained and mentored close to 5 000 health workers,

entrenching MSM-competent health services in over 400 clinics nationally, enabling facilities to respond with considerable expertise to the sexual health needs of the MSM community. To attract men to HIV testing and treatment services, Anova launched the Score4Life campaign, which offers free, safe and confidential HIV testing and counselling. Semi-permanent pop-up sites in Alexandra, Roodepoort, Soweto and Lenasia tested 31 000 men for HIV in 18 months, identifying 1 750 HIV-positive men. Score4Life has successfully attracted older men to the services, a group that is especially difficult to get into HIV treatment. Anova’s many successes would not be possible without the valuable partnerships it has forged along the way. The institute’s long-term partnership with government, in particular, has ensured that it can successfully reach even the remotest communities and provide friendly, proficient and groundbreaking healthcare solutions and support for those who need it most. Anova acknowledges the contribution of its major funders: USAID/PEPFAR and The Global Fund.

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Fast facts | Department of health

The World Health Organization identifies many uses of mHealth, one of which is remote patient monitoring and critical care. With its MomConnect and NurseConnect mobile programmes, as well as electronic record systems at public healthcare facilities, the Department of Health is putting its best foot forward in the technological era.

Healthcare powered by technology

Source: statista.com; mhealthshare.com

33%

The mHealth technology market is set to grow by 33% by the year 2020

76 000 000

South Africa has over 76 million mobile phone subscribers, with 75% of mobile phone owners being in low-income groups and aged 15 years or older. Using this medium, mHealth is seen as a catalyst in the strengthening of health systems and has the potential to transform health service delivery

165 000 The combined number of Android and iOS apps dedicated to the healthcare category alone

$37 BILLION Estimated global mHealth market by 2019. In 2017, the estimated mHealth revenue in Africa and the Middle East was US$1.1 billion

84%

57%

of patients in emerging markets say mHealth will change how they manage their overall health

The percentage of health apps worldwide that are free without in-app purchases

TOP 3

The health and medical industry has been named as one of the top three fields to accelerate the growth of mobile devices. Mobile health has the ability to improve the overall healthcare system by improving efficiency, communication, costs, and quality of healthcare services

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Embrace the future generation of healthcare

Enterprise IoT The future is exciting. JHB 5136V/VODA

Ready?


Healthcare IoT is transforming the healthcare sector, through remote patient care and telecare. It is improving the effectiveness of clinical trials and ensuring cold chain integrity.

Remote care Using IoT-powered mHealth solutions, medical staff can remotely monitor, consult with and even treat patients, avoiding the need for the sick and infirm to travel to a hospital or clinic. This not only results in better care through more accurate data collection, but also lower costs and better utilisation of limited clinical resources – vital in a world with an ageing population and more chronic conditions to manage.

Transforming cold chain management Any hospital or pharmaceutical company knows the importance of proper drug storage. Using IoT you can track shipments of medication end-to-end, verifying that drugs are stored at the correct temperature and waste is reduced. Beyond Wireless, uses Vodacom IoT Managed Connectivity to monitor medicinal fridges in clinics and hospitals across Africa, the Middle East and Asia on behalf of its clients.

Assisted living IoT is helping vulnerable people – such as the elderly – live more independently in their own homes for longer, without the need for round-the-clock care. IoT-enabled wearables allow families to keep an eye on their relatives, for instance locating them should they get lost, or raising the alarm if a person suffers a fall. Connected medicine cabinets can even remind patients to take their medication.

Clinical trials IoT-enabled monitors are already aiding in the research and development of new drugs and treatments, allowing clinicians to remotely collect and continuously monitor trial data, enabling deeper insight and faster reallocation of resources.

Supply chain Tracking devices and sensors in containers can naturally help prevent loss and theft, but just as importantly they enable organisations to prove the authenticity of shipments to tackle counterfeiting, and make it easy to verify that the condition of delicate stock has been maintained throughout the cold chain.

Gathering data around the clock Fitness monitors today count steps, Improving customer measure heart rate, track sleep quality and engagement feed that data to your smartphone – all through IoT. But wearables also help famiNearly three quarters of UK manufacturers lies keep an eye on relatives with cognitive (74%) say that the principal degenerative diseases whenmotivation they’re outfor and offering servitisation is to develop closer about. And for the first time, doctors can 5 relationships collect with their customers. continuously patient data without having to call them in to the clinic.

Monitoring patients in transit Paramedics are using IoT to wirelessly transfer critical patient evaluations to the hospital ahead of arrival, helping to ease the transfer from ambulance to the emergency room.


Ensuring emergency equipment is in prime condition

Helping vulnerable people live independently Healthcare doesn’t have to mean going to the hospital. Thanks to IoT-powered sensors, family members can receive alerts of any unusual activity, such as lights being left on during the night or whether a relative has fallen, so vulnerable patients can continue living in their own homes and maintain their independence.

Keeping blood sugars under control Diabetacare’s IoT-enabled glucometer is helping thousands of diabetics to manage their condition. The connected meter helps doctors track patient’s blood-sugar levels remotely. Controlling blood-sugar levels is key to reducing the long-term health risks associated with diabetes.

Visibility of the supply chain Vodacom provides an end-to-end solution to deliver visibility of the supply chain for critical drugs in the public health care systems. Vodacom’s Stock Visibility Solution (SVS) has been developed to allow pharmacists in remote clinics to capture the stock levels of defined drugs on a daily basis to reduce stock outs by matching supply to anticipated demands. This solution is deployed to over 3,000 clinics countrywide. JHB 5136V/VODA

Battery-powered defibrillators can save lives in the event of a sudden cardiac arrest. Medic assist’s IoT-enabled defibrillator constantly monitors the status of the devices, sending alerts in case of failure. This ensures the devices are in prime working condition should they be needed.


Empowering healthcare through Vodacom’s managed healthcare solutions Stock Visibility Solution

AitaHealth

mVacciNation

Vodacom’s Stock Visibility Solution offers a real-time stock management solution to help increase accessibility to Vital, Essential and Necessary (VEN) inventory items stocked by the Department of Health.

Developed in collaboration with the University of Pretoria and the Department of Health, AitaHealth is an end-to-end patient and workforce management system that captures clinical data, supporting community and home-based caregivers to provide better quality and efficient health and social care services.

mVacciNation is a multi-stakeholder partnership programme established to assess the impact of using mHealth to increase immunisation coverage in the public. This integrated project covers three main pillars: encourage mobile vaccination record, optimise supply chain, as well as enable easier communication with caregivers.

Using automated notification to all facilities to remind them to submit stock levels, pharmacists can use the native application on their mobile devices to submit weekly stock levels. To date, over 6 million stock updates have been processed in South Africa. The solution, which allows real-time decision-making among district and provincial management users, is currently active in 3,472 primary healthcare facilities in South Africa and 252 sites in Nigeria, with 546 sites to follow in Zambia.

The solution uses mobile devices to register households and household members on a database that allows them to undergo service assessments and individual health assessments for conditions such as HIV, tuberculosis and many others.

A one year demo project was completed in Mozambique with multiple partners including NDOH, UNICEF, WHO, SAVE and GAVI. The programme was also rolled out in Tanzania and Nigeria, with 52 and 50 users, respectively.

Currently in its fourth generation, the solution increases the public’s access to quality care. It has been deployed to 2,500 community health workers in the Tshwane district, as well as in the City of Tshwane and has completed 550,000 assessments to date. Rolled out since 2007, the solution is expected to be implemented in 3,200 additional clinics under the National Health Insurance (NHI).

With Vodacom’s Stock Visibility Solution, the National Department of Health can monitor critical supply chains and compare centrally purchased volumes with medicine actually available on the shelves of dispensaries.


mLearning (LEAP) mLearning (LEAP) is a sustainable and scalable mobile learning platform for health workers across Africa. Initiated through a successful publicprivate partnership between Accenture, M-Pesa Foundation, Safaricom, Vodafone (Mezzanine) and the government of Kenya, the programme has trained over 3,000 Community Health Workers (CHWs) in Kenya, with over 715,000 IVR training calls successfully completed. The programme provides content delivered through a combination of text and audio messages, accessible on basic mobile phones, allowing learners to exchange knowledge with peers. Achieving significant results, such as an increase in immunisation rates in Kenya, the programme boasts high learner completion rates and significantly raised test scores.

hearScreen South Africa’s Intergrated School Health Policy (ISHP, 2012) requires learners to undergo hearing screening, but less than 15% actually go through it because of the lack of proper equipment and lack of nurses.

Integrated School Health Programme (ISHP)

National School Nutrition Programme – Limpopo

Bolstering of school health services is one of three components of government’s commitment to re-engineering public healthcare.

Rolling out a successful proof of concept (POC) in Limpopo province, Vodacom created a daily reporting tool that feeds into the National School Nutrition Programme mandated by the Department of Basic Education.

In a bid to help government improve health and education service delivery, Vodacom has initiated the Integrated School Health Programme. By registering and assessing learners’ health status using the Vodacom mobile app, the school’s Health Team are able to refer at-risk individuals to a Mobile Health Team (MHT), who will then review pre-identified cases and capture clinical data. They could also refer the cases to the relevant medical professionals where necessary. Some key components to the programme include learner profile and registration, school profile and registration, reporting and administration, appointment scheduling and clinical data capturing. Aggregated data and vehicle tracking are available on national, provincial and district levels.

Using mobile devices, school principals must indicate if learners received meals and complete a checklist of questions. If no meals were provided, escalating alerts and notifications must be submitted to relevant management. This zero-rated application ensures that users are able to use the mobile devices at all times, ensuring that scheduled daily tasks are completed. Users receive support messages from the Master Administrator of the system.

Understanding this challenge, Vodacom collaborated with partners to introduce hearScreen, a low-cost mHealth solution for hearing problems. It provides clinically valid tests, operated by untrained persons with cloud-based data management and referral systems linking patients to services.

JHB 5136V/VODA

Through hearScreen, Vodacom’s vision is to impact the 3.2 million South Africans who suffer from hearing difficulties through affordable access and linkage to hearing health.


mHealth | Department of health

Taking healthcare into the 21st century

T

he Department of Health’s mHealth Strategy 2015 – 2019 explores the need for mobile health in South Africa in a way that does not contribute to the fragmentation of health information systems. mHealth refers to mobile computing, medical sensors and communications technologies used for the delivery of health-related services and the support of medical and public health practices. Employing mobile telecommunication and multimedia technologies such as mobile phones, patient monitoring devices, PDAs, and other wireless devices, mHealth is a fast-growing subset of eHealth. The World Health Organization (WHO) identifies the following uses of mHealth: emergency response systems (road traffic accidents, emergency obstetric care); disease surveillance and control (malaria, HIV/ AIDS, TB, avian flu, chronic diseases); human resources coordination, management and supervision; synchronous and asynchronous mobile

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With the rapid convergence of mobile and fixed information and communications technologies (ICTs), there are increasing trends towards the migration of eHealth applications to mobile platforms, and the development of new mobile technologies and solutions for healthcare.

telemedicine diagnostic and decision support for clinicians and point-of-care; remote patient monitoring and clinical care; health extension services, health promotion and community mobilisation; health services monitoring and clinical care; health-related m-learning for the general public; and training and continuing professional development for healthcare workers.

The implementation of the mHealth Strategy forms an essential part of the realisation of the South African eHealth Strategy published back in 2012. In fact, the mHealth Strategy follows the needs-driven approach used in the overarching eHealth Strategy, and adopts the following principles: • Adhere to the standards given in the Department of Health Normative Standards Framework. • Maintain simplicity in design and development of mHealth interventions while still addressing the needs of users. • Build sustainable partnerships, which include incentives for continued participation. • Strengthen the capacity to use mHealth by seeking to converge mHealth initiatives with other ICT initiatives, such as the implementation of healthcare ICT infrastructure and other government department eServices. • Look for points of intersection with other eHealth programmes and complementing eHealth interventions, especially telemedicine. • Anticipate future areas of technology convergence between mobile and fixed technologies.


mHealth | Department of health

The key take-home from the 2016 eHealth Alive Southern Africa Forum in the area of South Africa’s interoperability strategy, the Health Normative Standards Framework (HNSF), is that it extends beyond data to include people in a very forward-thinking approach. The implementation of interoperability is a long-term programme that will provide an essential foundation for the country’s National Health Insurance plan, and that will provide a valuable benchmark in other African countries. The HNSF for Interoperability (V1.0), which was approved by the National Health Council in 2013, provides a set of eHealth standards that will ensure a seamless flow of information between disparate devices over different networks and from different recipients. Attaining true interoperability will require significant coordination and cooperation among stakeholders.

Access to mobile The use of mobile technologies has increased exponentially worldwide and South Africa is no exception. The All Media and Products Survey 2012, produced by the South African Audience Research Foundation, found that nearly 100% of all mobile users make use of SMS, voice services and USSD – a menu system that works on all phones. This broad coverage highlights the importance of cell phones as a communication medium and the potential of mobile technology to play a transforming role in the improvement of the health system. mHealth devices vary widely in capability, price and strength of evidence that they may improve patient outcomes, workflow, efficiencies, and access to health information. In general, successful mHealth implementation must support the daily workflows in healthcare settings through the accurate collection, transmission, storage, computation and display of information.

GOOD TO KNOW MomConnect is a DOH initiative, which aims to support maternal health through the use of cellphone-based technologies integrated into maternal and child health services. The services are free to the user, and messages are available in all 11 official languages. MomConnect is voluntary and a pregnant woman can opt out at any time.

The implementation of mHealth solutions in developing countries has been hampered by several obstacles such as poor infrastructure, lack of resources and political commitment. In sub-Saharan Africa, many mHealth pilot projects have failed to be taken to scale due to changing health personnel practice, technological challenges, and the lack of sustainable funding and institutionalised system support.

Data security Important issues of patient confidentiality and data security have historically been managed on individual systems and have generally restricted access to information. Due to the complex and private nature of patient data, this is not adequate. The mobility of personal information on mobile ICT devices makes the requirement for standards an urgent and essential part of the realisation of the mHealth Strategy. Internationally, there has been considerable investment in mHealth research, while locally, research has been limited, primarily due to the lack of funding and the absence of an mHealth Strategy with which to align research.

85%

of the 35 million South African adult population has access to a mobile phone

DID YOU KNOW?

95%

of local households have a mobile phone (Source: All Media and Products Survey 2012)

NurseConnect, an extension of MomConnect, is a project that has been initiated by the DOH to support nurses and midwives in their daily work. NurseConnect uses mobile technology to support nurses and midwives working in maternal health, child health and family planning across South Africa, and offers them access to targeted support messages, advice and in-depth information and advice on maternal and child health.

The return on investment for mHealth, especially on the part of ministries of health, needs to be well documented. It is important that governments develop a strong business case for the implementation of mHealth solutions, and do not roll out technology for its own sake. Most mHealth interventions are based on small projects, often nongovernmental and not integrated into mainstream government health services. The evidence of success is based on pilot studies and focused on feasibility, not cost-effectiveness. To upscale these benefits requires a better understanding of local conditions, training of health workers, and appropriate choice of ICT tools. ICT project implementation generally takes longer and, therefore, costs more than was originally budgeted for. In South Africa, smaller mHealth projects are mainly donor funded and are not financially sustainable. These projects rarely include cost-effectiveness evaluations or information about going to scale. In most countries where these pilots are being rolled out, there is still the lack of a guiding legal framework. In South Africa, the current legal framework protects confidential patient’s health records. The National Health Act (No. 61 of 2003)

DOH 2018

45


mHealth | Department of health

stipulates that the protection of patients’ confidential medical information should be assured. This legislation includes the electronic transmission of personal medical information over networks. The right to privacy is also considered to be a fundamental right and is listed in the Bill of Rights of the Constitution in Section 14. Health facilities collect personal information for the purposes of

patient care; however, it is unclear at what point a person loses the right to control information so collected (if at all) and what legal mechanisms are available to address privacy and security concerns. In the case of mHealth, there is a need for a clear security policy on care and loss of mobile devices, including cell phones.

Prioritising mHealth The strategic implementation plan for mHealth in South Africa is aligned to the national eHealth Strategy for South Africa 2012 – 2016, which is driven by many initiatives, including: • the proposed National Electronic Health Record System

• the proposed National Health Insurance (NHI) • the roll-out of a national electronic medical record system for monitoring antiretroviral (ARV) treatment for HIV/AIDS. In the short to medium term, this mHealth strategy seeks to address the nDOH’s short- and medium-term priorities. These priorities are outlined in the DOH’s Strategic Plan for 2014/15 – 2018/19 and the Annual Performance Plan 2014/15 – 2016/17. Tables 1, 2 and 3 look at opportunities to enable and support service delivery, and the contribution of mHealth to the DOH’s five-year (2014/15 – 2018/19) strategic goals.

TABLE 1 Strengthening health system effectiveness SERVICE DELIVERY INTERVENTIONS

OPPORTUNITY FOR mHEALTH TO ENABLE AND SUPPORT INTERVENTION

Strengthening Health Information Systems

Strengthen the District Health Information System (DHIS)

Improve ICT infrastructure and connectivity so that DHIS software can be implemented at clinics and move to a web-based, centralised platform. Include mobile technologies and infrastructure

Develop framework for a monitoring and evaluation function with Health Management Information System (HMIS)

Improve ICT infrastructure and connectivity so that related software can be used more effectively. Include mobile technologies and infrastructure

Enforce common standards, norms and systems across the country

Provision of online training and testing on service delivery norms and standards. Include mobile platform

Re-engineering the PHC approach

Implement the re-engineered Primary Healthcare approach to aggressively reduce avoidable morbidity and mortality

• Use telemedicine delivered via mHealth to strengthen the referral system and identify at-risk patients early on and refer timeously and appropriately • Community health workers to communicate via cell phones – send and receive data via cell phones • School nurses to screen children in mobile clinics and use mHealth solution to refer timeously and appropriately

Health promotion and disease prevention at a household and community level delivered via mobile platforms – e.g. podcasts to mobile phones, radio, etc.

School nurses to screen children in mobile clinics and use mHealth solution to refer timeously and appropriately

Improve patient care and satisfaction

Mobile communications infrastructure used for educational information channels for the public

Reduce queuing times in clinics

Mobile communications infrastructure used for educational information channels for the public

Improved HR for health

Strengthen HR and HRM systems

Capacity building for existing staff using eLearning

Improve the functioning of clinic services

Support implementation of a mobile platform for DHIS

Improved logistics and monitoring of equipment

46

Reporting stock-outs and low stock levels

Tool to notify supply chain when stock levels are low

Monitor equipment

Utilise sensors and the internet of things to check that equipment is working correctly and report to a central location

DOH 2 0 1 8


mHealth | Department of health TABLE 2 Preventing disease and reducing its burden, and promoting health Service Delivery Interventions

Opportunity for mHealth to enable and support

Prevent non-communicable diseases through education on benefits of healthy lifestyles

Mobile communications infrastructure used for educational information channels for the public

Reduce communicable diseases such as malaria

mHealth support for data collection and reporting for intervention programmes, including the Epidemic Preparedness Response (EPR) programme for malaria

Mobilise communities and extend care through community health workers

Community health workers communicate via cell phones, send and receive data via cell phones

Establish innovative methods of early detection of noncommunicable and chronic diseases

• Mobile communications infrastructure used for educational information channels for the public • ICT support for mobile PHC facilities

Conduct routine assessment and screening

• Mobile communications infrastructure used for reminders to citizens/patients • mHealth systems used for data collection and reporting for assessment and screening programmes

Provide high-quality antenatal and post-natal services, in time

• Use of mHealth-enabled telemedicine to strengthen the referral system and identify at-risk patients early on and refer timeously and appropriately • Use of mHealth-enabled telemedicine to make decisions to move patients to higher levels of care

Provide accessible, high-quality infant and childcare services

• Mobile clinics for immunisations, post-natal care linked to Electronic Health Record (EHR) • mHealth-enabled referral system. Pick up at-risk infants and refer

Provide HIV counselling and testing (HCT) during pregnancy and prevention of mother-to-child transmission (PMTCT) prophylaxis where necessary

mHealth system for monitoring and evaluation (M&E) of HCT programme

Employ an effective referral system for pregnant women and infants with high-risk conditions

mHealth-enabled referral system. Pick up at-risk patients and refer

Enable expert support to remote sites

• Use of mHealth-enabled telemedicine in clinics, with appropriate infrastructure installed, especially in remote and rural areas • Mobile clinics with telemedicine capability

Effective and available ambulance services

Effective emergency medical services (EMS) information systems, using the latest mobile technology to enhance communication

Support community health workers so that they can provide post-natal care at patients’ homes

• Community health workers communicate via cell phones – send and receive data via cell phones • mHealth-enabled referral system. Pick up at-risk patients and refer

Public health education for the community

Mobile communications infrastructure used for educational information channels for the public

Action HCT, scale up HCT

mHealth system for M&E of the HCT programme

Reach people in their homes, work and public places, social mobilisation

Mobile communications infrastructure used for educational information channels for the public

Integrated HIV/AIDS and TB treatment, care and support with PHC services

• Community health workers communicate via cell phones – send and receive data via cell phones • School nurses to screen children in mobile clinics and use mHealth solutions to refer timeously and appropriately

Monitor treatment, follow-up and adherence

Community health workers communicate via cell phones – send and receive data via cell phones

TABLE 3 Strengthening research and development SERVICE DELIVERY INTERVENTIONS

OPPORTUNITY FOR MHEALTH TO ENABLE AND SUPPORT

Strengthen research and development

• Collaboration with research institutions and HEIs • Determine mHealth research areas especially in support of: – mHealth standards localisation – NHI implementation – Evaluation of mHealth benefits – Web and media technologies – Effective open-source mHealth solutions

DOH 2018

47


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InterSystems | Profile

Improving health outcomes

F

or over 20 years, the use of IT to support improved healthcare outcomes in South Africa has been littered with a history of small, stand-alone, isolated systems that are unable to provide information in an accurate and timely manner. This is not dissimilar to experiences around the world as people grapple with limited budgets, scope determined by specific project requirements and pressure on resources. A few examples of some challenges faced in South Africa are the over 50 different software solutions that have been developed just for HIV in public healthcare, all with differing functionality, usability support and levels of accuracy. Another example is an error rate of up to 70% in data captured into the distributed application installed on stand-alone systems in hundreds of government clinics for the capturing and collation of key health statistics. Some pundits are now proclaiming that these systems simply need to be connected to each other or to a national backbone, in the mistaken belief that by using standards such as those defined in the South African Normative Standards of Healthcare Interoperability, utopia will be delivered. They are mistaken.

The way forward Following on from this is the complexity introduced by the scale at which healthcare needs to be delivered. We have 45 million people to be serviced by the public healthcare system in South Africa and this could well be over 60 million in 10 years’ time. Outside of centralised pathology services supplied by the NHLS, it is the mandate of the provinces to deliver healthcare services and they own the facilities and employ the resources, so the scale of the problem at the provincial level is reduced somewhat, but still large.

InterSystems is the engine behind the world’s most important applications. In healthcare and other sectors where lives and livelihoods are at stake, InterSystems is the power behind what matters. In South Africa, InterSystems underpins a national pathology service covering 45 million lives on a single system. In addition, 5 million lives in a provincial healthcare system are supported on an enterprise server.

The way forward is in line with successful eHealth communities and global best practice through the implementation of large backend Electronic Medical Record (EMR) based systems. They serve as a critical tool for improving patient safety, standardisation of processes, care coordination across multiple levels and locations of care, improvement of clinical outcomes and a reduction in the risk of being sued for medical negligence.

Electronic Medical Records Globally there are now large, proven and modern software packages available with inbuilt electronic medical records that can collate all the administration and clinical information required along with the necessary privacy and security, whilst also being able to interface with applications in other key areas such as radiology and pathology. Products

with proven capabilities of handling millions of patient records and thousands of concurrent users in real time are essential. In a South African provincial context this means a single Electronic Medical Record per citizen covering the clinic and hospital levels while also being able to connect to national centralised services for patient identification, demographics, provider and facility directory services. The provincial EMR systems need to be implemented using proven implementation methodologies that focus on rapid and phased implementation while ensuring clinical safety.

www.intersystems.com

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InterSystems HISP | Profile | Profile

Placing systems at the centre of

healthcare transformation

F

or almost two decades, the National Department of Health (DOH) has been implementing a wellfunctioning health information system, which ensures the availability, accessibility, quality and use of information that is critical to decisionmaking to improve the health and well-being of the country’s population. The Health Information Systems Programme South Africa (HISP-SA) has been a valuable partner to the DOH along this journey.

Born locally, connected globally HISP-SA is a non-profit organisation that develops and implements a range of tools and approaches to strengthen health information systems and support the use of data and information management, primarily in resource-constrained primary healthcare and hospital settings. We are members of the global HISP network. From our roots in the Western Cape, where HISP-SA developed its flagship programme, the District Health Information System (DHIS) – a paper-based and computerised system for managing routine health information in primary healthcare facilities – we have supported the DOH in its adoption of the DHIS and health information management processes as a national standard used in all provinces and public hospitals across the country.

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DOH 2 0 1 8

Reliable, relevant health information is the foundation of a strong and effective health system. The World Health Organization ranks information as one of the key building blocks of a functional health system.

Today, the DHIS has expanded globally and is used in more than 57 countries worldwide as the information system supporting quality healthcare service delivery for some two billion people, including an estimated 71% of Africa’s population.

Beyond data processing An effective national health information system is more than just a tool to collect, analyse, and produce good quality data. It encompasses a broad system of policies; legislation; governance; human, financial and technology resources; health indicators; data sources; data management processes; information products; and the effective dissemination and use of information. HISP-SA, therefore, develops and implements progressive health information systems and solutions that help to transform healthcare systems into effective structures that are able to improve health outcomes for all citizens.

We aim to develop integrated health information systems, and support the development and implementation of health information policies and governance structures. These, in turn, support the improvement of healthcare quality at service points and universal health coverage for the National Health Insurance (NHI) system in South Africa. Another core focus of ours is developing innovative software solutions to address specific health information management needs. By drawing on a wealth of best practices and lessons learned from our global partnership, as well as our own local knowledge and expertise, our team of developers are constantly working on advances in data storage, management and analysis; server management; webbased reporting systems; geographical information systems (GIS); and mobile health (mHealth) solutions.

Ensuring capacity According to the World Health Organization, health information system performance should be measured not only on the quality of data produced, but also on evidence of the continued use of data to improve health system performance in order to respond to emerging threats and improve health. Research on the health information system in South Africa further shows that there is a need for the appropriate human and other resources to support the effective use of the health information system and the information


HISP | Profile

HISP-SA PRODUCTS AND SERVICES it provides. While training in the use of the information system is essential, there is also a need to ensure a cadre of staff and managers who understand the role of the information system in supporting health services, are able to interpret data and use the information learned, and ensure data quality. HISP-SA has an experienced training and mentorship team that provides tailor-made training and mentorship in computer literacy; health information systems; data quality; data analysis; the use, monitoring and evaluation of data; and efficient ways of reporting. In support of the government’s priority to address the critical shortage of qualified health information staff, HISPSA is leading the way by developing accredited qualifications to support career paths in health informatics. Our courses are offered at several universities in South Africa and, through our global network, we have contributed to training at other universities in Africa and internationally. At HISP-SA, we believe that healthcare data must be used for evidence-based decision-making and management purposes. Our in-depth knowledge on the functioning of routine health information systems allows us to support people who work at all levels in the health system – from data collectors in clinics and hospitals to information managers and decision-/policymakers at district, provincial and national levels. We offer a variety of individualised support, ranging from understanding the data collection and collation processes and improving data quality, to the development of an integrated and essential national indicator dataset. Our team has extensive experience in the analysis and use of information, and in innovative ways to present and display data that empowers managers and decision-makers to effectively use information for action.

www.hisp.org +27 (0)43 721 2605

Health Information Systems DHIS 2 (webDHIS) is a web-based, open-source routine health information management system that supports the collection, collation, analysis and use of health information. It is currently the preferred health management information system in over 50 countries and 23 organisations across four continents. MHealth Applications HISP-SA has teamed up with local and international partners to develop a range of applications for use on cell phones to support data capturing and the reporting of routine and epidemic data (e.g. DHIS data, HPV campaign data and notifiable medical conditions); and promote health education and awareness (e.g. MomConnect). Hospital Information Software HISP and its partners have utilised a range of technologies to improve the quality of hospital data. This ranges from improving data quality for hospital-based maternal and child health services, and HIV/ AIDS services, to the development of a modular hospital information system that provides continuity of care through a basic electronic patient record system. National Health Information Repository and Data Warehouse (NHIRD) The NHIRD is a data warehouse that integrates data from various specialist information systems – such as demographic and health surveys, the District Health Expenditure Review, Statistics SA surveys and population-based data, and DHIS databases – and applies sophisticated data analysis and GIS techniques to the data to create dynamic visualisation of the data. These visualisations highlight comparisons, trends and relationships to improve managers’ understanding of the status of health services and service delivery from multiple perspectives. National Data Dictionary The National Data Dictionary is a public repository of metadata for South Africa. It provides a single authoritative and up-to-date source of information on the health system hierarchy, data element and indicator definitions and GIS coordinates. The availability of services such as these is essential for ensuring that software used in the public (and private) sector is interoperable and utilise standardised features (such as UIDs and GIS coordinates). Capacity Building Services Recognising that health information officers represent a new cadre of health worker, HISP has initiated the process of developing a framework that will support career path progression of information officers and managers in health information systems. In support of this, a number of short- and longterm initiatives are under way to create opportunities by developing one-onone interactive training, under- and postgraduate curricula courses through universities, and eLearning support. Examples include: • Interactive HIM training modules – working closely with the DOH to develop relevant, interactive HIM training modules, including DHIS2 Foundation, Introduction of DHIS2 for Managers, Data Quality Improvement and Use of Information for Data Capturers and Information Officers, Evidence Based Health Results Management (EBHRM) for Managers, etc. • UNISA courses – Evidence Based Health Results Management for Managers • UWC Winter School Training – Introduction to DHIS2 and GIS in DHIS2 • eLearning – DHIS2 Foundation and Patient Experience of Care (PEC) • Training on demand to both private institutions and NGOs.

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Imperial Logistics | Profile

Customise, collaborate, compete

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t its core, Imperial Logistics offers value-add logistics solutions, supply chain management solutions and route-to-market solutions. Across all industry verticals, the company achieves this by supplying warehouse management, transportation management, and international freight management and distribution management solutions. Together with international-standard quality assurance compliance (ISO 9001:2008), Imperial’s clients receive the highest possible level of service and assurance.“We offer our clients reliability and confidence, which is key in the healthcare sector, with the service security and cost transparency necessary for our developing world markets,” shares Lara Haigh, CEO, Imperial Health Sciences. “We also conform to all regulatory and compliance standards in every market that we service.”

Strategically aligned A division of Imperial Holdings Limited, Imperial Health Sciences operates under the Imperial Logistics Business. Imperial Logistics is Africa’s largest supply chain company and the 27th largest logistics company globally.“With the ability to leverage off Imperial Logistics’ established network across the globe, we are able to service our clients’ needs in all our markets,” she continues. Imperial Logistics’ healthcare strategy focuses on commercial and public health supply chain solutions, including system strengthening, training and logistics. A Level 2 BBBEE supplier, Imperial Logistics scored full points for enterprise development and socio-economic development areas on its latest scorecard. The company’s preferential procurement spend with QSEs, 51% black-owned and 30% black-woman-owned businesses was more than double the target percentage. Imperial Logistics also made progress on the employment equity front, achieving 66% of the target points, proudly achieving 95% of the ownership target score. In terms of economic interest, Imperial Logistics has 22% equity ownership fully vested in the hands of black shareholders.“Going forward, we will continue to actively seek

Imperial Health Sciences was established in March 2000 through a need to offer a consolidated supply chain to pharmaceutical companies in South Africa. As the leader in African healthcare supply chain management, Imperial Health Sciences delivers more than 27 million packs of medicine across the continent each month. out opportunities to partner with QSEs, EMEs and other designated group suppliers that are 51% black-owned and 30% blackwoman-owned in order to facilitate maximum benefit for our clients in terms of their own procurement scorecards,” comments Sibongile Zikalala, director: Transformation, Imperial Logistics.

African footprint Over the years, Imperial Health Services has fulfilled its strategic intent to expand into Africa, establishing pharmaceutical operations in Nigeria, Ghana, Malawi and Kenya, boasting extensive experience in all the private sector channels, namely: wholesalers, doctors, pharmacies, hospitals and FMCG. The company also plays an important role in the public health space, servicing donors, governments and associated partners. “We view ourselves as more than a logistics supplier by focusing on being a partner with flexible solutions and joint value creation,” Haigh adds.

The next step Imperial’s bonded facility at its Centurion premises has, for the past 10 years, transformed the level of service to the SADC region, providing centralised storage and the distribution of life-saving antiretrovirals (ARVs) for people living with HIV/AIDS. But, over the years, global donor support has increased to include vaccines, essential medicines, family planning and the treatment of threats such as malaria,

tuberculosis, HIV/AIDSassociated opportunistic infections, as well as testing kits. At the same time, the commercial pharmaceutical market has expanded materially, with more and more patients self-funding their medicines through private pharmacy channels. In December 2017, Imperial Logistics was awarded a revised licence for its pharmaceutical bonded warehouse in Centurion. Prior, the warehouse operated within the Medicines Control Council (MCC) licence exclusions, which restricted the warehousing activities to certain donated ARVs. Following the lifting of these restrictions by the MCC, the revised licence will extend the benefits of Imperial’s model, enabling the company to provide additional services to its clients and optimally serve patients across the continent, whether through commercial, donor-funded or government channels. “The revised licence will enable Imperial to support the global donors as well as multinational clients wishing to service the SADC region through a centralised hub in South Africa,” Haigh concludes.

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Key to Diagnostic Excellence

Constantly improving laboratory testing technology aiming to provide efficient turn around times

Continuously seeking strategic Private Public Partnerships (PPP) to contribute towards a healthier South Africa

Over 115 pathologists with specialised expertise

Rapid & efficient delivery of results to support clinical decision making

Electronic access to laboratory results at your fingertips available on the Lancet Mobile App Available on the

App Store ANDROID APP ON

Google play

A South African Footprint covering all Provinces and extending into the African Continent

24 hour Laboratory services Providing a full range of SANAS accredited diagnostic services including Microbiology, Molecular Pathology, Virology, Histology & Cytology, Chemical Pathology, Coagulation, Haematology, Occupational health and Newborn Screening

Regional Head Of�ces: JHB: 0027 (0) 11 358 0800 | PTA: 0027 (0) 12 483 0100 | CPT: 0027 (0) 21 673 1700 DURBAN: 0027 (0) 31 308 6500 | POLOKWANE: 0027 (0) 15 294 0400 RUSTENBURG: 0027 (0) 14 597 8500 | NELSPRUIT: 0027 (0) 13 745 9000 BLOEMFONTEIN: 0027 (0) 51 410 1700 | KIMBERLEY: 0027 (0) 53 836 4460

@LancetLab

LancetLaboratories

www.lancet.co.za


lancet laboratories | Profile

New immunology and allergy services Lancet’s Immunology and Allergy Department conducts the following tests:

allergy testing

1

Autoimmune testing

2

Allergy testing

3

Therapeutic drug monitoring biologicals

4

Primary immune deficiency testing

• ANF/dsDNA (automated platform) • ENA • ANCA IFA/ANCA serology (automated platform) • Intrinsic factor/parietal cell Abs • Adrenal Abs (manual) • Autoimmune hepatitis testing (LKM/smooth muscle/mitochondrial Abs) • Aquaporin • Autoimmune encephalitis blots • Paraneoplastic blots • Coeliac disease screening (TTG/EMA/ASCA/DQ2/DQ8) • Cardiolipin antibody testing • C3/C4 • C1 esterase • RhF • CCP • MBL (mannan binding lectin) • Complement classic/alternative

• Full range of allergy screens and specific IgE Abs Thermo Fischer/Phadia platform • Skin prick tests • CAST testing (flow cytometry) • MAST cell tryptase for the detection of anaphylactic reactions or MAST cell activation syndromes

Lancet Laboratories is proud to announce that it now has an Immunology and Allergy Department that provides testing and consultation services.

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he services offered through the department include the testing and consultation of pathogens that can cause disease, allergy and auto-immune conditions including connective tissue and neurological disorders, and advice on how to assess patients with primary immune deficiencies. Lancet Laboratories is at the forefront of these continuously evolving fields of medicine through an active programme of research and assessment to ensure superior diagnostic testing. Over the last few years, Lancet has focused on accessing cutting-edge technologies and introducing new tests to assist in the diagnosis and management of both common and rare infections, autoimmune and allergic conditions. Whenever possible, there are fully automated platforms that are selected to ensure favourable turnaround times, technical efficiencies and results of the highest quality for patients.

• Levels for two TNFα inhibitors are measured in Lancet’s lab – infliximab (Revellex) and adalimumab (Humira)

• HIV fourth-generation testing • T cell; numerous panels include CD3+ & Cd3% | CD4 & Cd4% | CD45RA (naive) |CD45RO (memory) | CD8 & CD8% | CD4:CD8 | %CD19/CD20 | % NK Cells | Absolute NK cells • NK cells • Th17 • Functional Ab testing (tetanus, pneumococcus, haemophilus) • Immunoglobulins (IgA/IgG plus subclasses, IgM)

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InterSystems Pharmacy | department | Profile of health

Good practice makes better The vision of the South African Pharmacy Council, in serving the public interest and in terms of its statutory obligation, is to ensure quality pharmaceutical services for all the people of South Africa. The vital element in this vision is the commitment of the pharmacy profession to promote excellence in practice for the benefit of those they serve.

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he South African Pharmacy Council continuously strives to ensure that the highest standards are maintained in the manner in which pharmaceutical services are provided, and that any new amendments or additions to the Good Pharmacy Practice (GPP) standards are brought to the attention of all pharmacists and other healthcare professionals as soon as possible. It is important that the current amendments, as reflected in the new manual – relating to matters of the confidential maintenance and disposal of patient information – coincide with two issues that are likely to dominate the healthcare landscape in South Africa for a long time into the future. The first is the intensification of the battle against HIV/AIDS, which will require that stigma and a lack of

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confidentiality do not continue to impede people living with HIV from seeking help from the healthcare system – be it in the public or private sectors. The second issue is occasioned by the fact that government has decided to move along with plans to prepare for the implementation of a national health insurance (NHI) system. Whatever form it takes, all health facilities, including community and hospital pharmacies, will have to meet certain standards if they are to be accredited to supply services to the NHI authority. It is, therefore, important that all pharmacy facilities continue to strive to be compliant with the requirements of GPP. The education and training of pharmacists in South Africa must equip them for the roles they have to undertake in practice and be in line with the unit standards for entry-level

pharmacists accepted by Council. Within the necessary basis of pharmaceutical sciences, there must thus be adequate emphasis on the action and uses of medicines, a reasonable introduction to disease states and the relevant elements of the social and behavioural sciences. At all stages, the development and improvement of communication skills should be given due emphasis. Education is equally important when it comes to patients. Patient information is of vital importance in the correct use of medicines. A lack of information and misunderstanding contribute to the failure of the therapy, thus wasting resources and adding to the costs of care.

Good practice When it comes to GPP requirements, this could be summarised around one statement: a pharmacist’s first concern


Pharmacy | department of health

Good to know must be the welfare of the patient and the public in general. This should always be top of mind when undertaking pharmaceutical activities such as the prescribing and dispensing of medicines; safety and quality assurance; staying abreast of industry changes; and continuous learning. The keeping, compounding, dispensing or supply of any medicine or scheduled substance by a pharmacist, pharmacist intern or pharmacist’s assistant or the provision of services that form part of the scope of practice of a pharmacist, may only take place in or from a pharmacy if the pharmacy complies with minimum standards relating to premises, facilities and equipment, is duly licensed by the Department of Health, and is recorded in terms of the Pharmacy Act (No. 53 of 1974). The minimum requirements for pharmacy premises,

facilities and equipment are outlined in Chapter 1.2 of the Good Pharmacy Practice in South Africa manual, and include factors such as design and layout of the pharmacy, cleanliness and maintenance, and unobstructed display of the name of the pharmacist on duty. Security, access control, hygiene, storage areas and environmental factors are also highlighted in the manual. Any storage area, which is not physically an integral part of the premises of a pharmacy, must constitute part of a pharmacy licensed by the Department of Health and recorded with Council. Such a storage area must fall under the authority of the responsible pharmacist of the pharmacy of which it forms a part, and be operated in compliance with GPP. Thus, such a storage area cannot operate independently of a pharmacy.

Schedule 6 medicines or substances must be stored in designated places under lock and key at all times, and the key must be in personal possession of an authorised person responsible for the control of schedule 6 medicines or substances. A register of schedule 6 medicines or substances must be kept and shall be balanced so as to show clearly the quantity of every schedule 6 medicine or substance remaining in stock. A pharmacist’s assistant shall not handle any schedule 6 medicine or substance except for the purpose of dispensing under the direct personal supervision of pharmacist.

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InterSystems Pharmacy | department | Profile of health

Supply in a primary healthcare clinic The provision of pharmaceutical services in a primary healthcare clinic or mobile clinic must be managed, monitored and supervised by the responsible pharmacist of the institutional pharmacy in a public health facility from which the services are managed, or by a pharmacist designated by a province or a local authority, e.g. a district pharmacist. This pharmacist will be accountable to Council for compliance with the applicable legislation relating to the services, which pertain to the scope of practice of a pharmacist in the primary healthcare clinic(s) under their supervision. In cases where the pharmaceutical services in a primary healthcare clinic or mobile clinic are not provided by a pharmacist, they must be provided by a pharmacist’s assistant working under the indirect supervision of a pharmacist

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or, alternatively, a person licensed to dispense medicine in terms of Section 22C(1)(a) of the Medicines Act (No. 101 of 1965). Furthermore, the distribution of medicines within a hospital/institution must take place under the direction and control of a pharmacist and must be in accordance with Regulation 36 of the General Regulations published in terms of the Medicines Act. If a drug information service is established within a hospital, it must be maintained and developed in conjunction with other established drug information centres. This service must take cognisance of the specific needs of the hospital personnel and patients. If a drug information service is established, it must comply with the standards as set out in the manual.

Pricing of prescriptions Pricing of medicines is usually a contentious issue, especially with the

huge price gaps that exist between the public and private sectors. The Good Pharmacy Practice in South Africa manual, however, offers guidelines on the pricing of prescription medicines. It states that the pricing of approved services must be in accordance with the rules relating to services for which a pharmacist may levy a fee and guidelines for the levying of such fees. The advertising of prices must be in accordance with Regulation 45 of the General Regulations published in terms of the Medicines Act. The pricing of the prescription must include the following: • all information necessary to prevent a member of a medical aid scheme from gaining any benefit to which he/she would not otherwise be entitled • the final price paid by the patient/ member or an indication of the total cost of the account rendered if payment is not effected. Prices for services, including dispensing, must not be advertised in a manner that: • is calculated to suggest that a pharmacist’s professional skills or ability or his facilities for practising his profession or rendering his professional services are superior to those of other pharmacies • could be construed as touting or attempting to tout for prescriptions or business with regard to the sale of


Pharmacy | department of health

medicines or the provision of approved supplementary services. Prescription monitoring is just as important as prescription pricing. This helps to ensure that patients receive drug treatment as intended by the prescriber and as required for optimal care. Prescription monitoring is a component of, and not a substitute for, the assessment of patients to identify patient and medication risk factors. Through prescription monitoring, the pharmacist must identify problems or opportunities for optimising treatment.

Screening services Over and above the dispensing of medicines, a pharmacy can offer services relating to screening and testing a patient’s biochemical and physiological parameters. Pharmacists who are competent to do so may provide such screening and monitoring services. The taking of samples, the performance of screening tests, and the monitoring of blood pressure must be done in a private consultation area in the pharmacy. The same conditions apply when taking samples for HIV testing, the performance of HIV antibody tests, diabetes tests, and immunisations. The consultation area must comply with the requirements described in Section 1.2.13 of the manual. However, protocols must be established to ensure that records of test results are kept and that the objective validation of the quality of both methods and equipment used for screening is allowed. Testing should be carried out at regular intervals within the protocol. There must be effective communication with the patient’s

doctor and other relevant healthcare professionals. Pharmacists and members of staff involved must have sufficient training to enable them to give appropriate and sound advice. Additionally, reliable tests and instruments must be used at all times. Pharmacists performing the tests must be familiar with the instructions and requirements of individual products on the market, and must be aware of the limitations of the tests and realise that no test is 100% accurate. It is highly important that the storage requirements of the test material be noted and the product stored according to the manufacturer’s instructions. In the case of HIV testing, pre- and posttest counselling is imperative. Pre-test counselling must include information on confidentiality; definitions of HIV/ AIDS and the transmission of HIV infection, and the details of the HIV test. Post-test counselling, on the other hand, is provided to a patient after he/ she receives the test results. It includes feedback and help in understanding the results, risk reduction, infection in the window period, and a suggestion to retest.

Protecting patient information In terms of the National Health Act (No. 61 of 2003), all information concerning patients – including information relating to his/her health status, treatment or stay in a health establishment – is confidential. Patient information is generally held under legal and ethical obligations of confidentiality. Information provided in confidence must not be used or disclosed in a form that might identify a patient without his or her consent. The exception to the above is contained in the rules relating to the code of conduct for pharmacists and other persons registered in terms of the Pharmacy Act. Confidential information is defined as information accessed or maintained by the pharmacy, which contains personally identifiable information that could be used to identify the patient, e.g. the patient’s name, address and telephone number; medicines sold to the patient; and identifiable data about the patient. In order to protect personal information from improper disclosure and potential misuse, the responsible pharmacist of the pharmacy must take the necessary action to prevent the acquisition and misuse of personal information relating to patients. The responsible pharmacist must ensure that there are policies and procedures in place in the pharmacy to protect documents relating to patient information from any unauthorised disclosure and use, whether or not it results from disposal. At a minimum, this means restricting access to documents relating to patient information to staff whose responsibilities do not require them to have this information – i.e. persons who are not registered with Council.

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Tower City Trading is a manufacturer and supplier of medical and surgical consumables. We supply all types of disposable surgical gowns, and pride ourselves on being one of the first companies to open a manufacturing factory for disposable surgical gowns in South Africa. High-risk, sterile disposable surgical gowns (reinforced) High-risk, 100%reinforced sterile gowns Standard surgical gowns (sterile and non-sterile) Various sizes are available or as per client specification.

We also manufacture and supply a wide range of linen savers. Our quality linen savers afford maximum protection by forming a moisture barrier between the skin and bedding. Our unique manufacturing technique makes our linen savers extremely durable, even when wet. They also resist sliding and bunching. All sizes are available according to client specification, from two-ply to six-ply

To order or for further enquiries, email us on info@towertrading.co.za 62

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We provide the best and most cost-effective cleaning and hygiene solutions including portering services.

Specialists in: • Healthcare and commercial cleaning (hospitals, clinics and medical centres) • Retail and janitorial cleaning (shopping centres and office buildings) • Portering services

Through our monthly in-service training and development, our staff are geared to provide excellent service at all times. We are highly driven by our core values of professionalism, reliability and integrity at all times.

t: 031 9043 329/13 f: 031 9043 323 DOH 2018

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Fast facts | Department of health

Steps in the right direction Over the years, South Africa has invested in progressive policies to transform its national health system into one that is both integrated and comprehensive. GLOBAL STANDARDS

At the end of March 2017, the total number of clients remaining on antiretroviral therapy was 3 831 730. The Department revised its HIV guidelines to align with the World Health Organization HIV guidelines

SNIP, SNIP

Prevention is the mainstay of efforts to combat HIV and AIDS. Since the HIV Counselling and Testing campaign was introduced in 2010, over 44 million people have been tested.

Voluntary medical male circumcision (VMMC) is one of the Department’s combination HIV prevention interventions. During 2016/17, a total of 491 859 VMMCs were conducted (this included VMMC data obtained from partners)

A total of 14 233 123 people were tested for HIV, exceeding the annual target of 10 million for the 2016/17 financial year

FROM HIV TO ARV According to the Rapid Mortality Surveillance Report 2016, total life expectancy in South Africa increased from 62.2 years in 2013 to 63.0 years in 2015. South Africa is also experiencing downward mortality trends; this could be attributed to continued expansion of the government ARV programme, with an increased number of HIV-positive persons who are taking ARV drugs living longer

FIRST, VACCINATE The human papillomavirus (HPV) vaccine targeting girls in grade 4 was introduced to protect them against cervical cancer – a major cause of death, especially among black women. The programme has been largely successful, reaching 420 356 targeted girls for the first dose HPV immunisation, and 327 460 for the second dose HPV immunisation coverage

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WHAT’S YOUR STATUS?

LIVING LONGER Chapter 10 of the National Development Plan (NDP) 2030 sets out the vision for the South African health system, namely, “to achieve a long and healthy life for all South Africans”. The NDP envisaged the following by 2030: a life expectancy rate of at least 70 years for men and women; a generation of under-20s largely free from HIV; a reduced quadruple burden of disease; an infant mortality rate of less than 20 deaths per 1 000 live births; and an under-five mortality rate of less than 30 deaths per 1 000 live births

LEARNING CURVE In the 2016/17 financial year, the Department of Health continued to implement the Integrated School Health Programme (ISHP), which contributes to the health and wellbeing of learners by screening them for health barriers to learning. The ISHP exceeded its target to screen 28% of grade 1 and 12% of grade 8 learners. A total number of 3 330 926 learners have been screened through this programme since inception; 352 766 learners were identified with health problems and referred for intervention


The Clicks Helping Hand Trust

supports the following Department of Health awareness campaigns by offering tests and screenings at all Clicks clinics.

Breast Cancer Pink Health Check, which includes a Breast Examination, at our Clicks clinics for the month of October.

HIV/Aids FREE HIV testing and counselling at our Clicks Clinics for the month of December, and selected days

FREE Glucose Screening at any Clicks Clinic for the month of November, and selected days.

Diabetes

FREE Blood Pressure Test & Cholesterol Screening at any Clicks Clinic for the month of September, and selected days.

Heart Health

To date The Helping Hand Trust has... • More than 196 Clicks Helping Hand clinics nationwide. • Administered over 39 800 FREE baby immunisations and baby consultations. • Facilitated over 21300 family planning consultations. • Dispensed over R13 million worth of medication.


AFFORDIBILITY ACCESSIBILITY CONVENIENCE

AFFORDABLE HEALTHCARE • • •

LOW DISPENSING FEES LOW PRICES ON SELF MEDICATION LOWER-PRICED GENERIC ALTERNATIVES

Our exclusive private label range of vitamins and supplements represents an affordable offering to our customers.

MEDICAL SCHEME DSP AGREEMENTS

Out-of-pocket expenses are minimised through agreements with many medical schemes.

Earn points on purchases.

485 197

OVER

PHARMACIES NATIONWIDE

CLICKS CLINICS

35-40

Providing primary healthcare services & advice to thousands of people.

NEW PHARMACIES EACH YEAR

Chronic Medication pick-up points for state patients 200 Clicks Pharmacies act as medication pick-up points.

FREE RPS

CLICKS APP

The Clicks App makes ordering and collection of medication more convenient.

SERVICE

Repeat Prescription Service reminds patients to collect their pre-packed medication.

DELIVERY

Clicks Direct Medicine ensures patients can get their medication delivered wherever they are.

CENTRAL

DATABASE

The Clicks database allows patients to collect medication at any Clicks Pharmacy.


Affordable and Accessible Healthcare Q & A with

DAVID KNEALE CEO Clicks Group

Q How does Clicks help in making Healthcare more affordable to South Africans? Our pharmacists provide advice and counselling to patients to assist with the switching of medicines to lower-priced generic medicines where appropriate, whilst our low dispensing fees and self medication prices further assist cash and medical aid paying patients to save on their medication needs. In our support of holistic health, our exclusive private label range of vitamins and supplements represents a differentiated and affordable offering to our customers. Furthermore our loyal Clicks ClubCard members save even more by earning cash back on all frontshop purchases and dispensing fees.

Q How is Clicks growing access to healthcare across South Africa? Clicks is the largest retail pharmacy chain in the country with a network of close to 500 pharmacies and 200 primary care clinics nationwide. Our dedicated courier pharmacy, Clicks Direct Medicines, enables nationwide delivery of medicines to patients. Clicks will continually expand its retail and pharmacy network with our aim being to have a pharmacy operating in every store. 35 new pharmacies are planned to open in 2018. In partnership with the Department of Health, over 200 Clicks pharmacies act as chronic medication pick up points for state patients, with over 90 000 parcels being collected each month. We remain commited to working with the Department of Health on further initiatives that improve access to healthcare for all South Africans.

Q How does Clicks support the Department of Health’s mission to improve health status through the prevention of illness and the promotion of healthy lifestyles? Clicks provides important healthcare services and advice across primary care clinics, with a specific focus on preventative screening and maternal and child healthcare. Through the Clicks Helping Hand Trust, HIV, Diabetes and Heart Health screenings are offered free of charge to customers without medical aid on a weekly basis. Clicks also provides free mother and baby services such as family planning advice and baby vaccinations. State vaccines and family planning medication is made available through Clicks clinics.

Q How does Clicks support people living with diseases to remain healthy? Our free Repeat Prescription Service is a value added service that provides a monthly reminder to patients living with a chronic disease to collect their pre-packed medication reducing queuing time, ensuring availability of medication and improving their adherence & compliance to therapy. The new Clicks App can be downloaded on any smart phone and is our most exciting new development. ClubCard members are able to submit their prescriptions by simply taking a photograph and sending the image to the Clicks Pharmacy of their choice. The script will be dispensed by their Clicks Pharmacist and they can then collect their medication within a few hours.


InterSystems Cancer | Department | Profileof health

Cancer

prevention and control One in three individuals is diagnosed with cancer at some point in their life, and up to 10% of the common cancers – including breast, ovarian and colorectal cancer – are due to inherited cancer-predisposing genes. As such, the Department of Health’s early detection and prevention initiatives include genetic testing, education, and reducing the risk factors.

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he harsh reality is that cancer is one of the major killers throughout both the developed and developing world, including South Africa. Breast cancer is the most common cancer among South African women, followed by cervical cancer, while it is estimated that 1 in 75 men will develop colorectal cancer (cancer of the colon or rectum). Concern around the increase in cancer incidence and rising trends in cancer risk factors have led to the recognition that cancer not only threatens development, but also that many cancer cases and deaths can be prevented. To this end, as reflected in the country’s Sustainable Development Goal 3: “to reduce, by one-third, premature mortality from non-communicable diseases through prevention and treatment, by 2030”, the

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international health community has begun focusing on global oncology. In addition, the World Health Assembly together with the World Cancer Declaration and Global Action Plan for the Prevention and Control of NonCommunicable Diseases (NCDs) 2013 – 2020 have formalised strategies and targets to prevent and control cancer.

Combined effort The Department of Health (DOH) has a broad-based programme to address several women’s health issues, including cancer of the cervix. Organised cervical cancer screening for eligible women is the central element within the DOH’s existing cervical cancer prevention strategy. This policy updates the existing strategy to take into account technological advancements in cervical

38.5% Breast and cervical cancer are leading causes of cancer-related deaths in South African women, together accounting for 38.5% of all cancers diagnosed in women

cancer prevention and new evidence on screening, approaches and methods in context of the HIV epidemic. Although cervical cancer is managed within the DOH, collaboration with other sectors in government to reduce the risk factors that predispose women to the development of cervical cancer is critical. Some of the factors contributing to high cervical cancer incidence in South Africa are: socio-economic status


Cancer | Department of health

DID YOU KNOW? Of note, the Age Standardised Incidence Rate (ASIRs) in black women in 2003 and 2010 was 26.7 per 100 000 and 26.1 per 100 000 respectively, compared to 19.02 per 100 000 and 16.3 per 100 000 in coloured women, 12.96 per 100 000 and 12.91 per 100 000 in white women, and 10.57 per 100 000 and 8.04 per 100 000 in Asian women. This reveals considerable racial disparities in the magnitude of cervical cancer, with significantly higher ASIRs in black women. These statistics may reflect inequities in access to effective cervical cancer prevention and control services. Despite the existence of a national cervical cancer screening programme since 2002, cervical cancer incidence has remained unchanged. And the prognosis associated with a cervical cancer diagnosis is poor, with half of cervical cancer cases estimated to result in death. The mean age of diagnosis of cervical cancer is about 45 years in South Africa, despite many cases occurring before the age of 35. Black women and women living with HIV bear a disproportionate burden of cervical cancer disease, reflecting a lack of access to comprehensive and effective integrated care. DOH Revised Cervical Cancer Prevention and Control Policy

The policy makes provision for three free cervical cancer screening tests in 10-year intervals for all HIV-negative, asymptomatic women over the age of 30 attending public sector health services. It also introduces new guidelines for cervical cancer screening for women living with HIV. Screening these target groups has been proven most effective at detecting and preventing cervical cancer in women by numerous international and local research studies. A number of concurrent health system interventions through other government priority programmes will ensure that the necessary infrastructure, medical technology, and material and information resources will be provided to facilitate the implementation and monitoring of these policy provisions.

Revised policy outcomes and place of residence, education level, social arrangement of families, access to services, healthcare worker skills, and stigma.

HPV vaccine The updated Cervical Cancer Prevention and Control Policy expects to scale up collaborative efforts between the DOH and the Department of Basic Education to ensure increased access to and uptake of HPV (human papillomavirus) vaccination for adolescent girls in school. It makes provision for the introduction of primary prevention of cervical cancer through HPV vaccination of young girls in grade four aged nine and up, and the promotion of awareness regarding HPV prevention through safe sex practices and dual protection (barrier plus other methods of contraception).

It also provides for secondary prevention by strengthening cytology screening and, in the public sector, introducing both HPV DNA-based screening, where resources permit, and SVA, which is referred to as test-and-treat, in resourcelimited settings where treatment immediately follows a positive screening test such as VIA (visual inspection with acetic acid).

Here’s what is new in terms of the revised Cervical Cancer Prevention and Control Policy: Alignment to the global framework: It responds to the SDG target 3.7, which calls for governments to ensure universal access to sexual and reproductive healthcare services, including information, education and the integration of reproductive health into national strategies and programmes by 2030. All the guiding principles, action areas and selected targets of the Global Strategy for Women’s, Children’s and

A randomised controlled trial in India reported a 50% reduction in subsequent invasive cervical cancer

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Cancer | Department of health

DID YOU KNOW? The overall ASR of breast cancer in 2011 was 31.43 per 100 000 compared to 25.86 per 100 000 in the previous report (2010). In terms of population groups, this translated to 74.55 per 100 000 in whites, 47.34 per 100 000 in coloureds, 31.43 per 100 000 in Asians, and 18.63 per 100 000 in blacks. These figures were comparable to those of the 2010 report in black females at 18.33 per 100 000, had decreased in Asian females at 46.04 per 100 000, but had increased in whites at 49.02 per 100 000 and coloured females at 37.35 per 100 000. Several studies have investigated the lower incidence of breast cancer in black South African women compared with other population groups in the country. They concluded that certain factors, known to be important in the epidemiology of breast cancer, are unique in this racial group. These factors include late menarche, early age of first birth, multi-parity, universal and prolonged lactation, low use of hormone replacement therapy, and a diet low in fat and high in fibre.

Adolescents’ Health – namely: “ensure universal health coverage and access to quality essential services and vaccines” and “reduce by one third preventable mortality from non- communicable diseases by 2030” – are alluded to in this policy.

Alignment with national priorities and frameworks: This revision is guided by the South African National Health Insurance (NHI) white paper, which recommends massive reorganisation of the healthcare system to create a new platform for

Cancer Mortality Profile

health service provision. The policy also responds to a number of critical national priorities, including: • the National Development Plan 2030 goals • the increasing quadruple burden of disease in South Africa • the high prevalence of HIV and NCDs in South Africa • the scale-up of HPV immunisation initiated in 2014 • current implementation of the primary healthcare (PHC) re-engineering strategy • the introduction of NHI in South Africa. Integration: The policy complements other existing policies and guidelines, which aim to ensure universal access to sexual and reproductive health services such as the National Contraception and Fertility Planning Policy and associated service delivery guidelines, the HPV Vaccination Standard Operating Procedure, the health sector HIV Prevention Strategy (2016), and the Palliative Care Policy (2016). Holistic approach and outcome focus: Unlike the previous cervical cancer screening policy, which was restricted to screening services, this policy offers guidance for a full continuum of care and includes prevention, screening, diagnosis, treatment, and palliative care services. It further outlines the minimum service delivery package for the different levels of care (the community; PHC

Total population: 52 386 000 Income group: Upper middle Total deaths: 608 000

Life expectancy at birth (WHO, 2017): Total:63.5 Males:59 Females:66

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World Health Organization - SA Cancer Country Profile, 2014


Cancer | Department of health

facilities; district, regional and tertiary hospitals; and private institutions). Special considerations: As the policy is aligned with World Health Organization recommendations, special considerations for high-risk groups are considered, such as women living with HIV, women with other immunosuppressive conditions, sex workers, adolescents, and migrants. Community engagement and involvement: The policy explains the role of civil society organisations and provides for a communication strategy to increase awareness of cervical cancer at community level, as well as increase demand for and utilisation of cervical cancer prevention and control services. Technological advances: The policy takes cognisance of the availability of new screening technologies, the technological advances in primary prevention, screening and treatment of pre-cancerous lesions, and proffers different alternatives depending on available resources.

Genetic counselling for familial breast cancer involves assessing family pedigree, the discussion of inherited breast and or ovarian cancer, and an assessment of the chance that there is an inherited cancer syndrome in the family, as well as an individual’s personal chance of developing cancer.”

Genetic testing Individuals and families who are at risk for inherited breast cancer require genetic counselling, genetic testing and potentially further management, depending on the outcome of their testing. Genetic counselling is a relatively new profession in South Africa but is available in all provinces. Genetic counselling is a process that involves helping people understand and adapt to the medical, psychological, and familial implications of the genetic contributions to disease, and includes: • interpreting family and medical histories in order to assess the risk of occurrence or recurrence of disease • educating individuals and families about the genetic aspects of disease, testing, management, resources and research • providing psychosocial support to assist individuals to adapt to their risks and to make informed decisions. Genetic counselling for familial breast cancer involves assessing family pedigree, the discussion of inherited breast and/or ovarian cancer, and an assessment of the chance that there

is an inherited cancer syndrome in the family, as well as an individual’s personal chance of developing cancer. Women whose family history is associated with an increased risk

Females have a higher risk of developing breast cancer than males. The ratio of male to female breast cancers is 1:135

for deleterious mutations in BRCA1, BRCA2 or TP53 genes should be referred for genetic assessment. Although there are no standardised criteria for selecting candidates for BRCA counselling, the National Cancer Institute, the National Comprehensive Cancer Network and the US Preventive Services Task Force outline family history red flags, which generally point to first- and second-degree relatives with breast and/or ovarian cancers, especially at young ages. Patients from population groups with

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Cancer | Department of health

Age-Standardised Cancer Mortality Trends

specific mutations should be screened for those first. For all other patients and for patients who test negative for the population-specific mutation, testing should then be extended in discussion with a laboratory. The management of individuals with hereditary breast and/or ovarian cancer syndrome may include intensive screening, chemoprevention and prophylactic surgery.

Data management A breast cancer registry is important for reliable breast cancer statistics. These are required to formulate and re-evaluate local and national breast cancer plans or policies. Breast cancer incidence and mortality data should

be obtained from population-based national cancer registries and mortality registers, such as the National Cancer Registry. Data for stage, tumour size at diagnosis, and survival by stage (to monitor quality of treatment) should be collected to assist policymakers in recognising the prevalence and public health burden of breast cancer, and attention paid to timelines to ensure treatment adequacy and health system improvement. All health facilities should collect breast-cancer-related data from diagnosis and throughout the course of disease. This should be entered electronically into a database. The information gathered will determine priorities and aid with the

Age-Standardised Cancer Mortality Trends

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World Health Organization - SA Cancer Country Profile, 2014

implementation of targeted initiatives. A data manager should be allocated for quality assurance, the ethical use of data and to respond to audit requests.

Policy in place Through the Breast Cancer Policy, the DOH aims to ensure that South Africans have access to a network of breast units, which provide timely breast management. The desired outcomes of units should include early disease recognition, work-up and treatment, and thus ensure expeditious movement through the healthcare system with the shortening of waiting times, and the effective prevention or minimisation of morbidity and mortality due to disease progression.

World Health Organization - SA Cancer Country Profile, 2014


Cancer | Department of health

35 - 65 The risk increases with age. From 35 to 65 years, there is a sixfold increase in breast cancer

The goals are to: • improve survival • decrease time to presentation and time to treatment • decrease stage at presentation • improve quality of life in survivorship and palliation • effectively monitor and evaluate programme implementation and the impact of breast cancer interventions. While the strategic objectives are to: • improve early detection rates by promoting community awareness, and educating communities and

healthcare workers on breast healthcare and breast cancer management • facilitate referral pathways for patients with breast healthcare concerns • provide guidelines for establishing appropriate facilities for the management and care of breast conditions • set standards for the optimal care and management of breast conditions • provide a framework for auditing standards and outcomes. With regard to the treatment of breast cancer, the policy further sets out the case studies for lymphedema care, palliative care management for patients, radiotherapy, cytotoxic chemotherapy, hormonal therapies, biological therapies, bone-directed therapies, systemic therapies, contralateral prophylactic mastectomy, and surgery, among others. 

Supporting all South African tissue banks in regulatory and legal matters, data collection, training, accreditation, quality assurance, communication and collaboration - to the benefit of patients.

SATiBA enjoys observer status at the World Union of Tissue Banking Associations

www.satiba.org.za

info@satiba.org.za


InterSystems The Biovac Institute | Profile | Profile

t i o a n y n h t l a e h a g n i r e t s Fo The Biovac Institute, better known as Biovac, is a vaccine-manufacturing company that originated from a successful publicprivate partnership with the South African government. Biovac was established to revive the development and manufacture of vaccines and biologicals in South Africa for the Southern African region.

T

he benefits of vaccination extend beyond prevention of specific diseases in individuals. They enable a rich, multifaceted harvest for societies and nations. Vaccination makes good economic sense, and meets the need to care for the weakest members of societies. Reducing global child mortality by facilitating universal access to safe vaccines of proven efficacy is a moral obligation for the international community, as it is a human right for every individual to have the opportunity to live a healthier and fuller life,” states the World Health Organization bulletin ‘Vaccination greatly reduces disease, disability, death and inequity worldwide’. While the majority of governments invest in vaccines only through the procurement of products, the South African government through a publicprivate partnership has gone a step further by creating an organisation that manufactures vaccines for both local (South Africa) as well regional (the broader Africa) needs. This approach ensures that the African region has timeous access to the required product while stimulating the economic growth and development of a local and regional biotechnology sector.

According to the WHO, “Poor health has been shown to stunt economic growth while good health can promote social development and economic growth. Health is fundamental to economic growth for developing countries and vaccinations form the bedrock of their public health programmes. The annual return on investment in vaccination has been calculated to be in the range of 12% to 18%, but the economic benefits of improved health continue to be largely underestimated.”

Driven by the lack of a vaccine industry in Africa Like all successful industries, the health industry, within which vaccination resides, is driven by large successful corporates, mainly in developed countries with their focus predominantly based on high profitability supported by market needs of the more affluent population. On the other hand, the African healthcare market has limited purchasing power and limited access to capital investment in the biotechnology sector, which reduces our continent’s affordability to establish vaccine-manufacturing entities. This is evident when


The Biovac Institute | Profile

considering the current global vaccine-manufacturing model of quick returns, which in our environment does not naturally fit in with the investment criteria required by traditional pharmaceutical (specifically vaccine) companies. State-owned vaccine manufacturers, on the other hand, have shown very limited success globally hence the need for Africa to successfully initiate a hybrid and unique model, such as the Biovac model. This model is creating opportunities in the health industry for Africa to buy from Africa thereby ensuring its unique healthcare are met and security of supply achieved, while building a self-sustainable modern entity that complies with global standards.

Investing in world-class facilities, technology and processes Biovac’s goal is to ensure that the country has the required domestic capacity to respond to local and regional vaccine needs through the establishment of a manufacturing facility and the supply of quality products. To this end, Biovac has built

a modern, worldclass and state-of-the-art manufacturing site, making it one of the select few licensed vaccinemanufacturing facilities in Africa. This was achieved through deliberate and concerted investment in sound and locally relevant vaccine process and product development capability situated in its Cape Town operation.

A centre of excellence Formed in 2003, Biovac was tasked with the responsibility of ensuring an uninterrupted supply of all the vaccines required for the children’s programme known as the Expanded Programme of Immunisation (EPI). Careful coordination between suppliers and the Department of Health enables Biovac to handle over 25 million doses of vaccines each year and ensure that the required vaccines get to where they are needed, by applying strict cold-chain criteria in all nine provinces of South Africa and a few neighbouring countries.

Continued growth and development With the company’s recently awarded manufacturing licence, Biovac is well positioned to manufacture vaccines and other sterile biological products for South Africa and rest of the African continent.

+27 (0)21 514 5000 www.biovac.co.za Facebook @thebiovacinstitute 0200492018 EXP02/2019

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InterSystems Mental Health| |Profile Department of health

The road to The Mental Health Policy Framework and Strategic Plan 2013 – 2020 was developed through an extensive consultation process with relevant stakeholders. All nine provinces held summits to review the state of mental health and mental health services in their province, to identify best practices and to generate a roadmap for improving mental health.

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resilience

P

ost apartheid, South Africa set about reforming its outdated apartheid-era mental health legislation and, in 2004, the Mental Health Care Act (No. 17 of 2002) was promulgated. This legislation was a major departure from the past. Among other things, it enshrines the human rights of people with mental disorders, providing specific mechanisms for the protection and promotion of those rights, and broadens the range of practitioners and other stakeholders, including mental healthcare users, who can contribute to improving the mental health status of South Africans. The Act also improves access, makes primary healthcare (PHC) the first contact of mental healthcare with the health system, and promotes the integration of mental healthcare into general health services and the development of community-based services. Despite these important reforms, mental health in South Africa faces several ongoing challenges:


Mental Health | Department of health

50% Most mental disorders have their origins in childhood and adolescence. Approximately 50% of mental disorders begin before the age of 14 years

Mental Health Policy 2013 – 2020

TABLE 1 12-month prevalence of adult mental disorders in South Africa Disorder

%

Anxiety

8.1

Mood

4.9

Impulse

1.8

Substance abuse

5.8

Schizophrenia

1.0

Bipolar

1.0

Any anxiety, mood, impulse or substance use disorder

16.5

• Until the development of the Mental Health Policy and Framework Strategic Plan 2013 – 2020, there had been no officially endorsed national Mental Health Policy for South Africa. • Mental healthcare continues to be under-funded and under-resourced compared to other health priorities in the country, despite the fact that neuropsychiatric disorders are ranked third in their contribution to the burden of disease in South Africa, after HIV/AIDS and other infectious diseases. • There is enormous inequity between provinces in the distribution of mental health services and resources. • There is a lack of public awareness of mental health and widespread stigma against those who suffer from mental illness. • There is a lack of accurate, routinely collected data regarding mental health service provision. • Mental health services continue to labour under the legacy of colonial mental health systems, with heavy reliance on psychiatric hospitals. • While the integration of mental health into PHC is enshrined in the White Paper and the Mental Health Care Act, in practice, mental healthcare is usually confined to management of medication for those with severe mental disorders and does not include

the detection and treatment of other mental disorders, such as depression and anxiety disorders. Given the challenges that exist with regard to mental healthcare in the country, there was undoubtedly an urgent need to develop a national mental health policy that reflects the opinions and priorities of a wide range of mental health stakeholders – one that is based on sound evidence and provides a blueprint for action on mental health in South Africa. This Mental Health Policy, therefore, has been developed through a number of processes: • Data was gathered from a review of current mental health policy and service literature in South Africa, and a situation analysis of the mental health system in South Africa, which included semi-structured interviews with over 100 key stakeholders. • International guidance materials provided by WHO were used to

Improved mental health for all in South Africa by the year 2020 is the vision of the Mental Health Policy Framework 2013 – 2020

inform both the content and format of the policy. • The policy was aligned with the current 10-point plan of the Department of Health (2009 – 2014). • An extensive public consultation process was undertaken, during which the draft mental health policy was made available for provincial and national consultations, through the provincial heads of Health.

Scope of the policy Mental illnesses present themselves through clusters of symptoms, or illness experiences. When these symptoms, or experiences, are associated with significant distress and impairment in one or more domains of human functioning (such as learning, working or family relationships), they are defined as clinically significant mental disorders. These disabling disorders include a number of distinct conditions, which affect people across the course of life, with diverse epidemiological characteristics, clinical features, prognoses and possible intervention strategies. Substance abuse Historically in South Africa, substance abuse treatment services have been provided by both the Department of Social Development and the Department of Health. The policy and legislative framework for this area is set out in the Prevention of and Treatment for Substance Abuse Act (No. 70 of 2008) and the National Drug Master Plan (2006). There are important issues of co-morbidity between substance use and mental disorders, and hence a need to coordinate services. Substance use

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disorders are to be covered by the Mental Health Policy Framework insofar as there is co-morbidity with mental disorders. The Department of Health (DOH) committed itself during parliamentary debate of the Prevention of and Treatment for Substance Abuse Act to provide care, treatment and rehabilitation for those users that present with co-morbid substance use and mental disorders in designated psychiatric hospitals, rather than referring them to the substance abuse treatment centres run by the Department of Social Development. Intellectual disability The Mental Health Care Act provides for care and rehabilitation services for mental healthcare users. The responsibility of the DOH is to provide developmentally appropriate healthcare for those with severe and profound intellectual disabilities, many of whom will also have physical disabilities. The vocationally related service needs of people with mild and moderate intellectual disabilities are the responsibility of the Department of Education and later the Department of Labour, while housing and community service needs are currently provided in some provinces by the Department of Social Development. Where co-morbidity exists between intellectual disability and mental disorders, the treatment and care of the person suffering from these disorders is the responsibility of the DOH.

Mental illness and diseases Neuropsychiatric disorders are ranked third in contribution to the overall burden

of disease in South Africa, TABLE 2 12-month prevalence of child and after HIV and AIDS and other adolescent mental disorders in the Western Cape infectious diseases. The first Disorder % nationally representative Attention-deficit hyperactivity disorder 5.0 psychiatric epidemiological Conduct disorder 4.0 study – the South African Stress and Health (SASH) Oppositional defiant 6.0 survey – found that 16.5% of Enuresis 5.0 adults have experienced a Separation anxiety 4.0 mood, anxiety or substanceSchizophrenia 0.5 use disorder in the previous Depression and dsythymia 8.0 12 months (see Table 1). The 12-month prevalence of Bipolar 1.0 child and adolescent mental Obsessive compulsive 0.5 disorders in the Western Cape Agoraphobia 3.0 was reported to be 17%, Simple phobia 3.0 based on a review of local and international epidemiological Social phobia 5.0 literature (see Table 2). There Generalised anxiety 11.0 is no evidence that there Post-traumatic stress 8.0 are any differences between Any child and adolescent disorder 17.0 socially defined racial groups or cultural groups in the prevalence of mental disorders. However, of non-communicable diseases, such there are important gender differences: as cardiovascular disease and diabetes women are at increased risk of developing mellitus; high levels of violence and injury; depression and anxiety disorders, whereas and maternal and child illness. men are at increased risk of developing In the South African context, the substance-use disorders. relationship between HIV/AIDS and The burden of mental illness is felt not mental illness is particularly pertinent. only through the primary presentations Research in South Africa shows a high of mental disorders, but through its high prevalence of both, with mental illness co-morbidity with other illnesses. As and HIV co-existing in a complex South Africa is a country with a quadruple relationship. Mental health impacts disease burden, mental ill-health on and is exacerbated by the HIV/ features prominently in its high level of AIDS epidemic, both being mutually co-morbidity with infectious diseases, reinforcing risk factors. Mental health such as HIV/AIDS and tuberculosis; its problems are common in HIV disease, association with the growing burden cause considerable morbidity, and are often not detected by physicians.

Cost of mental illness South Africa has major challenges regarding substance abuse, and has the highest incidence of alcohol abuse in the world, after the Ukraine. Until recently, areas of the Western Cape had some of the highest rates of foetal alcohol syndrome (FAS) in the world, but have now been surpassed by the Northern Cape. In the Western Cape, there is a growing methamphetamine (tik) epidemic. Cannabis is the most common illicit drug in the country, with particularly high use among the youth. The consequences of these patterns of substance abuse include increased risk for mental disorders, crime and violence, and motor vehicle injuries.

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Mental Health Policy 2013 – 2020

Mental Health | Department of health


Mental Health | Department of health

Mental health problems have serious economic and social costs. These include direct costs related to the provision of healthcare, and indirect costs such as reduced productivity at home and work, loss of income and loss of employment. These costs have a direct effect on the mental healthcare user and their families’ financial situation. The indirect cost of mental disorders outweighs direct treatment cost by two to six times in developed countries and may be even higher in developing countries. In the first nationally representative survey of mental disorders in South Africa, lost earnings among adults with severe mental illness over a 12–month period amounted to R28.8 billion. This represented 2.2% of GDP in 2002, and far outweighs the direct spending on mental healthcare for adults (of approximately R472 million). In short, it costs South Africa more not to treat mental illness than to treat it. The social costs of mental illness can include disrupted families and social networks, stigma, discrimination, loss of future opportunities, marginalisation and decreased quality of life. Stigmatising beliefs reported in South Africa include beliefs that people with mental illness are bewitched, weak, lazy, mad, insane, not capable of doing anything or unable to think. The consequences of such inaccurate beliefs are that individuals who have been labelled as having mental illnesses are feared, ridiculed or exploited. Many individuals have also been neglected, isolated, rejected by family and peers, abused or excluded from social engagement and basic rights. Stigma can thus act as a barrier to accessing education, employment, adequate housing and other basic needs.

Current services for mental healthcare Current mental health service provision in South Africa is marked by a number of features, as outlined: 1. There is wide variation between provinces in the availability of service resources for mental health. 2. Mental health services continue to labour under the legacy of colonial and apartheid-era mental health systems, with heavy reliance on psychiatric hospitals.

Social costs of mental illness can include disrupted families and social networks, stigma, discrimination, loss of future opportunities, marginalisation, and decreased quality of life.”

3. Some progress has been made with the integration of mental health into general healthcare. 4. M  ost provincial services endorse the importance of integrating mental health into PHC, and some training initiatives have been undertaken for PHC nurses. At district level, the integration of mental healthcare into PHC is focused on the emergency management and ongoing psychopharmacological care of patients with chronic stabilised mental disorders, with little coverage of children and adolescents, or adults with depression and anxiety disorders. 5. The total number of human resources working in mental health in the DOH and NGOs is 9.3 per 100 000 population. 6. There is an urgent need for mental health training of general health staff. 7. There is currently only one indicator for mental health on the District Health Information System, namely the number of mental health visits. 8. There is a coordinating body to oversee public education and awareness campaigns on mental health and mental disorders in South Africa, namely the National Directorate: Mental Health and Substance Abuse, DOH. 9. A  few consumer and family associations have been established in some provinces, often with the support of NGOs, such as the SA Federation for Mental Health. There are a few locally based, user-run self-help associations.

10. Some important steps have been taken towards intersectoral collaboration, particularly at national level. However, at district level, and in many provinces, such intersectoral collaborations are the exception rather than the rule. This situation is improving with the legal requirement that districts should produce Integrated Development Plans (IDPs). 11. The emphasis on current spending for mental health falls on treatment and rehabilitation. There are few scaled-up, evidence-based mental health promotion and prevention programmes. 12. Deinstitutionalisation has progressed at a rapid rate in South Africa, without the necessary development of community-based services. This has led to a high number of mentally ill homeless people, people living with mental illness in prisons, and revolving-door patterns of care.

Areas for action In line with WHO recommendations regarding the organisation of mental health services, the mental health systems will include an array of settings and levels that include primary care, community-based settings, general hospitals and specialised psychiatric hospitals. By 2020: 1. Community mental health services will be scaled up to match recommended

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Mental Health | Department of health

national norms, and will include three core components: a) Community residential care (including assisted living and group homes) b) D  ay-care services c) O  utpatient services (including general health outpatient services in PHC and specialist mental health support). These community mental health services will be developed before further downscaling of psychiatric hospitals can proceed. In accordance with the Mental Health Care Act, NGOs, voluntary and consumer organisations will be eligible to provide and be funded for community programmes/facilities. This includes capacity development for users (service users and their families) to provide appropriate self-help and peer-led services – for example, as community health workers. 2. The district mental health system will be strengthened in the following areas: a) Specified mental health interventions will be included in the core package of district health services, embracing a task-shifting approach whereby trained non-specialist workers deliver evidence-based psychosocial interventions. This should include: •m  edication monitoring and psychosocial rehabilitation within a recovery framework for severe mental illness •d  etection and a stepped approach to management and referral of depression and anxiety disorders in PHC clinics • detection and management of child and adolescent mental disorders in PHC clinics and at community level; referral where appropriate • r outine screening for mental illness during pregnancy, and a stepped approach to management and referral. b) Mental health training programmes for general health staff will be conducted at PHC level and district and regional hospitals. c) Supervision systems will be put in place for mental health staff at PHC level. d) Specialist mental health teams will be established to support nonspecialist PHC staff and communitybased workers.

e) C  linical protocols will be available for assessment and interventions at PHC level, through Integrated Management Guidelines, which will include mental health. f ) Community-based rehabilitation programmes will be established in all districts, using a taskshifting approach. g) Mechanisms will be developed for intersectoral collaboration for mental health, led by the health sector and engaging a range of other sectors. h) Where inpatient units are needed, these will be developed in district and regional hospitals. i) Voluntary mental health users that require admission will be admitted in terms of general health legislation. j) Assisted and involuntary mental healthcare users will be admitted in terms of the provisions and procedures described in the Mental Health Care Act as emergency admissions, or for 72-hour assessment in facilities that are listed for this purpose. Further care, treatment and rehabilitation of such users will be provided at health establishments designated for this purpose in terms of the Mental Health Care Act. 3. P  sychiatric services in general hospitals: a) Inpatient units will be provided in general hospitals to improve access to voluntary admission, assisted care, emergency mental health services, 72-hour assessment of involuntary mental healthcare users, further care, treatment and rehabilitation. b) Voluntary mental health users that require admission will be admitted in terms of general health legislation. c) The psychiatric wards that are attached to general hospitals must be designated in terms of the Mental Health Care Act, where they meet the criteria. d) General hospitals that provide 72-hour assessment for involuntary mental healthcare must be listed as prescribed in the general regulations of the Mental Health Act.

e) Information regarding health establishments that provide 72hour assessment for involuntary mental healthcare must be compiled and provided to relevant stakeholders to facilitate referral and access to services. 4. Specialised psychiatric hospitals: a) Further care, treatment and rehabilitation of mental healthcare users will be provided in specialised psychiatric hospitals. b) P  rovision of inpatient and limited outpatient mental health services. c) F unctioning as centres of excellence that provide ongoing routine training, supervision and support to secondary and PHC services. d) P  rovision of sub-specialist services, such as forensic psychiatry and child and adolescent services. e) Forensic facilities will fulfil their role as set out in the Criminal Procedure Act (No. 51 of 1977) as amended, with regard to forensic psychiatric observations. Section 41 and 49 of the Mental Health Care Act provides for designation of health establishments and procedures with regard to state patients and mentally ill prisoners. 

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Emergency services | Department of health

Accessing the right skills In keeping with the provisions of the National Development Plan (NDP) 2030, National Health Insurance addresses key areas for improvement within emergency medical services. One such intervention involved a critical assessment of emergency care education and training and a subsequent alignment with the provisions of the Higher Education Act (No. 101 of 1997).

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Emergency services | Department of health

T

he fragmentation of ambulance services stems back to the South Africa Act, 1909, with the splitting of ambulance services and hospital services between the three tiers of government. The subsequent State Health Plan and promulgation of Section 16(b) of the Health Act (No. 63 of 1977) placed the responsibility for ambulance services with the then four provinces; while the former black homelands were excluded. The mid- to late-1970s heralded the introduction of a one-week basic ambulance course and a rescue medic course for staff working in ambulances. Following this, the then Pre-hospital Emergency Care Committee, under the auspices of the South African College of Medicine, introduced Emergency Medical Assistant Course 1 for nonambulance personnel. Ambulance departments started a similar Ambulance Medical Assistant Course 1. Later, Ambulance Medical Assistant Course 2 was introduced, which was to form the basis for the current Critical

Care Assistant (CCA) course. These short courses provided skilled ambulance personnel that would function under the direction of a medical doctor. A three-week Basic Ambulance Assistant (BAA), 12-week Ambulance Emergency Assistant (AEA) and four-month CCA short course were introduced in 1985 and remained relatively unchanged, apart from the CCA course, which was extended to include an additional five months of clinical roadwork. It became apparent that in order to professionalise the industry and align the emergency care profession to the other health professions in the country, professional qualifications would be required – which would be recognised, regulated and registered by the Health Professions Council of South Africa (HPCSA). The first such qualification was introduced in 1987 in the form of a three-year national diploma offered at the then technikons (now universities of technology). It was envisaged that the threeyear qualification would replace short-course training and equip the graduates with additional rescue capabilities, medical skills and knowledge to function as independent pre-hospital

emergency care personnel. With the election of the democratic government in 1994, nine new provinces were established, incorporating the former black homelands. This resulted in an inequitable distribution of resources within the provinces. The need to increase geographical reach meant emergency care personnel were required to operate independently and provide an increased level of clinical care. This necessitated a higher level of training. This came in the form of a Bachelor of Technology degree in Emergency Medical Care (BTech EMC), introduced in 2001. The BTech EMC could be obtained by completing an additional two years of part-time study after

TABLE 1 Current operational public and private sector ambulances and employment statistics (as at 31 March 2017) Ambulance

BAA

AEA

ECT

Paramedic

ECP

Total Human Resources

Eastern Cape

266

1 755

637

23

23

5

2 463

Free State

148

1 428

136

62

7

0

1 633

Gauteng

679

1 041

213

120

41

12

1 427

KwaZulu-Natal

501

1 639

899

24

79

11

2 652

Limpopo

125

1 295

386

7

22

1

1 711

Mpumalanga

98

653

174

0

4

0

831

Northern Cape

116

484

163

8

2

0

657

North West

90

312

184

115

0

0

611

Western Cape

246

619

665

109

125

8

1 526

Private sector

928

2 045

1 976

48

249

65

4 383

3 197

11 291

5 433

516

552

102

17 894

63.1

30.36

2.89

3.08

0.57

100

Total Percentage

National Emergency Care Education and Training Policy 2017

Province

DOH 2018

85


Emergency services | Department of health

TABLE 2 Details of the current emergency care education and training offerings and the number of registrations per category. This table shows that the majority of providers only have four weeks of training. The short courses are not NQF aligned. Despite this, there remain a number of training providers who continue to offer short course training Current emergency care education and training Registration category

Type of

Name of course

course

Alignment with

*Total

NQF level and

number per

credits

category

Total students per category

Basic Ambulance Assistant

Basic Ambulance Assistant (BAA)

Four-week short course

Not aligned to NQF

52 531

Ambulance Emergency Assistant

Ambulance Emergency Assistant (AEA)

Three-month short course

Not aligned to NQF

9 575

Paramedic

Critical Care Assistant (CCA)

Nine-month short course

Not aligned to NQF

1 581

545

National Diploma: Emergency Medical Care

Three-year qualification

NQF 7; 360 credits NQF 6; 240 credits 1 108

584 725

Emergency Care Technician

Diploma: Emergency Care Two-year qualification

Emergency Care Practitioner

BTech: Emergency Medical Care

One-year qualification

NQF 7; 120 credits 520

Bachelor’s degree: Emergency Medical Care

Four-year qualification

NQF 8; 480 credits

*The numbers are as per HPCSA registration statistics as at 1 March 2017. obtaining the undergraduate three-year national diploma qualification. Between 2004 and 2006, the HPCSA, as the Education and Training Quality Assurer (ETQA) and Standard Generating Body (SGB), undertook a revision of the learning outcomes of the existing short courses and higher education qualifications. One of the outcomes of this review and restructuring was the introduction of a two-year 240 credit NQF 5 Emergency Care Technician (ECT) formal qualification. The National Department of Health (DOH) views this ECT programme as the mid-level, health worker equivalent for the emergency care profession. At the respective higher education institutions, the three-year national diploma and one-year BTech programmes in emergency care were reviewed. This review resulted in the creation of a four-year 480 credit NQF 8 professional Bachelor’s in Emergency Medical Care (B EMC). In 2005, a master’s and a doctorate programme were also introduced.

Lack of formal training There is a lack of appropriately qualified emergency care personnel to treat and transport critically ill or injured patients over long distances, resulting

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in sub-optimum levels of patient care. The Minister of Health’s negotiated service delivery agreement focuses on prioritising efforts to decrease child and maternal mortality and improve the overall effectiveness of the health system. Patients have a right to quality healthcare. Currently, the majority of patients are receiving emergency care and transportation, which may involve travelling over long distances, from BAAs with only a few weeks of training. This is clearly not in the best interests of the

public and may be negatively affecting mortality rates, which invariably impacts on the effectiveness of the entire health system. The majority of emergency care personnel registered with the HPCSA have no formal qualifications and only a few weeks of training. This creates a barrier towards accessing higher education for many of the EMS staff. Furthermore, the articulation between the short courses and the higher education offerings has become increasingly


Emergency services | Department of health

TABLE 3 The three-tiered ECQF to meet the emergency care service level Emergency Care Qualification Framework Tier

Name of qualification

NQF level and credits

HPCSA register

Entry level

Higher Certificate in Emergency

NQF 5; 120 credits

Emergency Care Assistant

Mid level

Medical Care

NQF 6; 240 credits

Emergency Care Technician

Professional level

Diploma in Emergency Medical

NQF 8; 480 credits

Emergency Care Practitioner

difficult as the knowledge gap between the non-credit-bearing short courses and the higher education qualifications grows ever wider. This has led to a situation where emergency care personnel remain disadvantaged compared to all other healthcare professionals, who historically had access to higher education and training opportunities. Career pathing, personal growth, and development and lifelong learning opportunities are poorly supported by a short-course system of skills-based training, which is not aligned to the NQF. Access to NQF-aligned formal qualifications is, therefore, a requirement to support the further development of EMS members within the health sector.

Defining the way forward The general South African public and relevant stakeholders may continue to access first-aid level 1, 2 or 3 courses approved by the Department of Labour. However, the national DOH has embarked on the development of a first responder course, which would adequately serve as a first responder qualification for the South African Police Services (SAPS), fire services, traffic police, surf life-saving etc. in carrying out their duties. It is envisaged that this course would be registered with SAQA at an appropriate NQF level. The resultant National Emergency Care Education and Training (NECET) Policy aims to facilitate the normalisation and alignment of emergency care education and training with current education legislation, national training needs and imperatives in order to render quality healthcare to the population of South Africa. The policy is applicable to all emergency care personnel and emergency care education and training providers.

The objectives of this policy are to: Develop an NQF-aligned framework for emergency care education and training. Facilitate access to, and mobility and progression within, emergency care education, training and career paths. Rationalise, enhance and maintain the quality of emergency care education and training programmes. Redress the past inequalities of the educational system, thereby contributing to the full personal development of emergency care personnel and the provision of emergency care to the nation at large. Produce emergency care workers who are able to render quality, effective and efficient services. The DOH has adopted a three-tiered ECQF to meet the emergency care service level needs of South Africa. The ECQF consists of entry-level, mid-level and professional-level qualifications as outlined in Table 3. Post 1994, recognition of prior learning (RPL) in South Africa is regarded as a means of access and redress for our disparate past. RPL enables potential students, including those who had suffered disadvantage in the past, to be admitted to higher education programmes depending on their assessed knowledge and skills. Education and training providers who are accredited to offer the Emergency Care Assistant (ECA), Emergency Care Technician (ECT) and/or Emergency Care Practitioner (ECP) programmes will be required to develop and implement RPL policies that may allow holders of short-course diplomas and other relevant qualifications to gain access to, and/or advanced placement within, their NQF-

aligned programmes. All qualifications and emergency care education and training providers, both public and private, are required to be registered and accredited by the Department of Higher Education and Training, HPCSA and the Council for Higher Education (CHE) in line with the applicable legislation prior to the offering of any of the qualifications featured on the ECQF. All existing and future training providers who wish to provide emergency care education and training will be required to comply with the necessary registration and accreditation criteria required to receive approval from the CHE to render their learning programmes. Training providers that have not been recognised by the Department of Higher Education and Training, which clearly states that the training provider may offer the specific qualification, will no longer be recognised as an accredited provider for emergency care education and training. Furthermore, education and training providers will be required to produce evidence of accreditation with the CHE and the HPCSA prior to the implementation of their emergency care learning programmes. For the development of any new qualification, the HPCSA and the national DOH must be consulted and provide approval. New qualifications will only be considered on the basis of clear evidence of need within the South African context.

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InterSystems Philips | Profile | Profile

Advanced oncology diagnostics modernises public health A new leading-edge facility tackles the burden of cancer with patient-specific precision.

About Royal Philips

Royal Philips is a health technology company focused on improving people’s health and enabling better outcomes across the health continuum – from healthy living and prevention to diagnosis, treatment and homecare. Philips leverages advanced technology and deep clinical and consumer insights to deliver integrated solutions. Headquartered in the Netherlands, the company is a leader in diagnostic imaging, imageguided therapy, patient monitoring and health informatics, as well as in consumer health and homecare. Philips’ health technology portfolio generated 2016 sales of 17.4 billion and employs approximately 71 000 employees, with sales and services offered in more than 100 countries.

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A

s part of the Gauteng Department of Health’s (GDOH’s) concerted efforts to boost service delivery and fast-track the diagnosis of patients suffering from cancer, Gauteng MEC for Health Dr Gwen Ramokgopa launched a R36 million advanced oncology facility at Dr George Mukhari Academic Hospital (DGMAH) in GaRankuwa, Tshwane. The GDOH and DGMAH in Ga-Rankuwa collaborated with Philips South Africa to bring advanced oncology care to patients with a new, leading-edge oncology diagnostics facility that harnesses multiple technologies to provide high-quality data quickly, and creates a comfortable and calming environment for patients to increase chances of a good quality life and positive treatment outcomes.

A first of its kind “I cannot contain my excitement with the launch of this much-needed biomedical equipment because, to us, patient care and safety will always come first. Today’s launch of the first-of-itskind PET-CT imaging system in Africa serves as a testimony to our unreserved commitment to improving patient care and the realisation of the Gauteng government’s agenda of Transformation, Modernisation and Re-industrialisation,” said Ramokgopa. The facility includes an advanced Philips Ingenuity TF PET/CT – a nuclear imaging technique that combines positron emission tomography (PET) and computed tomography (CT) to evaluate the structure and function of cells and body tissue. This advanced PET-CT solution ultimately offers a variety of patient-specific methods and tools to


Philips | Profile

Left The first Ingenuity TF PET/CT with Ambient Experience installed in Africa will support the DOH’s plans to modernise public health services in its quest to improve the quality of life of its communities Below (left to right) Ntutule Tshenye, GM, Philips HealthTech Southern Africa; Dr Gwen Ramokgopa, Gauteng MEC for Health; Dr Freddy Kgongwana, CEO of Dr George Mukhari Academic Hospital; and Jose Fernandes, MD: South Africa, Philips Healthcare, at the oncology diagnostics facility’s inauguration

facilitate the optimal management of both image quality and radiation dose – allowing practitioners to truly focus on each patient’s specific needs. “The DGMAH serves a 1.7 million population catchment area, which includes the Bojanala District in the North West and Limpopo. Therefore, I am optimistic that today’s launch will mark the beginning of the end of suffering for the majority of our cancer patients who used to be referred to Steve Biko Academic Hospital (SBAH) for appropriate PET-CT scan diagnostics prior to specific treatment for their type of malignancy. This was less than ideal because the overloading of SBAH resulted in tremendously long queue delays, which impacted negatively on effective patient management,” added the MEC. “The system was installed in June 2017, and has already helped guide decision-making for early diagnosis and the assessment of treatment efficacy for over 140 patients,” says Professor Trevor Mdaka, head: Nuclear Medicine at the GDOH.“We are thrilled with the results and the level of care we are able to provide our people with this worldclass technology.”

Next-level innovation Understandably, many patients referred for PET suffer from anxiety that has been found to affect the image quality and often result in a false positive, which impacts the diagnosis and quality of care. To address this challenge, the new solution transforms the experience by customising both the uptake and scanning room to create a comfortable and calming environment for patients by using technology as a positive distraction when needed most. The immersive, multisensorial experience can lead to greater

involvement from patients in their own therapy, reduced anxiety, increased comfort, higher patient satisfaction, and even a possible reduction in procedure time. “In today’s complex care environment, delivering high-quality critical care demands new approaches and thinking,” says Ntutule Tshenye, GM, Philips HealthTech Southern Africa.“We know that there are no simple solutions to the complex realities associated with oncology care, which is why innovation drives us to push the boundaries that are standing in the way of organising healthcare around the patient to deliver better outcomes.”

Helping to fight the scourge The newly acquired facility will go a long way in contributing towards the effective diagnosis and management of patients, improving the training and education of healthcare professionals, and sustaining efforts to improve medical research for the benefit of finding solutions to the burden of disease in our communities.

According to Cansa.org.za, every year, cancer kills more people than AIDS, tuberculosis and malaria combined. Through ongoing innovation, Philips and the project collaborators intend to tackle the rising incidence of cancer in South Africa by collaboratively empowering the next generation of doctors to stay on the cutting edge of technology and shape the future of care with a system designed to work across the oncology care cycle. Creating access to the latest technology will not only create a more conducive environment for doctors, but it also offers enhanced healthcare service delivery, and capacity for specialist training to make the GDOH more competitive in cancer research, innovation and the development of effective treatment modalities for cancer.

www.philips.co.za

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The quality you need. The dose you want. Philips brings you the benefits of high-resolution, low-dose scanning with increased integration and collaboration, patient care, and economic value in an upgradable family that’s designed to grow as you grow.

See how we are advancing computed tomography at www.philips.co.za/healthcare


We help the world play safe

www.cupidlimited.com info@cupidlimited.com

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InterSystems Profile Sponsor’s Message Cupid Limited || section

Empowering women

in the fight against HIV/AIDS

A

Omprakash Garg, Chairman & Managing Director

In July 2016, UNAIDS warned that the reduction of new HIV infections had stalled globally and if efforts were not redoubled, the HIV community around the world could see a reversal of earlier successes.

ccording to the Department of Health’s National Strategic Plan 2017 – 2022, a strong focus is placed on improving the prevention of HIV infection among adolescent girls and young women because of the extremely high rate of infection in this section of the South African population. Not only does early infection irreversibly shape the lives of hundreds of thousands of women from their teens and early 20s onward, but reaching the country’s national targets for reducing HIV is unthinkable without putting young women first. And this is not just a South African concern. Worldwide, women represent more than 50% of all people living with HIV infections, the majority of whom are adolescent girls and young women between 14 to 24 years old. Add to this the estimated 75 million unplanned pregnancies each year, and we have a major crisis on our hands. In 2012, the UN Commission on Life-Saving Commodities identified the female condom as one of the 13 priority items for its five-year development plan. The UN estimated that, during the course of the development plan, an estimated 6 million lives could be saved. Condoms are extremely cost-effective and have made a major contribution in preventing new HIV infections. At Cupid Limited, we are India’s leading manufacturer of male and female condoms, and waterbased personal lubricants. The company has over 18 years’ experience in the industry and ours was the second company in the world (and first in India) to have a WHO/UNFPA prequalified female condom in July 2012. Considering the challenges around the aesthetics of female condoms, Cupid Limited established an in-house Research & Development Centre in 2008, with the objective of designing and developing an unique female condom. The output of the Centre’s extensive research resulted in the Cupid female condom, which resulted in a patented design. At Cupid, we view the female condom as a dual-protection device that empowers women in the fight against the prevention of STIs, including HIV/AIDS, and unplanned pregnancies. Not only are our female condoms made out of the finest quality latex, using state-of-the-art infrastructure, but our unique design makes it easy to use, too. Our octagonal external retainer prevents the condom from being pushed inside the vagina during intercourse and help with clitoral stimulation. Since the Cupid female condom was prequalified in 2012, we have been supplying female condoms to the National Department of Health for use in its HIV/AIDS prevention programme – and we aim to remain relevant and a supplier of choice in the South African market.

Omprakash Garg Managing Director & Chairman, Cupid Limited

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Cupid Limited InterSystems | section |sponsor Profile

Helping South Africa Go figure!

S

play safe

ince 1998, Cupid Limited has been successfully manufacturing and marketing condoms in over 40 countries around the world. Headquartered in Nashik, India, the company is a leading manufacturer of male and female condoms, and personal lubricants, claiming one of the largest manufacturing facilities as well as an in-house Research and Development (R&D) Centre. Cupid Limited was incorporated as a Public Limited Company in 1993 and listed on the Bombay Stock Exchange in 1995 and the National Stock Exchange in 2016. The company’s modern facility has a current production capacity of over 325 million pieces of male condoms, 52 million pieces of female condoms, and 210 million lubricant sachets per year. Cupid has CE and SABS certification marks,

Cupid Limited is a leading manufacturer of quality male and female condoms, and lubricant. It was the second company in the world and the first in India to have launched the WHO/ UNFPA prequalified female condom in 2012. Since this prequalification, Cupid Limited has been supplying female condoms to the National Department of Health for use in its HIV/ AIDS prevention programme.

and adheres to ISO 9001:2008 and WHO GMP (Goods Manufacturing Practices). Considering the challenges faced with the aesthetics of the female condom and as part of its five-year plan, Cupid established its R&D Centre in 2008, with an objective to design and develop a unique female condom. Today, the company’s strength lies in it’s R&D Centre. This R&D Centre engaged in extensive research into the development of Cupid’s unique female condom.

Challenges facing young women According to the United Nations Population Fund (UNFPA), it is estimated that 12.2% of the South African population (6.4 million persons) are HIV positive. This is 1.2 million more people living with HIV than in 2008 (10.6% or 5.2 million), with the main cause of HIV transmission being heterosexual sex. On 31 March 2017, South Africa launched the National Strategic Plan (NSP) on HIV, TB

Cupid was the first Indian company to obtain WHO/UNFPA prequalification for female condoms

The number of years of experience Cupid Limited has in the industry

The number of countries in which Cupid Limited has a presence, including 22 countries in Africa

Approximate number of people employed at the company

million The number of male and female condoms Cupid Limited can produce in one year

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InterSystems Cupid Limited || section Profile sponsor

Benefits of the Cupid female condom: Made from the finest quality latex, using state-of-the art infrastructure and technology. Quality management takes centre stage in the manufacturing process.

Octagonal external retainer prevents condom being pushed inside the vagina during use, and helps to stimulate the clitoris. Well lubricated, available in different colours and scents. Available in two sizes: version 1 with longer pouch and thicker sponge, and version 2 with shorter pouch and thinner sponge – giving users a choice.

Unique design. Easy to use; soft open cell foam is used as an internal retainer, as opposed to a hard ring. The user feels stimulated once the Cupid female condom is inserted. Prevents spillage of semen during removal.

Can be supplied in customised packaging with customer’s own brand. Millions of pieces sold across different continents with highly satisfactory user acceptability.

Cupid Limited is the first company in the world to have been Pre-qualified by WHO/ UNFPA for supply of both

Male & Female Condoms

InterSystems | Profile

The UNAIDS target is to reduce new HIV infections to fewer than 500 000 by 2020

and STIs 2017 – 2022. Launched under the theme ‘Let our Actions Count’, the NSP is a five-year plan that serves as a roadmap in the implementation and monitoring of the HIV, TB and STI response. It aims to achieve targets by focusing on the 27 districts most severely affected, using a combination of interventions and strengthening systems to provide the foundation for higher performance. The NSP also has a strong focus on the prevention of HIV infection among vulnerable and key populations, particularly adolescent girls and young women aged 15 to 24 years. In addition to the alarming rate of new HIV infections among adolescent girls and young women, the issue of unplanned pregnancy is another cause for concern. Each year, there are an estimated 75 million unintended pregnancies

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worldwide, with 46 million of these ending in induced abortion, of which about 25 million are considered unsafe abortions. Three out of four abortions that occurred in Africa and Latin America were unsafe, while the risk of dying from an unsafe abortion was the highest in Africa (WHO statistics, 2010 – 2014).

Saving lives Based on need, in 2012, the UN Commission on Life-Saving Commodities for Women and Children identified and endorsed an initial list of 13 overlooked life-saving commodities that, if more widely accessed and properly used, could save the lives of more than 6 million women and children. The female condom was identified as one of the 13 commodities. Condoms are extremely cost-effective and have made a significant contribution in preventing new HIV infections. The female condom empowers women to prevent unintended pregnancies also in the prevention of STIs and HIV.

Why should consumers in South Africa use WHO-approved condoms? The process of getting WHO/UNFPA approval involves verification of quality assurance, infrastructure, product verification and consistency. This prequalification process is carried as per the Generic Specification, Prequalification and Guidelines for Procurement, 2012. What is required to pass certification? A Product Passed certificate is issued after testing each lot as per national/international standards. Approved sampling plans, qualified personnel and laboratories are used for this purpose. These processing standards have been established for many years and have proved to be very reliable. How does the lack of certification affect the integrity of a product and adversely affect the end-user? If the process or product is not certified by WHO/UNFPA or any other internationally accredited body, there is no guarantee of product quality, safety and consistency. Hence, the end-user will receive an unsafe product of substandard quality.


Cupid Limited InterSystems | section |sponsor Profile

Cupid Limited is committed to training healthcare practitioners in South Africa on the use of the female condom and intends to accelerate the training initiatives in South Africa across all nine provinces in Q2 2018.

South African market The Cupid female condom was launched in the South African market during the 2010 FIFA World Cup. Since 2012, Cupid Limited has been supplying female condoms to the National Department of Health for its HIV/AIDS prevention programme. The approved female condoms were also distributed to mine workers in an attempt to prevent new HIV infections. With the entry of Cupid in the South African market, the monopoly of only one type of female condom since 1993 ended. The national government contract, namely, HDM01-2015, included the procurement of female condoms from 2015 to 2018. Cupid’s active participation resulted in

Cupid receiving an award of 80% (43 million units) of a total quantity of 54 million units. As of January 2018, Cupid Limited has supplied its committed quantity of 34.7 million units of female condoms to all nine provinces through its four local associates namely, Abafazi Healthcare Services Pty Ltd, Isigidi trading Pty Ltd, Crystal Pear Trading and Biocor Hospital. Cupid remains committed to providing South Africans with quality products, male condoms, female condoms and and sexual/personal lubricants. To achieve this objective and in support of the South African Government’s localisation strategies, Cupid is exploring the possibility of establishing a manufacturing facility in South Africa in 2018/19, in a joint venture with Abafazi Healthcare Services, to produce these products locally.

Male condoms

Cupid Limited also manufactures male condoms that meet ISO 4074:2015 and WHO/UNFPA-2010 (As revised in April 2013) specifications. Each male condom is 100% electronically tested and has a five-year shelf life. The new Cupid male range offers multi-texture condoms – plain, dotted, ribbed and contour; extra-strong condoms, extra-long condoms, speciality male condoms, ultra-thin condoms, and extra-time condoms. The super-dotted condom range is available in three different flavours.

Brand comparison

Did you know?

When it comes Globally, girls between to the female the ages of 15 and 24 are condom, the experiencing 5 000 new main challenges HIV infections weekly, lie in the and almost 50% of aesthetics of the these occur in design, and correct South Africa use. The Cupid female condom was the first WHO/UNFPA Pre-Qualified female condom made out of natural rubber latex. This female condom is a womancontrolled, dual-protection device to protect women from both STIs, including HIV/AIDS, and unintended pregnancy. The condoms have proved that, when used correctly and consistently, it can reduce risk of HIV transmission by 97%, while the risk of unplanned pregnancy is reduced by 80%. Through its innovative design, the Cupid female condom offers unique benefits, including a lack of side effects, which is often the deterring factor for the use of female protection during intimacy. The Cupid brand female condoms liberates women by allowing them to introduce (insert) the condom prior to sex, avoiding coital disruption. The carefully considered structure of the product’s outer ring covers parts of the external genitalia, helping to protect against STIs.

Abafazi Healthcare Services

A

“Abafazi Healthcare – providing women with access to the Cupid female condom in South Africa since 2013.”

bafazi Healthcare Services (Pty) Ltd is a distributer and supplier of medical products and equipment. Incorporated in 2009 and based in Johannesburg, Abafazi Healthcare is a wholly black-female-owned and controlled South African healthcare company, with a Level 1 BBBEE rating. The company is passionate about public healthcare in South Africa and is committed to providing quality medical products at an affordable cost to its fellow South Africans. Abafazi Healthcare’s offerings are underpinned by a strong relationship

with Cupid Limited, a leading manufacturer of quality male condoms, female condoms and lubricants. Abafazi Healthcare has been supplying the National Department of Health of South Africa with the Cupid female condom since 2013. It supplies and distributes these condoms to over 200 sites across all nine provinces. The company is committed to the localisation strategies set out in the National Development Plan and intends to establish a manufacturing facility in South Africa in 2018, in

collaboration with Cupid, to produce male condoms, female condoms and lubricants. In addition to creating significant jobs for South Africans, more than 50% of all employees hired at the manufacturing facility shall be women.

www.abafazigroup.com

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InterSystems HIV, TB & STIs || Department Profile of health

NSP 2017 – 2022: Where to from here?

The story of the HIV/AIDS response in South Africa can be characterised as a journey from denial to acceptance, dependency to ownership, despair to hope, and impressive results. Since 2009, the country has seen unprecedented political commitment and leadership to address the AIDS response at the highest level.

T

he South African National Strategic Plan on HIV, TB and STIs 2017 – 2022 (NSP) serves as a roadmap for the next stage of the country’s journey towards a future where these three diseases are no longer public health problems. This plan sets out the destinations – or goals – of our shared journey and establishes landmarks in the form of specific measurable objectives. The purpose of the NSP is to enable the many thousands of organisations and

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individuals who drive the response to HIV, TB and sexually transmitted infections (STIs) to act as a concerted force, moving in the same direction. This NSP aims to achieve its ambitious targets by: • intensifying the focus on geographic areas and populations most severely affected by the epidemics • using a combination of interventions that have proved to deliver high impact • strengthening systems and initiating processes to provide the foundation necessary for higher performance.

A strong focus of this NSP is improving the prevention of HIV infection among adolescent girls and young women because of the extremely high rate of infection in this section of the population. Not only does early infection irreversibly shape the lives of hundreds of thousands of women from their teens and early 20s onward, but reaching our national targets for reducing HIV is unthinkable without putting young women first.


HIV, TB & STIs | Department of health

Five-year NSPs for HIV, TB and STIs are an established tool for directing and coordinating our national efforts and ensuring our interventions are relevant, based on evidence and guided by methods that have been shown to be effective. However, this particular NSP comes at a critical stage in our protracted effort to overcome HIV, TB and STIs. South Africa has made major gains in terms of treating millions of people living with HIV and TB, slashing the death toll due to these infections, and reducing the number of new infections. In spite of the successes, there are still many challenges that exist for the country. South Africa has 3.7 million people on antiretroviral treatment (ART) for HIV but is only reaching 53% of those who are eligible for treatment under the new Test and Treat policy. The number of deaths due to HIV and TB is still massive and underscores the gravity of the epidemics. Furthermore, in July 2016, the United Nations Programme on HIV/AIDS (UNAIDS) warned that the reduction of new infections had stalled globally and, if efforts were not redoubled, the HIV community around the world could see a reversal of earlier successes. South Africa is at a tipping point in relation to HIV, TB and STIs. The actions we take in the next few years will decide whether we move forward towards victory or slide back into a state of mounting infection and resurgent death rates.

High-burden districts for HIV Province

Districts

Gauteng

City of Johannesburg, Ekurhuleni, City of Tshwane, Sedibeng

KwaZulu-Natal

eThekwini, uMgungundlovu, uThungulu, Zululand, Ugu uThukela, Harry Gwala

Mpumalanga

Ehlanzeni, Nkangala, Gert Sibande

Eastern Cape

Oliver Tambo, Amathole, Alfred Nzo, Chris Hani, Buffalo City

Free State

Thabo Mofutsanyane, Lejweleputswa

North West

Bojanala, Ngaka Modiri Molema, Dr Kenneth Kaunda

Limpopo

Sekhukhune, Waterberg, Capricorn, Mopane

Western Cape

City of Cape Town High-burden districts for TB

Province

Districts

Gauteng

City of Johannesburg, Ekurhuleni, City of Tshwane, West Rand

KwaZulu-Natal

eThekwini

Mpumalanga

Ehlanzeni

Eastern Cape

Oliver Tambo, Nelson Mandela Metro, Chris Hani and Buffalo City, Saartjie Baartman

Free State

Mangaung Metro, Lejweleputswa

North West

Bojanala, Dr Kenneth Kaunda

Limpopo

Greater Sekhukhune, Waterberg

Western Cape

Cape Metro, West Coast Capricorn

Other HIV high-burden districts HIV and TB high-burden districts

Ehlanzeni Bojanala City of Tshwane Nkangala Ngaka Modiri Molema Ekurhuleni Sedibeng Gert Sibande Dr Kenneth Kaunda Umkhanyakude Zululand Lejweleputswa Thabo Mofutsanyane

Targeting districts The burden of HIV and TB is spread unevenly across South Africa. The NSP has identified 27 districts with the highest rates of HIV and 19 districts with the highest incidence of TB. These two sets of districts overlap. Detailed, localised statistical evidence is critical to help identify hotspots within these highburden districts. For instance, informal settlements, long-distance trucking routes and areas where commercial sex is common are likely to be associated with higher HIV risk. All provinces, districts and wards should intensify efforts to reduce new HIV infections and improve access to services among adolescent girls and young women. This is a focus that must be consistently maintained across the country for the entire period of this plan.

Mopani

TB high-burden districts

Uthukela

Uthungulu

Mangaung

Mgungundlovu

iLembe

Harry Gwala eThekwini Ugu Alfred Nzo Chris Hani

Cacadu Cape Winelands City of Cape Town

O.R. Tambo

Amathole Buffalo City

Eden

Provincial and local planners should determine the population size and service delivery gaps for each of the key and vulnerable populations, based on their local statistics and knowledge, and move to improve this using geospatial mapping and profiling.

Nelson Mandela Bay

Prevention better than cure Effective responses to the HIV, TB and STI epidemics always utilise a combination of interventions. In general terms, these are prevention programmes, treatment programmes and initiatives to tackle the social and economic conditions that drive

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HIV, TB & STIs | Department of health

Cascade of South African Sectoral, Performance, Strategic and Development Plans

NDP 2030 MTSF April 2016 – March 2019 and April 2019 – March 2022 NSP for HIV, TB and STIs April 2017 – March 2022

Clusters, intersectoral collaboration and cooperation Sector Plans, Departmental and Strategic Plans, Departmental Annual Plans (Apps), Municipal Plans, e.g. Integrated Development Plans

the epidemics. Prevention programmes are always guided by the fact that HIV is mainly transmitted by sexual activity and TB, like influenza, is an airborne disease, which is spread by minute particles when an infected individual sneezes or coughs. In selecting the precise mix of interventions, note that some approaches to prevention and treatment have a higher impact than others. High-impact interventions include: • For both HIV and TB: Social and behaviour change communication. • For HIV: MMC, condom promotion and distribution, targeted use of ARVs by HIVnegative individuals at high risk in order to prevent infection, and the provision of ARVs to survivors of sexual assault as well

Clear line of sight

CASCADE OF PLANS

as healthcare workers who have been exposed to HIV during their work. People who are HIV infected should be put on treatment as soon as they are ready so as to maintain a suppressed viral load. • For TB: Tracing and checking all close contacts of TB patients, providing a course of preventive therapy, as appropriate, to all people living with HIV and close contacts of patients with TB. Prevention, treatment and care for HIV, TB and STIs are labour-intensive activities and require diverse categories of workers, from specialised professionals to programme managers and community volunteers. These human resources are located in the public, NGO and private sectors and span multiple areas of service, not only healthcare. The ambitious targets of the NSP will clearly require increased human resources ranging from doctors, professional nurses and pharmacists, to mental healthcare workers, social workers, social auxiliary workers, community health workers and peer educators.

Cost estimates for NSP 2017 – 2022 by strategic goal

50.00

Enabler

45.00

Goal 8

ZAR Billions

40.00 35.00

Goal 5

30.00

Goal 4

25.00

Goal 3

20.00

Goal 2

15.00

Goal 1

10.00 5.00 -

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2017/18

2018/19

2019/20

2020/21

2021/22

Strong leadership South Africa has an established multisectoral approach to HIV and TB, with a national AIDS Council founded on collaboration between government, civil society and the private sector, and some well-functioning provincial and district AIDS councils. The country also has a statutory framework for cooperation among the various tiers of government. However, the vision of this NSP demands more powerful leadership and stronger ownership than ever before. Provinces have a critical role to play in driving integrated, multisector planning for the implementation of the NSP and the provision of health, education and social services. With the designation of priority districts, local government leadership becomes increasingly important, while civil society leadership has a unique ability to reach and mobilise vulnerable and key populations, nurturing leadership within these groups. The plan sets out mechanisms and systems that will encourage collective responsibility and will show where the gaps in leadership lie. Ultimately, the unwavering commitment that is required resides in the individuals who hold positions of leadership at various levels – premiers of provinces and their executive teams, mayors of cities and towns, ward councillors, leaders of organisations of people living with HIV and TB, business and labour leaders, and leaders of civil society organisations and community structures. A particular emphasis in the coming five years will be to secure far greater participation of organised labour and the private sector in the implementation of the NSP. The plan will also be used as an instrument of coordination with development partners, ensuring that their assistance is attuned to local priorities.


HIV, TB & STIs | Department of health

Understanding the goals The NSP set out eight major goals as well as many other specific objectives and interventions to support the achievement of these goals. The goals of the NSP demand stronger service delivery systems and the plan outlines measures that can be taken – within the health system and in society more broadly – to enable services to work more effectively and efficiently. These system-level changes are not an optional extra; they are critical to the success of service delivery and failure to mobilise them would seriously undermine performance under the NSP.

Goal Accelerate prevention in

Goal Reduce illness and death by providing treatment, care and adherence

order to reduce new HIV and TB infections and new STIs – breaking the cycle of transmission The NSP sets out intensified prevention programmes that combine biomedical prevention methods, such as medical male circumcision (MMC) and the preventive use of antiretroviral drugs (ARVs) and TB medication, with communication designed to educate and encourage safer sexual behaviour in the case of HIV and STIs, and environmental interventions to control TB infection.

support for all – 90-90-90 in every district With regard to HIV, the UNAIDS 90-90-90 targets provide that by 2020: • 90% of all people living with HIV will know their HIV status • 90% of all people with an HIV diagnosis will receive sustained antiretroviral therapy • 90% of all people receiving antiretroviral therapy will achieve viral suppression. As described in the Global Plan to End TB 2016 – 2020, the 90-90-90 targets for TB provide that: • 90% of all people who need TB treatment are diagnosed and receive appropriate therapy as required • 90% of people in key and vulnerable populations are diagnosed and receive appropriate therapy • Treatment success is achieved for least 90% of all people diagnosed with TB.

Goal Reach all key and

Goal Address social and structural drivers of

Goal Ground the

vulnerable populations with comprehensive, customised and targeted interventions – nobody left behind The NSP asserts that no section of our society will be left behind by efforts to combat HIV, TB and STIs. The NSP specifies how government and civil society will go the extra mile in order to enable these populations to overcome the barriers of access to HIV, TB and STI prevention and treatment programmes.

HIV and TB infection and STIs – a multidepartment, multisector approach This goal responds to the reality that the health of individuals is shaped by economic, social and environmental factors, such as poverty, gender discrimination, substance and alcohol use, and poor housing. The NSP identifies social and structural factors that increase the risk of people acquiring HIV, TB and STIs, and describes multidepartment and multisector interventions to address these factors. It pays particular attention to the features of our society that make adolescent girls and young women especially vulnerable to HIV.

response to HIV, TB and STIs in human rights principles and approaches – equal treatment and social justice The NSP focuses on equal treatment for all, increased access to justice, and the reduction of stigma associated with HIV and TB.

Goal

Goal Strengthen strategic information to drive

Goal Mobilise resources to support the achievement of NSP goals

progress towards the achievement of NSP goals – data-driven action The plan emphasises the generation and use of relevant, timely data to monitor progress on implementation and track the impact of interventions to allow for timely adjustments where needed. It also contains measures to encourage and coordinate medical and social research to provide stronger evidence for interventions and new tools for treatment and prevention.

Promote leadership at all levels and shared accountability for a sustainable response to HIV, TB and STIs – mutual accountability The NSP requires diverse leadership for implementation at national, provincial, district and community level.

and ensure a sustainable response – spend now, save later The plan proposes to maximise funding from existing sources and improve efficiency in order to extract full value from available funding. It also anticipates the need to develop innovative funding mechanisms to generate new funding for HIV, TB and STI initiatives.

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SANAC | Interview

Understanding the NSP With the South African government and its partners implementing the largest HIV treatment programme in the world as part of the National Strategic Plan 2017 – 2022, what guidance and leadership expertise can SANAC offer in this regard? SB As SANAC, we make progress through dialogue, mutual respect and consensus. By involving everyone in finding solutions, we inspire hope and build trust. It is only when we are honest, accountable and engage each other frankly that we are able to manage tensions in this HIV treatment space. It is critical to collaborate and bring in all sectors and constituencies to build a strong HIV treatment, care and adherence programme in South Africa. We need commitment from all sectors of society to continue to make the treatment programme a success. Huge challenges remain for the HIV response. HIV care provision requires a functional healthcare service, and hence our support in aiding all efforts aimed at building resilient systems and structures and well-informed communities to support the achievement of the UNAIDS 90-90-90 targets in every district in South Africa. The size and scaling up of South Africa’s treatment programme must be complemented by an equivalent focus on improving service quality and on reducing loss to follow-up among people who initiate care, while simultaneously implementing the new Universal Test and Treat policy. The programme is estimated to target 4.2 million people. However, an estimated 7.1 million South Africans are infected with HIV. Tell us more about SANAC’s monitoring approach that will see the organisation recalibrate the targets to ensure a more efficient approach, and that no one is left behind (in line with Goal 3 of the NSP 2017 – 2022). For our part, the SANAC Secretariat – working with government, civil society and the private sector – will do

Dr Sandile Buthelezi, CEO, SANAC

The South African National AIDS Council (SANAC) is a voluntary association of institutions established by government to build consensus across the public sector, civil society and all other stakeholders to drive an enhanced country response to HIV, TB and STIs. Dr Sandile Buthelezi, CEO of SANAC, provides some insight into the National Strategic Plan 2017 – 2022 on HIV, TB and STIs.

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InterSystems SANAC | Interview | Profile

The LGBTI HIV Plan brings us closer to a world in which members of LGBTI populations can realise their health and human rights in an environment that is affirming of their sexual orientations, gender identities, and gender expressions.”

everything we can to ensure that we successfully coordinate and monitor the implementation of the NSP. The NSP capitalises on the strategic information resources that the country already has, but SANAC will ensure improved coordination, prioritisation, accountability, and dissemination of findings. SANAC has also introduced the Focus for Impact approach, which lies at the heart of the NSP. With Focus for Impact, emphasis has been placed on targeting key and vulnerable populations, zooming in on geographical locations experiencing a high burden of HIV and TB. Furthermore, in partnership with all its relevant stakeholders, SANAC will work at different levels – from national to ward level – to review and strengthen data collection, use and dissemination for decision-making. Through an NSP Steering Committee, when technical working groups review NSP performance and reach consensus, guidance will be provided on the recalibration of targets where necessary to ensure that no one is left behind. South Africa is one of the few countries worldwide to include the LGBTI community in its response to HIV (launched during the 2017 8th National AIDS Conference held in Durban). What are some of the

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important factors of the LGBTI HIV Plan, and why do you think this was a remarkable step forward for our country? Members of LGBTI populations have not received the same attention as the general population in our country’s response to HIV. Many factors, including widespread social disapproval of homosexuality in South Africa, create stigma and barriers to accessing healthcare. Recent studies have shown that members of LGBTI populations have a substantially elevated risk for HIV. The LGBTI HIV Plan brings us closer to a world in which members of LGBTI populations can realise their health and human rights in an environment that is affirming of their sexual orientations, gender identities, and gender expressions. The development and launch of the LGBTI Plan shows that we are serious about combating new infections in this population segment. The plan provides for a standardised minimum package of services to be implemented by all sectors, within and outside of government. It outlines five interlinked service packages, namely: health, empowerment, psychosocial support, human rights, and evaluation. This plan adds substance to service provision, human rights,

strengthened community networks, and other priorities of the national HIV response through a peer-led approach. Why is the Global Fund (GF) an important initiative in the fight against AIDS, TB and malaria? How has South Africa benefited from the GF to date? The GF is a key contributor to the fight against HIV, TB and malaria because it provides performance-based funding for targeted interventions that have significant impact, including those for key and vulnerable and marginalised populations who are often neglected in their countries’ response . In South Africa, the GF grants have played an ever-increasing role, as we have accessed the most funding that we are eligible for and have then used these funds to drive the implementation of programmes for key and vulnerable populations for HIV and TB, as well as the improvement of health and community systems. While the funding for the GF forms a small percentage of the country’s total allocation to the implementation


SANAC | Interview

of the National Strategic Plan for HIV, TB and STIs, these funds have been used to drive innovation, stimulate change in the programmes available for key and vulnerable populations, and ultimately change government policy and guidelines. The GF grants to South Africa have focused largely on prevention, with an increasing portion of the budget being allocated to prevention programmes for HIV and TB in key and vulnerable populations. The current GF grant to South Africa is being implemented from 1 April 2016 to 31 March 2019, has a budget of US$312 million and focuses on prevention (adolescents and youth, gender-based violence, behaviourchange communication, geospatial mapping and community profiling with targeted interventions, men who have sex with men and transgender people, people who inject drugs, inmates, peri-mining communities, informal settlements, and inmates), multidrugresistant TB, antiretroviral drugs, adherence and health and community systems strengthening. We are currently preparing our next request for funding to the GF to access a maximum of $353 million over a three-year period. The NSP on HIV, TB and STIs 2017 – 2022 is said to have quite ambitious targets. What plans/proposals does SANAC have in place to ensure the achievement – or near-achievement – of these objectives? At the heart of this NSP is the strategy to ‘focus for impact’ using the more detailed information and insights now available to direct programmes where they are most needed and where they will have the greatest impact. To maximise the impact of efforts, the NSP introduces this more intensified, more strategic focus at provincial, district and ward levels.

There will be a greater priority on primary prevention and on strategies to address the social and structural drivers of the three infections in a thoroughly multisectoral manner, which will enable the achievement of the objectives and ambitious targets of the NSP by creating an enabling environment for the achievement of targets. The NSP also includes goals and a strategic approach for leadership and accountability, as well as resource mobilisation to support the achievement of targets as outlined in the NSP. While the death rate in South Africa due to HIV dropped from 681 434 in 2006 to an estimated 150 375 in 2016, the UNAIDS warned that the reduction of new infections had stalled globally and the HIV community worldwide could see a reversal of earlier successes. Are there increased efforts in place to counter the spread of new infections in South Africa? HIV prevention is the number one priority of the NSP 2017 – 2022. We have a wealth of evidence and experience in terms of what prevention programmes work, what programmes are scalable, and what programmes have the greatest value for money. We boast a large basket of prevention tools and approaches that are innovative and accessible to the population.

However, the NSP recognises that more effort needs to be put into the multisectoral application and implementation of these programmes at a national scale to counter the spread of new HIV infections and this is the responsibility of SANAC. SANAC is dedicated to reviving primary prevention to close the tunnel of new infections. We are committed to developing and leading a countryowned national prevention agenda that is driven by national imperatives and not by an international agenda, which often fragments our efforts. We are stepping up to take responsibility for HIV prevention, and for the planning, coordination, monitoring, oversight and implementation of a South African Prevention Roadmap that will outline the path to significantly reduce new HIV infections. Goal 6 of the NSP addresses the promotion of leadership at all levels. How important is collaboration in terms of executing this plan, especially by influential individuals and organisations? Leadership, mutual accountability and commitment remain key ingredients for a successful HIV, TB and STI response. This requires improved cooperation and collaboration among government departments, inclusive and empowered

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InterSystems SANAC | Interview | Profile

AIDS councils at provincial and district levels, and the mobilisation of leadership at the ward level. Collaboration with the private sector is vital to executing the plan. There is need to deepen the involvement of the private sector and organised labour, and to capacitate civil society sectors and community networks to lead the response. This NSP is a plan that belongs to all people living in South Africa. Through this NSP, we also look to communities for leadership of the response. This NSP invites South African leaders from different walks of life and different corners of the country to take action to end the epidemics of TB, HIV and STIs. Each person in South Africa needs to collaborate with us to make their voices heard, make their actions count and champion the vision of the NSP for an AIDS-free generation. In the context of getting all stakeholders to work towards a common set of goals as reflected

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in the NSP, concerns were raised about the functionality of SANAC, including allegations of corruption and mismanagement. The last press statement on this indicated that the concerns are being addressed by the board via the Treatment Action Campaign. Where in the process is the SANAC board with regard to this? The SANAC Board of Trustees takes these allegations of corruption and mismanagement very seriously and has engaged with the Treatment Action Campaign through the Office of the Deputy President, who chairs SANAC. We value continuous engagement and hope that stakeholders will continue to raise their concerns within SANAC structures and continue to play a meaningful role within SANAC to ensure that we meet our goal of a generation free of HIV by 2030. Which populations of the country will receive priority in the NSP and why? Does the prevention of mother-tochild transmission (PMTCT) feature on this agenda? The strategic approach of the NSP directs our efforts and resources to geographic areas that have the highest burden of HIV. In each of these high-burden districts and cities, programmatic efforts are strategically targeted towards the [key and vulnerable] populations among whom the need is greatest, and where the impact of efforts will be most pronounced. Given the degree to which transmission among adolescent girls and young women is driving HIV across the country, every province, district and ward must take steps to intensify efforts to reduce new HIV infections and increase service access for adolescent girls and young women, including addressing the social and structural factors that increase their vulnerability. Guided by local data and circumstances from geospatial mapping and profiling, provincial and local responses should prioritise key and vulnerable populations. Other key and vulnerable populations

listed in the NSP include sex workers, members of LGBTI populations, people who use drugs, inmates, children, people in informal settlements, mobile and migrant populations, and people with disabilities. PMTCT is an important tool in the country’s HIV prevention toolbox and is included in all basic prevention packages, including those for key and vulnerable populations. Social and structural drivers of epidemics exist and play a considerable role in determining an individual’s risk of acquiring HIV, TB and STIs. One of these drivers is low literacy. What is SANAC doing in terms of educating the masses on the prevention and treatment of HIV/AIDS? The NSP is closely aligned with the National Development Plan, locating the struggle against HIV, TB and STIs within the broader struggle for economic and social development. These are mutually reinforcing efforts: progress in reducing the burden of disease contributes to development, while faster development improves our ability to address the social and structural drivers of HIV, TB and STIs. For as long as babies and mothers die from preventable HIV transmission, for as long as young women remain vulnerable because they have no work or education, for as long as men are stripped of their dignity because they cannot provide for their families, the development agenda is unfulfilled. The NSP recognises the critical importance of addressing social and structural drivers that put individuals at risk of HIV infection. Treatment literacy and knowledge of HIV transmission and prevention are key. The SANAC Secretariat notes the importance of social and behaviour change communication as a key enabler for the implementation of the NSP and is developing a communications plan for the NSP, which will include a comprehensive approach for reaching all members of society regardless of their language, level of education or other socio-demographics. The South African response leaves no-one behind.


LET OUR ACTIONS COUNT

SOUTH AFRICA’S NATIONAL STRATEGIC PLAN FOR HIV, TB and STIs 2017-2022

We want an AIDS free generation by 2030 and dramatic reductions in TB and STIs, therefore we have set ambitious goals in our National Strategic Plan (NSP) for the next five years.

We want to reduce NEW INFECTIONS OF HIV

from 270 000 per year to less than 100 000

If you are sexually active, always use a condom.

Act against gender-based and sexual violence.

WE WANT 90%

of all people living with HIV to know their HIV status,

90%

diagnosed with HIV infection getting their antiretroviral treatment and

90%

of them having the virus suppressed.

We want to reduce NEW TB INFECTIONS BY

30%

We want to find 90% of all people living with TB

90%

treat 0% and ensure a 90% treatment success rate for drug-sensitive TB.

90%

We want to significantly reduce gonorrhoea, syphilis and chlamydia infections.

J7277 - 0860 PAPRIKA

The South African National AIDS Council (SANAC) brings together government, civil society and the private sector to create a collective response to HIV, TB and STIs in South Africa. One of our main objectives is to advise government on HIV and AIDS, TB and STI policy and strategy. www.sanac.org.za 011 748 1000 Find us on FACEBOOK at: www.facebook.com/ SANationalAIDSCouncil Find us on TWITTER at: @SA_AIDSCOUNCIL

Check your HIV status regularly so that you can stay negative or get care to remain healthy. If you have HIV do everything you can to stay on your treatment and join a group of other people living with HIV. Get screened for TB if you have a cough that is not going away or if you know someone who has TB. If you have TB make sure you finish your treatment so that you can be cured.


SANAC | PROFILE

Eliminating HIV, TB and STIs SANAC Chairperson, Deputy President Cyril Ramaphosa pictured with Minister of Health Dr Aaron Motsoaledi and UNAIDS Executive Director Michel Sidibé during the launch of the National Strategic Plan for HIV, TB and STIs (2017 – 2022)

W

The South African National Strategic Plan for HIV, TB and STIs 2017 – 2022 was launched by South African National AIDS Council (SANAC) Chairperson, Deputy President Cyril Ramaphosa on 31 March 2017.

hile we have made exceptional progress in tackling these infections, HIV, TB and STIs remain national health, social and development priorities. Some 270 000 people became newly infected with HIV in 2016, 100 000 of whom were adolescent girls and young women, and more than 3 million more people need to receive lifelong HIV treatment. Tuberculosis (TB) is our leading cause of death and large numbers of South Africans have untreated, asymptomatic sexually transmitted infections (STIs). Is the National Strategic Plan (NSP) a credible response and what does it offer?

Firm foundations The development of the NSP began with a national 18-sector civil society consultation in September 2016 and a 400-participant national multistakeholder consultation; it ended with the NSP’s endorsement by the national cabinet in March 2017.In-between, there was

extensive further consultation to solicit the exceptional experience and insight of those living with these diseases, working in the field or researching them. There was also an open call for comments on drafts of the NSP. All of this wisdom was blended into the final NSP – an undoubtedly ambitious plan. It is ambitious because it seeks to reduce new HIV infections by 63% by 2022 (from 270 000 in 2016 to less than 100 000 by 2022, and compared to a 25% reduction in the last five years), and double the number of people receiving anti-retroviral treatment (ART), with the concomitant impacts on TB and STIs. Is there enough that is new and different in this plan to its predecessors to warrant confidence that we can achieve these goals and the other goals of the NSP? SANAC believes this to be the case.

Focus points While continuing to be grounded in human rights principles and approaches, the 2017 – 2022 NSP has a strengthened focus on equal treatment and social justice. It heralds a ‘focus for impact’ approach, which will see an intensified focus on districts and locations with high burdens of HIV, STIs and/or TB; on adolescent girls and young women; and on tailoring The SANAC Plenary is the highest policyand decision-making body on HIV in the country

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InterSystems SANAC | PROFILE | Profile

Some 270 000 people became newly infected with HIV in 2016, 100 000 of whom were adolescent girls and young women

interventions for the key and vulnerable populations disproportionally affected, so that nobody is left behind. HIV prevention will be prioritised – this time through the intensification of combined prevention approaches. Implementation of the recently launched, universal ‘test and treat’ approach for HIV will be accelerated. This means that people with HIV will start ART as soon as possible after their diagnosis. The aim is for 90% of those living with HIV to know their status; 90% of these individuals should be on sustained ARV medication; and 90% of individuals receiving sustained ART should have suppressed viral loads – and live healthily. Testing and treating will now be accompanied by differentiated care to provide a client-centred approach that takes into account the treatment needs of people living with HIV across the treatment cascade and stages of HIV disease. The imminent introduction of the master patient index number will enable the early identification of those missing appointments and allow for continuity of care if people change clinics. There will be a new focus on prioritising service quality and on the critical health and social system enablers that are needed to translate the NSP into reality. This includes: trained, caring health and

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The new NSP seeks to implement tailored interventions to address challenges facing young women and girls

social service workers; effective supply chains that prevent shortages of drugs or condoms; the use of innovative social behaviour change communication strategies for effective messaging; and building the strong social systems needed, including families and communities, to address the root causes of infection.

Committing to success Success will also require a strengthened multisectoral response. The NSP seeks to capacitate civil society to be resourced to play its full role, to embrace the potential of the private sector, and for every government department to contribute. HIV, TB and STIs are not just Health and Social Development responsibilities: the new basic education approach, the initiatives in higher education, and the advances in correctional services all have much potential for impact, as does the call on other departments to contribute more – like agriculture to take the message to

every farm and fishing village; sport, arts and culture to every event; and transport to every truck stop, taxi rank, marine vessel and airline. The ingredients for success are there, but the ambitions of the NSP will not be realised without exceptional leadership, effective implementation and adequate financing. An action framework for leadership and accountability has been committed to and SANAC and AIDS councils will need to be strengthened at all levels. Implementation will need to be more focused at ward level and in local communities, and better driven at the provincial level through the multistakeholder provincial implementation plans currently under development, and by matching plans in each civil society sector and the private sector. Detailed economic modelling has shown that South Africa spent R28.8 billion on HIV, TB and STIs in 2016/17 and this is projected to reach R38.5 billion in 2021/22. However, if we want to realise the goals of this NSP and the NDP vision of a generation free from the burden of HIV, TB and STIs, then the projected funding gap – reaching R7.2 billion in 2021/22 – will be need to be breached in tandem with greater efficiency in the use of available resources. SANAC will continue to mobilise for the necessary funding so that the country can realise the social, economic and health benefits the NSP offers and remain on track to eliminate HIV, TB and STIs as public health threats by 2030. The goals of the NSP are attainable, but only if the plan is followed in its entirety to achieve compounding benefits, if systems are actually strengthened, if all heed its call to action, and if additional resources are mobilised to bridge the funding gap. Delivering on these is the heart of the challenge. We all need to work together to let our actions count.


Fast facts | Department of health

health statistics The World Health Statistics series is the World Health Organization’s (WHO) annual compilation of health statistics for its 194 member states. The 2017 statistics focus on the health and health-related Sustainable Development Goals (SDGs) and associated targets by bringing together data on a wide range of relevant SDG indicators. These were some of the findings. Unless otherwise stated, all estimates have been cleared following consultation with member states and are published here as official WHO figures.

2030

Launched at the end of 2015, the 2030 Agenda for Sustainable Development is the world’s first comprehensive blueprint for sustainable development. The Agenda frames health and wellbeing as both outcomes and foundations of social inclusion, poverty reduction and environmental protection. In addition to acting as a stimulus for action, the 2030 Agenda provides an opportunity to build better systems for health – by strengthening health systems to achieve universal health coverage (UHC), and by recognising that health depends upon, and in turn supports, productivity in other key sectors such as agriculture, education, employment, energy, the environment and the economy

100% 23%

The percentage of global deaths reported to WHO with precise and meaningful information on their cause

Under 5 years By 2030, SDG Target 2.2 aims to end all forms of malnutrition, including achieving, by 2025, the internationally agreed-upon targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons

South Africa ranks 1st (100%) in terms of African countries on International Health Regulations (IHR) capacity and health emergency preparedness such as early warning, risk reduction and management of national and global health risks

69% Proportion of South Africa’s target population covered by all vaccines included in their national programme: diphtheria-tetanus-pertussis (DTP3) immunisation coverage among 1-year-olds in 2015

66% The proportion of South Africa’s population using safely managed sanitation services, including a handwashing facility with soap and water – ranking the country 6th out of 47 African countries

93% The proportion of South Africa’s population using safely managed drinking water services – ranking the country 6th out of 47 African countries

Top achiever! South Africa was one of 14 African countries to have received recognition for its fight against malaria during the 2016 African Leaders Malaria Alliance (Alma) meeting as part of the 26th African Union Summit in Ethiopia. The 2016 Alma Awards for Excellence were given to Botswana, Cape Verde, Eritrea, Namibia, Rwanda, São Tomé and Principe, South Africa and Swaziland for achieving the Millennium Development Goal (MDG) target for malaria

94%

Proportion of births attended by skilled health personnel in South Africa between 2005 and 2016

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InterSystems South Africa Partners | Profile | Profile

Partnerships with a purpose Through partnerships, South Africa Partners works as a field catalyst in the areas of health and education in the country – two critical areas that serve as a foundation of a fair democracy.

As a field catalyst, South Africa Partners:

S

outh Africa Partners helps to bring partners together, build awareness, identify innovative and scalable solutions, share information with a system of global stakeholders, and mobilise funding towards transformative change. Worldwide, it is recognised that no single organisation or strategy, regardless of how large or successful, can solve a complex social challenge at scale. Instead, organisations need to work collaboratively to tackle pressing social problems. South Africa Partners serves as a hub for spokes of advocacy and action, rolling all stakeholders toward a

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defined goal. For over 20 years, the organisation has helped partners summon sufficient momentum to propel a solution up and over the tipping point to sweeping change.

Focus areas South Africa Partners’ focus areas are: Improving systems to provide care and support to people living with and at risk of HIV/ AIDS: The organisation’s I ACT, LinkCARE and STEPS programmes focus on prevention, retention and empowerment from the time of HIV diagnosis until the successful commencement of antiretroviral treatment.

Catalyses change by acting as an invisible hand that amplifies the existing efforts of local and international partners. Creatively meets evolving needs by filling key capability gaps across a range of disciplines and system levels. Engages in a range of functions to help stakeholders scale up innovative, evidencebased solutions. Remains nimble enough to fulfil rapidly evolving needs in health and education. Offers in-house expertise in public health and education. Maintains a commitment to social justice.


South Africa Partners | Profile

Tony Diesel, country director

Thembi Ngubane-Zungu, deputy country director

Increasing the capacity of health leaders to drive health system transformation: In partnership with the University of Pretoria, University of Fort Hare and Harvard TH Chan School of Public Health, the Albertina Sisulu Executive Leadership Programme in Health (ASELPH) strengthens and elevates executive-level training for future generations of health leaders. Supporting young children to reach their full potential in life: Through South Africa Partners’ Community Early Childhood Development Network, the organisation helps low-resourced crèches transform from minimally provisioned places of care into true centres of learning. The Sifunda Ngokuthetha (meaning: we learn by talking together) programme turns everyday environments, such as a grocery shops, into learning opportunities.

I ACT programme The South Africa Partners Integrated Access to Care & Treatment (I ACT) programme has empowered millions of South Africans living with HIV to make positive lifestyle changes and become advocates for effective HIV services. In 2002, South Africa Partners initiated a collaboration between the Department Designed to contribute to the goals of the Minister of Health’s Health Management Development Plan for South Africa, ASELPH mainly supports the initiative to improve executive leadership within the country’s healthcare system

Khaya Mavengana, national trainer

of Health in the Eastern Cape and the Commonwealth of Massachusetts, which focused on people living with HIV. The teams worked together to identify specific HIV prevention and care plans in the US, which had proven to be highly successful in slowing the rate of infection among key affected populations. After adapting the interventions to the South African context, the work led to the development of I ACT. The I ACT programme teaches people how to live positively with a positive diagnosis. It promotes the early recruitment, referral and retention of newly diagnosed people living with HIV into care and support programmes, and can be tailored towards children, adolescents or adults. The goal is to reduce the high loss-to-follow-up rate from the time of HIV diagnosis until the successful commencement of ARV treatment. This is achieved through empowering newly diagnosed people to advocate for and manage their health, and strengthening the active engagement of families, healthcare providers and communities into the continuum of care. Through a series of structured and curriculum-based meetings, I ACT group participants increase knowledge, skills, and confidence to advocate for their health. Participants are guided through a process of learning about living with and understanding HIV. The topics lead to: • knowing what HIV is, and its effects

• understanding that there is medication (ARVs) to help people live with HIV, including knowledge about side effects and responsibility to take the medication • accepting status through a process of overcoming self-stigmatisation, and knowing that it’s possible to live a long, healthy and productive life • understanding the principles of disclosing status, rights and how to build a support network among friends, family and strangers • knowing how to be healthy with HIV, what to eat, how to maintain a positive outlook on life and the importance of exercise • ensuring that prevention messaging is passed on to others • planning effectively to live a long life. In 2009, the Centers for Disease Control recognised the programme’s impact and funded national scale-up efforts through provincial departments and regional NPOs across the country. In 2015, I ACT was adopted as a national care and support strategy by the South African National Department of Health and included as a strategy in the National Adherence Guidelines for Chronic Diseases (TB, HIV and NCDs). It has been adapted in partnership with the Department of Correctional Services as STEPS – an HIV prevention strategy that serves offenders and staff members in correctional facilities. As part of the LinkCARE programme, South Africa Partners serves as a technical advisor to the National Department of Health’s Care and Support Directorate for this highly effective intervention. This achievement is just one illustration of how South Africa Partners has worked tirelessly over 20 years to harness sufficient momentum towards sweeping change.

+27 (0)11 268 1260 info@sapartners.org www.sapartners.org

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InterSystems Selfmed | Profile | Profile

Understanding Prescribed Minimum Benefits Healthcare in South Africa is extremely expensive. The cost of medical consultations, procedures and medications continues to rise annually. Without the assistance of a quality medical aid scheme, people are left to fend for themselves when it comes to their health and the well-being of their family.

S

elfmed Medical Scheme offers its clients a simplistic range of products and medical aid options to suit their essential healthcare needs. Being a part of a medical aid will also grant them access to a number of added benefits, which can make all the difference should a member, or their dependants, face serious illnesses of many kinds.

The list includes 270 medical conditions and 25 chronic conditions for which medical schemes are compelled by law to grant benefits to their members. That is, members will receive benefits towards the cost of diagnosis, treatment and care for the PMB conditions listed, no matter what medical aid plan they are on.

Prescribed Minimum Benefits

In the unfortunate event that a member is faced with one of the serious illnesses listed to receive PMB, they can rest assured that they will be well taken care of. Even if they are only subscribed to receive in-hospital cover through Selfmed, we will still ensure that members receive all the added benefits of PMB while in hospital, as stipulated by law. PMB are a guarantee that members will receive ongoing

Selfmed takes great pride in offering its members superior and affordable cover. As mandated by the Medical Schemes Act (No. 131 of 1998), Selfmed adheres to a list of PMB on offer to all of its members. The PMB refer to a list of medical and chronic conditions for which clients automatically qualify for benefits from their medical aid – as prescribed by the Department of Health.

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What does this mean for members?

support and quality, affordable healthcare for their listed condition. In some cases, the PMB may also include chronic medication.

How does it work? The 270 medical conditions are diagnosis-specific and fall into 15 subdivided categories, such as heart and vasculature; brain and nervous system; or ear, nose and throat. The PMB list is in the form of Diagnosis and Treatment Pairs (DTPs). A DTP links a particular diagnosis to a recommended treatment – one that has been known to offer the best results, and is medically approved and affordable. Besides the above conditions, a further 25 chronic conditions are covered. Chronic illnesses eligible for cover range from epilepsy and asthma to Crohn’s disease and diabetes (types 1 and 2). For some conditions, prescribed algorithms are used to determine the value of PMB coverage per patient.

Good to know It is important for members to read through the conditions of their medical aid plan and understand how the cover, pre-authorisation and claims process work. In most instances, PMB will also require members to make use of designated service providers in order to receive full cover. It is wise to plan ahead and for members to take control of their future well-being by investing in a quality medical aid scheme that will help lighten their burden when it comes to healthcare. Members of Selfmed can rest assured that, in the case of any of the PMB listed conditions, members will always receive the PMB that they are justly entitled to. This fact alone should give clients peace of mind that they will be looked after in times of illness, without the added worry of financial pressure.


THE SOUTH AFRICAN MEDICAL RESEARCH COUNCIL (SAMRC) RESPONDING, THROUGH INNOVATIVE MEDICAL RESEARCH, TO

SOUTH AFRICA’S HEALTH CHALLENGES The South African Medical Research Council (SAMRC) was established in 1969. We fund and conduct responsive medical research and innovation. Research at the SAMRC focuses on the following top 10 causes of death in South Africa:

The SAMRC is guided by the SAMRC Act, and it also invests financial and human resources into medical research that could lead to drug or vaccine discovery, affordable diagnostics and devices that beneficially impact the well-being of South Africans. The scope of the SAMRC’s research includes basic laboratory investigations, clinical research and public health studies.

SECOND NATIONAL BURDEN OF DISEASE STUDY 1997

CAUSE OF DEATH

2012

DEATHS

%

DEATHS

%

HIV/AIDS

60,336

14.5

153,661

29.1

CEREBROVASCULAR DISEASE

31,472

7.6

39,830

7.5

LOWER RESPIRATORY INFECTION

21,908

5.3

25,977

4.9

ISCHEMIC HEART DISEASE

23,813

5.7

24,969

4.7

HYPERTENSIVE HEART DISEASE

15,771

3.8

18,755

3.6

26,344

6.3

23,817

4.5

DIARRHOEAL DISEASES

18,737

4.5

16,349

3.1

INTERPERSONAL VIOLENCE

30,569

7.3

18,741

3.5

DIABETES MELLITUS

11,321

2.7

18,894

3.6

ROAD INJURIES

15,159

3.6

17,597

3.3

255,429 416,209

61.9 100

358,589 528,946

67.8 100

TUBERCULOSIS

TOP 10 CAUSES TOTAL DEATHS


WE EMPLOY STRATEGIES TO: INVEST IN

RESPONSIVE HEALTH RESEARCH

• SAMRC continues to engage with local and international institutions to establish, nurture as well as invest in strategic collaborations and partnerships in biomedical sciences.

GROW THE KNOWLEDGE ECONOMY OF SOUTH AFRICA • The SAMRC has shown a steady increment in the number of published peer reviewed articles. • The number of published articles have increased from 451 in 2014 to 660 in 2017.

FUND INNOVATION

INSPIRE THE NEXT

• The organisation hosts the Grants, Innovation and Product Development Division (GIPD) which is responsible for leading and managing innovation, with the goal of commercialising SAMRC funded innovation. • To date the SAMRC has invested in excess of R270 million in the innovation and technology space.

• The SAMRC prioritises career scientist programmes and has had an increase from 35 doctoral students in 2014 to 69 doctoral students in 2017. • The organisation has also funded 8 historically under resourced institutions to produce scientists that will accurately reflect the country’s demographic profile.

& TECHNOLOGY DEVELOPMENT

GENERATION OF SCIENTISTS

BREAKING NEW GROUND IN RESEARCH AND DEVELOPMENT The SAMRC funds and conducts responsive medical research and innovation that will enhance the country’s response to its health challenges. UMBIFLOW

Umbiflow empowers midwives and GP’s in mobile, rural and resource-poor primary healthcare environments by measuring the level of risk associated with pregnancies.

CDH2

A gene that is a major cause of sudden death among athletes and adolescents has been discovered and its early detection may circumvent abrupt deaths.

TB BIOINFORMATICS INITIATIVE

This project aims to establish a South African Bioinformatics platform to discover and evaluate new vaccines, diagnostics and novel chemotherapeutic strategies for TB.

PRODUCTION AND CHARACTERISATION OF CAP256-VRC26 MONOCLONAL IN PLANTS

Initiatives to discover low cost plant based expression technologies to reduce viral loads in HIV infection in individuals. The plant based expression systems are faster, inexpensive and scalable.

CLINICAL HEALTH GUIDELINES APP

This application assists adult and paediatric hospitals and clinics in speedy diagnosis that could potentially save the lives of South Africans.

POX-PROTEIN PUBLICPRIVATE PARTNERSHIP (P5)

The SAMRC is providing support to the Cape Town HVTN Immunology Lab to conduct research aimed at assessing the quality of cellular responses to HIV vaccine regimes.

SEXUAL VIOLENCE RESEARCH INITIATIVE (SVRI)

SVRI is a global network that promotes research on violence against women and girls in low and middle income countries to influence policy and practice. The SVRI has awarded more than $1 million to 10 research projects around the country including South Africa.


WE ARE TRANSFORMING OUR ORGANISATION AND

REFLECTING OUR COUNTRY’S DIVERSITY

The SAMRC has prioritised a transformation agenda that places focus on development programmes that fund and capacitate scientists to better reflect the demographic profile of our country.

TRANSFORMING OUR LEADERSHIP POSITIONS

Deputy Directors Programme: The organisation has introduced a Deputy Directors’ Programme that offers development training and opportunities for black and female senior scientists into leadership positions, this with the intention to reasonably change the face of leadership at the SAMRC.

TRANSFORMING RESEARCH-FUNDING STREAMS

New Self-Initiated Research guidelines have been applied to consider historically under-resourced institutions. The organisation is on a positive trajectory to ensure that grants are awarded equally. Grants in 2017 were awarded as follows: 37% White, 31% Black, 10% Coloured and 22%, a far cry from 72% White, and 11% Black, 5% Coloured and 11% Indian in 2012.

TRANSFORMATION AGENDA TO SUPPORT THE NEXT GENERATION OF SCIENTISTS

The SAMRC has instituted programmes to support mid-career scientists as they transition into independent researchers. In recognising the urgent need to assist in the production of a diverse pool of scientists, the SAMRC has invested in eight historically under-resourced institutions. The universities include Fort Hare, Limpopo, Venda, Walter Sisulu, Zululand, Western Cape, Mangosuthu as well as Sefakgatho Health Sciences University.

PROFESSIONAL TRANSFORMATION PLAN The SAMRC is committed to transformation and we seek to attract, develop and retain the best people and empower them to reach their full potential. Our researchers are recognised by their peers and are rated by the National Research Foundation (NRF).

Y-RATED 4

A: Leading International Researchers B: Internationally Acclaimed Researchers C: Established Researchers P: Prestigious Awards Y: Promising Young Researchers

GROWTH OF NRF RATED SAMRC SCIENTISTS

TOTAL NRF RATED SCIENTISTS IN 2017

Y

A

A-RATED 2

C-RATED 17

C TOTAL: 30

B

B-RATED 7

# OF RATED SAMRC SCIENTISTS

NRF RATING CATEGORIES

35

30

30

24

25

18

20 15 10

9

5 0

2014

2015

YEAR

2016

2017

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WE ARE INFLUENCING

COLLABORATIVE RESEARCH ACROSS THE GLOBE "We have and will continue to strategically respond to the constricting economic environment in order to deliver high impact medical research and honour our local and international collaborative commitments, to advance the research and development agenda." Glenda Gray, President & CEO South African Medical Research Council

REGIONAL: SENEGAL

Signed bilateral for Science, Technology and Innovation projects in areas that are health research priorities for both countries. It is estimated that in excess of $50k - $100k will be set aside for health related projects.

RWANDA

The SAMRC has partnered with the Rwanda Men’s Resource Centre and the Rwanda Women’s Network and Care Rwanda to assist in developing evidence-based violence against women prevention strategies.

SUDAN

Negotiated 1 million joint health related projects in biotechnology. The Department of Science and Technology will provide funding to the SAMRC amounting to R1 million over two years to implement and fund activities undertaken in SA to wards joint SA-Sudan projects.

INTERNATIONAL: CANADA

The SAMRC entered into a three year collaboration with the Canadian Institute on Health Research to participate in the Healthy Life Trajectories Initiative (HeLT). The aim is to establish a 5-10 year cohort to study interventions to prevent noncommunicable disease, particularly childhood obesity.

SWEDEN

Signed a Memorandum of Understanding to expand collaboration between South Africa and Sweden. Six projects are currently being funded and a further five joint projects with funding of R400 000 were funded in 2017.

INDIA

Established joint research priorities in HIV and TB. Three projects were selected for funding, along with four additional projects in South Africa focusing on capacity development.

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GROWING THE NEXT GENERATION OF SCIENTISTS CHANGING THE LANDSCAPE OF MEDICAL RESEARCH

SOUTH AFRICAN MEDICAL RESEARCH COUNCIL

Francie Van Zijl Drive, Parowvallei, Cape Town | Po Box 19070, Tygerberg, 7505, South Africa Tel: +27 21 938 0911 | Fax: +27 21 938 0200 | Email: info@mrc.ac.za | www.samrc.ac.za


DDG: MNCWH interview InterSystems | Profile | Department of health

Taking care of

our women and children Dr Yogan Pillay, Deputy Director-General for HIV & AIDS, TB and Maternal, Child & Women’s Health in the National Department of Health, offers insight into delivering quality MNCWH healthcare services in the public sector, HIV awareness among pregnant women, and how government’s proposed National Health Insurance will help level the playing field.

Dr Yogan Pillay, Deputy Director-General for HIV & AIDS, TB and Maternal, Child & Women’s Health in the National Department of Health

Maternal, Newborn, Child and Women’s Health (MNCWH) and Nutrition services are at the heart of health service delivery, thus expanding and strengthening these services is dependent on addressing key bottlenecks in service delivery within the health system as a whole. What are

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some of the major bottlenecks in the public healthcare sector affecting MNCWH services? What are the suggestions to counteract these challenges? YP For maternal and child health, we at the Department of Health (DOH) know what are the major causes of

mortality. We know how many moms die delivering in our facilities; we know how many neonates die (children in the first 28 days of life); we know how many children under the age of five years die in our facilities; and we know how all these deaths are caused. When it comes to the diagnoses, we are fairly advanced, and we also know the prescription. The key question remains: are we able to do it and, if we’re not, why not? I’ll use one example: One of the things we know is that the three major causes of maternal mortality are HIV – though these numbers are decreasing because of our huge antiretroviral therapy (ART) programme; pregnancy-related hypertension; and obstetric haemorrhage – bleeding either before, during or after delivery, but specifically during Caesarean sections. All of these things can happen anywhere, at anytime, and not necessarily in a hospital. This means at implementation we need to look at what happens in the household, what happens


| Profile DDG: MNCWH interview | InterSystems Department of health

in communities, what happens when these women get to a clinic, and if the clinic isn’t able to manage the patient, how quickly she will get to a hospital. Another factor is whether or not the healthcare workers at that hospital are skilled to do what is needed. Essentially, there’s an entire supply chain and that’s what makes this very complex; any one individual who dies might have been failed anywhere along that supply chain or pathway. We need to be able to look at the pathway in its entirety; to look at where the bottlenecks lie. The first challenge, if you just take pregnancy, lies with whether or not the pregnancy was planned as well as the age of the mother. One of the things we’ve done is strengthen access to contraception. In 2014, we released a new policy on contraception, family planning and fertility. Furthermore, we introduced the subdermal implant as an additional contraception, specifically targeting people new to contraception and young people. The second thing we’ve done, more recently, is we’ve mandated that rather than the usual four to five antenatal visits, eight ante-natal visits are now required. In this way, we can see women who are having normal deliveries more often because we think we are missing them in the four visits. The additional visits fall in the third trimester since this is where the big problems lie, and we need to detect any issues as early as possible. The next, of course, is to ensure that women who need referrals to hospitals can get there as quickly as possible. In this regard, we have mandated two things, with the first being obstetric ambulances. These ambulances are dedicated to obstetric and child cases, launched in 2013. The DOH launched this as an additional solution to prioritise pregnant women who rapidly need to be moved from clinics to hospitals, or from a district hospital to a regional hospital, or a regional hospital to a tertiary hospital. We also asked all provinces to ensure that district hospitals have maternity waiting homes for those women who are experiencing problematic pregnancies and can’t get to hospitals immediately, especially in rural areas. Then, we started to improve the skills of doctors and midwives at hospitals through a programme called ESMOE – Essential Steps in the Management of Obstetric

Emergencies – which also focused on resuscitation of newborns. In many cases, a mother may have a normal delivery but if the baby is born in distress, then staff must also be equipped to deal with the baby. In this case, we trained doctors and nurses in something called Helping Babies Breathe (HBB). Apart from asphyxia, some of the major causes of newborn deaths are infections, part of which is HIV, and prematurity. Prematurity is linked to very young women and we find that most of the preterms are born to teenage mothers. And there’s a good chance of both teenage mother and baby dying, which is why contraception is fundamental. We believe that we have a very comprehensive set of interventions, from contraception through to safe deliveries. We are now going a step further to see how we can strengthen C-section deliveries. In the private sector, the rate of C-sections is definitely higher; however, our C-section rate in the public sector has gone up to 26%. Where should we be? We think around 12%. What’s the rate in the private sector? More like 70%. Since the public healthcare sector has many mortality and morbidity deaths linked to C-sections, we are now starting a new process of accrediting doctors who will be re-trained to do C-sections properly and safely; and we are going to designate places where C-sections can be performed safely.

The DOH is continually reviewing and revisiting what needs to be done. The consequence of all this is that we can see maternal mortality coming down. In 2009, the figure was in the 300s; it’s come down to the 150s. So we have effectively halved it, but it’s not yet where we want to be. Our target for 2019 is below 100. The DOH’s Strategic Plan MNCWH and Nutrition in SA (2012 – 2016) highlights the importance of exclusive breastfeeding for the first six months of a child’s life, especially in the case of babies born prematurely. Your article on the Daily Maverick, dated 7 August 2017, says that “governments, decision-makers, development partners, professional bodies, academia, media, advocates and other stakeholders must work together to strengthen existing partnerships and forge new ways to invest in and support breastfeeding for a more sustainable future”. Even though SA has experienced a major increase in exclusive breastfeeding rates from 8% in 2003 to 32% at 2016, breastfeeding – particularly among the general public – remains taboo. What plans does the DOH have to actively market the benefits of breastfeeding, thereby allowing

The three major causes of maternal mortality are HIV – though these numbers are decreasing because of our huge antiretroviral therapy programme; pregnancy-related hypertension; and obstetric haemorrhage – bleeding either before, during or after delivery, but specifically during Caesarean sections.”

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DDG: MNCWH interview InterSystems | Profile | Department of health

mothers to objectively decide how they would like to feed their children? Yes, we’ve had a major campaign in 2017 where we also worked with civil society organisations to support breastfeeding in an ongoing way. These are societal campaigns, and are not just confined to health care facilities. We also had a major international conference in 2017 on breastfeeding. Obviously, we can never do enough, but the reason why the statistics have improved from 8% to 32% is partly linked to a change in our HIV programme as well as our increased investment at clinic level. Breastfeeding awareness has to start during ante-natal visits. The sisters at the clinics must convey to first-time moms and also repeat moms why breastfeeding is so important. We also have to include the partners; it’s not just about the mothers. We have to address the partners and then the family. It’s a societal issue. One of the barriers that exist especially for working-class parents is formula feeding, simply because society has painted formula feeding as something to aspire to. The marketers of formula feed do it in a particular way that makes people think that formula feeding is indicative of you moving up socially and economically, whereas what we know is that breastfeeding is best for both mom and baby. Our counter-marketing to the people who manufacture formula feed is that breast is best. Does an increase in breastfeeding bring about an increase in the chances of mother to child transmission in HIV-positive women? Will creating awareness around PMTCT and ART form a big component of the DOH’s exclusive breastfeeding campaigns? The DOH’s policy up to 2012 was that if a mother is HIV-positive, she should opt for formula feeding. However, all the research that’s been done globally showed that it’s better to do three things: (1) know your status; (2) if you are HIV-positive, you must go on ART; and, (3) you must be virally suppressed. If you do those three things, then it’s safe to breastfeed, but if you’re not doing any of this, then the chances of transmitting to your child is around 25%. If a mother follows the abovementioned

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three things and is virally suppressed, the chances of MTCT are minuscule. If she doesn’t and she lives in a poor community, her child is more likely to die as a result of pneumonia or diarrhoea. So, you’ve got HIV transmission on the one side, versus pneumonia and diarrhoea on the other. If you don’t have clean water, you should not be bottle feeding because you are going to pass on diarrhoea to your child. Also, if the child is poorly nourished, the child is probably going to get pneumonia. There are big risks apart from MTCT of HIV. In fact, the data suggests that more children will die from pneumonia and diarrhoea than HIV, and that is why

The marketers of formula feed do it in a particular way that makes people think that formula feeding is indicative of you moving up socially and economically, whereas what we know is that breastfeeding is best for both mom and baby. Our counter-marketing to the people who manufacture formula feed is that breast is best.”

the DOH has defaulted in ensuring that we test all pregnant women; we put them on treatment; and we explain to them why it’s so important. This is why our PMTCT programme is so successful. Our transmission rate is currently around 1%, but we owe the credit to the workers on the frontline; it’s got nothing to do with us sitting here at head office. It’s the nurses on the frontline who are doing all the right things to ensure this low statistic. Implementation of the WHO Ten Steps for the Management of Severe Malnutrition has been shown to reduce case fatality rates by between 30% and 55% in children. Where does South Africa stand on this? When a child arrives at a district hospital with severe acute malnutrition, or SAM, it is at this point that the WHO Ten Steps will be used. It’s important to understand what happened before that child arrived at hospital because to be severely acutely malnourished takes a long time, it doesn’t just happen, which could only mean that the child’s growth was not properly monitored. The Road to Health booklet is very important, as it is essential for growth monitoring. Every mom needs to have this booklet for every child she has. Whenever the child visits a clinic, growth is monitored, and weight and height plotted, so it’s easy to identify who is faltering. If a child is not achieving his/ her milestones, then supplementation should be offered at clinic level. If a child doesn’t receive supplementation over a period of time, he/she will become a SAM case, and then the 10 steps will need to be implemented. Sadly, by then, it may be too late. The DOH has started to look at the way in which we use the Road to Health booklet. We will be launching, fairly soon, a revised Road to Health booklet that focuses on what we call an under five campaign, using the tagline ‘Side by Side’. The campaign aims to kickstart the conversation between parents and communities; mothers-in-law and fathers-in-law; conversations between the community members and our health facilities; and between us as the DOH and the community at large, to show that we know what needs to be done.


| Profile DDG: MNCWH interview | InterSystems Department of health

We want to focus on three things when it comes to children: (1) survive – to their first 28 days, then to their first birthday, and then to their fifth birthday; (2) thrive – this is why the link between what we do in health and early childhood development is so important; and, (3) transform – once a child passes age five, they are much more resilient, but the first 1 000 days are crucial for development. The first 1 000 days are counted from conception, through to the nine months in the uterus, and then the next two years that follow. It is during this time that the nervous system is formed and the brain is wired. Nowadays, data from the first 1 000 days is even used to predict things like obesity. The promotion of health literacy intensified during 2016/17 via health information and education and behaviour-change communication interventions. Is the DOH finding that increased awareness and educational campaigns are proving to be more effective with the general public? While we can’t comment on our current campaigns because these are yet to be evaluated, historically we’ve had waves of successful campaigns. We’ve had the successful Komanani campaign and the National Communication Survey, done by various organisations and funded by donors, which showed the effect between campaigns and increased knowledge. Now whether that knowledge directs into behaviour change is another matter, even though we know this is key. We believe that providing information may not be sufficient. There’s also this new

theory around behaviourial economics, and it’s mostly around cash transfers. A number of research projects have shown that it works under certain circumstances, e.g. if you give young people a certain amount of money a month, and link this to them testing for HIV regularly and remaining negative. This has proved more likely for them to sustain a negative status than if they weren’t incentivised. Incentives work, but usually only under certain circumstances. Research published from the Eastern Cape tried to figure out under what conditions adolescents who are HIV-positive will take their treatment consistently. The research found three things, called the three Cs: 1. Cash – giving them money, although this alone doesn’t achieve the desired result. You have to include the other two Cs. 2. Caring – these adolescents must have someone in the household who cares about their well-being; cares about how they’re feeling and whether they’ve taken their meds. 3. Clinic – this is where patients receive their medication. If a patient goes to a clinic where the health worker is impolite and disrespectful, chances are the patient may not maintain his/her appointments. We can’t just do one thing, and that’s the issue we face with human behaviour; it’s so complicated. There’s no magic bullet. We have to do many things to achieve results. Communication is necessary and important, but not sufficient on its own. Which populations of the country will receive priority in respect of MNCWH and Nutrition, and why? That’s a very wide question because our country is heterogeneous, it’s not homogeneous, and I’m not talking just on the matter of race. It’s also where you live and your economic status. From 1994, we’ve taken the view that we must have a one-size-fits-all policy because of equity issues, but it’s now becoming clearer and clearer that the poorer sections of our communities need more focus and more attention than the richer ones. We need to shift focus from the rich to the poor because the poor are not going to get healthy by remaining poor.

Once a child passes age five, they are much more resilient, but the first 1 000 days are crucial for development. The first 1 000 days are counted from conception, through to the nine months in the uterus, and then the next two years that follow. It is during this time that the nervous system is formed and the brain is wired.” We will prioritise the people who are dependent on the public sector because, by definition, they’re the ones who can’t afford the private sector. Within the public sector, we also need to segment the market because what people in rural areas need is much different to what people in the urban areas need. While we in the urban areas complain, we have much better access to health care services than people in the rural areas. So the obstetric ambulances, for example, have to be prioritised in the rural areas because that’s where people live far away from clinics. We won’t worry about putting an ambulance here in Sunnyside (PTA) or Hillbrow (JHB) because people in these areas can easily access Charlotte Maxeke Hospital, for example. We need to have a highly differentiated response because the playing field is not level. That’s why the National Health Insurance (NHI) is important. The first thing that we’re working on in the NHI is that the package of services is mandated. Whether you’re in the private sector or the public sector, you will receive the same services at the same cost. In the private sector, you could still pay for services out of pocket or medical aid; whereas in the public sector, government will provide. The quality of these services and facilities must improve in the public sector to be in line with the private sector. We’re setting up the system with that intention. It’s like the UK; regardless of whether you visit an NHS facility or go to Harley Street, you’re going to get the same service for the same package. The only difference is that at Harley Street you can get cosmetic surgery.

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lth care a e h s ’ en Wom

erilization products t s & g n i packag l a c i d Me

th care Vision heal Pharmaceuticals

info@nationalmedical.co.za www.nationalmedical.co.za +27 (0)12 386 5698


Women, Children & Nutrition | Department of health

Improving The health OF

of women and children South Africa is committed to reducing mortality and morbidity among mothers and children. The introduction of free healthcare services for mothers and children, together with the revitalisation and building of more primary healthcare (PHC) facilities, has improved access to healthcare services for many women and children, especially in rural areas.

T

he delivery of comprehensive quality maternal, newborn, child and women’s health (MNCWH) services is dependent on a well-functioning health system. The three strands of PHC re-engineering – namely, the establishment of ward-based PHC outreach teams, the expansion and strengthening of school health services, and the establishment of district clinical specialist teams – all contribute to improving maternal and child health. The ward-based PHC outreach teams play a key role in delivering communitybased MNCWH services to communities at household level, and facilitate access to services at PHC and hospital levels. Strengthening school health services contributes towards improved health and learning outcomes for children and youth, while the district clinical specialist teams –

which will be made up of an obstetrician, a paediatrician, a family physician, an anaesthetist, an advanced midwife, an advanced paediatric nurse and a PHC nurse – play a key role in ensuring the provision of quality MNCWH services at all levels within the district, with a particular focus on ensuring the supervision and support of MNCWH services at PHC and district hospital levels. On an international level, efforts to improve maternal, newborn and child survival have focused on ensuring full coverage with packages of interventions with proven effectiveness. The key to making progress towards improving maternal, neonatal and child survival is to reach every mother, newborn and child in every district with a set of priority cost-effective interventions. This approach forms the basis of the African Union’s

According to the Rapid Mortality Surveillance Report 2016, total life expectancy in South Africa increased from 62.2 years in 2013 to 63.0 years in 2015

Campaign for the Accelerated Reduction of Maternal Mortality in Africa and the Strategic Framework for Reaching the Millennium Development Goals on Child Survival in Africa, which calls on countries to increase efforts to strengthen health systems, and to implement integrated packages of high-impact and low-cost health and nutrition interventions at scale. This strategic plan, therefore, aims to identify priority interventions that can be expected to have the greatest

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InterSystems Women, Children | Profile & Nutrition | Department of health

TABLE 1 Women’s health Priority interventions for women’s health

1. Access to contraceptive services, including pregnancy confirmation, emergency contraception, CTOP and a full range of contraceptive methods 2. Post-rape care for adults and children 3. Improved reproductive health services for adolescents through the provision of youth-friendly reproductive health services at health facilities and as part of school health services 4. Improved coverage of cervical screening and strengthening of followup mechanisms

TABLE 2 Newborns’ health Priority interventions for reducing newborn mortality rates

1. Promotion of early and exclusive breastfeeding, including ensuring that breastfeeding is made as safe as possible for HIV-exposed infants 2. Provision of PMTCT 3. Resuscitation of newborns 4. Care for small/ill newborns according to standardised protocols 5. Kangaroo mother care for stable low-birth-weight infants 6. Post-natal visit within six days, which includes newborn care, and supporting mothers to practice exclusive breastfeeding

impact on reducing maternal, newborn and child mortality, and enhancing gender equity and reproductive health. It also aims to provide a roadmap of how these interventions can be effectively implemented, with a focus on improving coverage, quality and equitable access to this package of core services.

The service delivery chain The district health system provides the

vehicle for the delivery of comprehensive MNCWH and nutrition services in South Africa. Although access to health services is good, serious weaknesses and deficiencies have been documented in the South African health system. MNCWH and Nutrition services are at the heart of health service delivery, thus expanding and strengthening these services is dependent on addressing key bottlenecks in service delivery within the health system

as a whole. Most MNCWH and nutrition services are provided by the provincial departments of Health, which are thus central role players in efforts to improve the coverage and quality of MNCWH and Nutrition services. Many other stakeholders also have key roles to play in promoting improved health and nutrition. These include other government departments such as Social Development, Rural Development, Basic Education,


Women, Children & Nutrition | Department of health

The NDP commitments are encapsulated in the Medium-Term Strategic Framework (MTSF) 2014 – 2019 sub-outcomes, which are aligned with the Strategic Plan and the Annual Performance Plan of the department. The MTSF outcomes are:

1 2 3 4 5 6 7 8 9 1

Studies have shown that provision of Kangaroo mother care (KMC) to stable newborns where the baby is carried on the front of the mother’s chest (with direct skin-to-skin contact) is an effective and safe way of caring for these babies. Perinatal Problem Identification Program data has shown that public hospitals that implemented KMC reduced their mortality rates among small babies, weighing between 1 kg and 2 kg, by 30%

UHC progressively achieved through implementation of NHI Creatively meets evolving needs by filling key capability gaps across a range of disciplines and system levels Implementation of the re-engineering of PHC Reduced healthcare costs Improved human resources for health Improved health management and leadership Improved health facility planning and infrastructure delivery HIV/AIDS and TB prevented and managed successfully Maternal, infant and child mortality reduced Efficient healthmanagement information system developed and implemented for improved decision-making

Water and Sanitation, Agriculture and Home Affairs, local government, academic and research institutions, professional councils and associations, civil society, private health providers and development partners, including the United Nations and other international and aid agencies. Within the National Department of Health, the Maternal and Child Health clusters

are responsible for policy formulation, coordination, and monitoring and evaluation of MNCWH and Nutrition services. Each province also has a unit, which is responsible for fulfilling this role and facilitating implementation at provincial level. At district level, services are provided by a range of health and community workers. These include nurses and doctors, as well as other professionals such as dentists, dieticians, physiotherapists and occupational therapists, and other cadres such as community liaison officers, specified auxiliary service officers and health promoters. A range of community health worker programmes also play an important role in many districts. The ward-based PHC outreach teams, when deployed and fully functional, will strengthen the provision of communitybased services. In the past, efforts to improve MNCWH services in South Africa have primarily focused on improving access to an expanded range of services, especially at PHC level. This strategy aims to build on these services and ensure that MNCWH and Nutrition interventions at community and hospital levels are also strengthened.

Focus on women and newborns One of the key goals of the HIV and AIDS and STI Strategic Plan for South Africa was to reduce the mother-to-child transmission of HIV, with a target of less than 2% transmission at six weeks by 2016. The

achievement of this target was expected to result in a significant reduction in child mortality rates. A 2010 prevention of mother-to-child transmission (PMTCT) study found that the national MTCT transmission rate was 3.5%. This was half the transmission rate compared to the 8% that the ‘Strategic Plan for Maternal, Newborn, Child and Women’s Health and Nutrition in South Africa 2012 – 2016’ report estimated for 2008. Chapter 10 of the National Development Plan (NDP) 2030 sets out the vision for the South African health system to achieve:“A long and healthy life for all South Africans”. The NDP envisaged the following by 2030: 1. A life expectancy rate of at least 70 years for men and women 2. A generation of under-20s largely free from HIV 3. A reduced quadruple burden of disease 4. An infant mortality rate of less than 20 deaths per 1 000 live births 5. An under-five mortality rate of less than 30 deaths per 1 000 live births 6. A significant shift in equity, efficiency, effectiveness and quality of healthcare provision 7. Universal healthcare (UHC) 8. A significant reduction in social determinants of disease and adverse ecological factors.

Life expectancy in South Africa According to the Rapid Mortality Surveillance Report 2016, total life expectancy in South Africa increased

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InterSystems Women, Children | Profile & Nutrition | Department of health

The implementation of the WHO’s 10 Steps for the Management of Severe Malnutrition has been shown to reduce case fatality rates between 30% and 55%

from 62.2 years in 2013 to 63.0 years in 2015. South Africa is also experiencing downward mortality trends; this could be attributed to continued expansion of the government antiretroviral (ARV) programme, with an increased number of HIV-positive persons who are taking ARV drugs living longer. In South Africa, as in other countries, deaths during the neonatal period (0 – 28 days) account for approximately a third of all deaths in children under five years of age. Thus, significant reductions in under-five mortality rates will only be

possible if deaths during the neonatal period are reduced. Under-five mortality rates declined from 41 child deaths per 1 000 live births in 2013 to 37 child deaths per 1 000 live births in 2015. Infant mortality rates also declined slightly, from 28 infant deaths per 1 000 live births in 2013 to 27 infant deaths per 1 000 live births in 2015. The maternal mortality ratio (MMR) decreased from an estimated 165 deaths among pregnant women per 100 000 live

births in 2012 to 154 deaths per 100 000 live births in 2016. The MMR decreased significantly by 42.8% compared with the MTSF baseline of 269 deaths per 100 000 live births in 2009. South Africa has experienced the erosion of its breastfeeding culture over the

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Women, Children & Nutrition | Department of health

past years due to, among other reasons, the aggressive marketing of breast milk substitutes by the infant feeding industry and a lack of clarity regarding optimal infant feeding practices in the context of the HIV/AIDS epidemic. In 2008, only 25.7% of children up to six months old were exclusively breastfed, with 22.5% of children up to six months old being exclusively formula fed and 51.3% of children in this age group being mixed fed. The 2010 World Health Organization (WHO) guidelines on HIV and infant feeding brought renewed efforts to put breastfeeding back on the agenda as a key child survival strategy. The WHO guidelines recommend that all HIV-infected mothers breastfeed their infants provided that they (or their infant) receive antiretroviral drugs to prevent HIV transmission during ongoing breastfeeding. A national breastfeeding consultative meeting was convened in August 2011. The meeting concluded with the Tshwane declaration of support for breastfeeding in South Africa, which declared South Africa to be a country that actively promotes, protects and supports exclusive breastfeeding as the infant feeding option of choice, irrespective of the mother’s HIV status.

Hospital care Strategies for monitoring and improving the care that children receive in public hospitals have not been implemented on a large scale, resulting in wide variation in the quality of care provided in different hospitals. The establishment of district clinical specialist teams provides an important opportunity for improving the quality of care provided at regional and district hospital levels. The teams will be expected to ensure that appropriate guidelines and protocols are available, and that healthcare workers are appropriately trained and supported to provide high-quality services. The WHO has developed and implemented a number of approaches to improving the quality of care for children in hospitals, such as the Emergency Triage Assessment and Treatment course. These approaches focus on improving the emergency care of ill children, and improving the management of common conditions,

Enteral vs Parenteral Enteral is when nutrition is provided via a feeding tube. Parenteral is when the digestive tract cannot be used and nutrition is provided through an intravenous tube directly into the veins especially diarrhoeal disease, pneumonia and severe malnutrition. The implementation of the WHO’s 10 Steps for the Management of Severe Malnutrition has been shown to reduce case fatality rates by between 30% and 55%. This approach has already been adopted by the majority of provinces and is currently being implemented in 125 hospitals. In an effort to implement this approach, wide-scale capacity building and advocacy workshops for senior managers have been conducted. Monitoring needs to be ongoing to ensure that the implementation of this approach is not neglected.

Nutrition impact The DOH is implementing interventions focused on clinical nutrition, public health nutrition and food-service management. Clinical guidelines on adult parenteral and enteral nutrition and paediatric parenteral nutrition were developed in the 2016/17 financial year. Guidelines for healthy eating in early childhood development (ECD) centres were also developed, with the aim to improve the quality of food served in these centres. A total of 45 national government departments and three public entities and professional associations were oriented on the provision of healthy meals in the workplace, with the aim of helping employees adopt healthy eating habits. The promotion of health literacy intensified through 2016/17 via health information and education and behaviourchange communication interventions. This was done in collaboration with partners and the provinces, with a special focus on the national health calendar events and programmes such as World No Tobacco Day, World Health Day, and Healthy Lifestyles month. The process to amend the Tobacco Products Control Act (No. 83

of 1993) was completed with the creation of a draft bill for presentation to the National Health Council and for onward submission to Cabinet. The three forms of malnutrition, namely under-nutrition, over-nutrition and micronutrient deficiencies continue to be challenges in South Africa. The DOH is implementing interventions focused on clinical nutrition, public health nutrition, and food-service management to address these challenges. As part of overcoming the high prevalence of overweightedness and obesity, the DOH has provided orientation workshops on healthy meals in the workplace to all national government departments. These workshops aim to help employees adopt healthy eating habits. Guidelines for healthy eating in ECD centres were also developed, with the aim of improving the quality of food served. The communicable disease subprogramme continues to strengthen capacity for epidemic preparedness and response in line with international health regulations (IHR 2005). Provincial outbreak response teams were capacitated to respond to food-borne illnesses in line with IHR. The sub-programme managed to protect 896 019 vulnerable individuals against seasonal influenza using the seasonal influenza vaccination, exceeding the target by 12%.

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InterSystems Jembi Health Systems | Profile| Profile

The next generation in

mobile health

J

embi is a not-for-profit company registered and based in South Africa. It has country offices in Mozambique, Rwanda and Zambia, as well as projects in other Southern, East and West African countries. Since 2009, Jembi has provided the technical skills, tools and implementation expertise needed to develop and enhance digital health and health information systems in low-resource settings. Its work is based on open architecture, standards, innovation and information systems, while partnering with governments, local and international organisations, and consortia to facilitate knowledge sharing, project work and coordination. This ensures technologies and services are accessible as well as interoperable across systems. Jembi’s core competencies exist in enterprise and systems architecture for health, as well as the analysis, design and development of software for health systems. It acts as an ethical mediator, developing software, analysing and re-engineering health systems and undertaking research on the application of health information systems.

MomConnect In South Africa, participating in the National Department of Health’s (DOH’s) flagship MomConnect project consortium has been an integral part of Jembi’s work since 2014. Jembi works closely with Praekelt.org and the Health Information Systems Programme (HISP) South Africa, as technical partners for the Department’s globally innovative delivery of healthcare

information on pregnancy and childcare using mobile phones. Jembi actively supports the MomConnect information systems architecture using open-source software, ensuring compliance with the DOH’s National Health Normative Electronic Standards Framework health data is for Interoperability always on the move. in eHealth in South Africa (HNSF), a Jembi Health Systems globally recognised, NPC exists to get it to advanced and where it should go, progressive quickly and securely, framework for national health no matter the information systems.

With support from Johnson & Johnson, the Department of Science and challenges. Technology, and the Working with Department of Health government – through the South African In an ever-evolving technological Medical Research Council – the potential landscape, Jembi sees its technical for any government department to use assistance to the DOH as support in mobile devices in improving public ensuring that public sector clients are sector service delivery is strengthened. able to access information, electronically, Jembi also collaborates with the DOH in an increasing variety of ways. through the African Health Information It looks to help the DOH extend Exchange project, funded through an its service offerings through the award to the University of Cape Town by development of a mobile phone the Bill and Melinda Gates Foundation. application that improves caregivers’ As a reference implementation of South access to information in the new ‘Road Africa’s national health information to Health’ booklet – a patient-held record systems architecture, this project of health events in every child’s life. This addresses the technical challenges to is the first step in the national promotion implementing interoperability among of mobile phones as enablers for public South Africa’s public healthcare services. health programmes for all South Africans. Together, these different projects Key to this is an integrated, open and support improving HIV and TB service managed programme for the deployment delivery, building a healthier life for all of mobile solutions for public health. by providing a common information Developing this mobile management systems platform. system with the DOH is part of Jembi’s focus on ensuring that digital health and health information systems infrastructure are compliant with the HNSF and the Protection of Personal Information Act (No. 24 of 2013), by addressing basic concerns such as remote access to private www.jembi.org information and mobile data costs.


www.jehuindustries.com info@jehuindustries.com

ALMIKA TRADING (PTY) LTD

‘Living the future of healthcare now’


ALMIKA TRADING (PTY) LTD

‘Living the future of healthcare now’

SURGICAL CONSUMABLES

Making provision for a vision

+27 (0)31 597 8045 +27 (0)83 782 0800 info@jehuindustries.com www.jehuindustries.com

H o s p i t a l co n s u m a b l e s Catheter solutions Flush Injection systems I nf e c t i o n p re v e nt i o n H a z a rd o u s d r u g s af e t y Orthopaedic solutions J e h u Fo u n d a t i o n


Jehu Industries | Profile

Living the future of healthcare, now Jehu Industries is a medical device company that aims to be recognised as one of South Africa’s leading healthcare companies. Established in 2005, the company today boasts an extensive range of surgical products as well as high-quality hospital equipment.

S

ince its founding, Jehu Industries has expanded in size, boasting a head office in Durban and new branches in Johannesburg and Cape Town. It is also currently establishing offices in Cameroon and Ghana. The company prides itself on being an original manufacturer, importer and distributer to the healthcare sector, sourcing products from countries such as the USA, Netherlands, UK, Malaysia and China. Additionally, Jehu offers a consultancy service, whereby it consults on developing products for other medical device companies, hospitals and clinics, as well as for export abroad.

Background The founding director, Jeremy Naidoo, embarked on the Jehu Industries

Jeremy Naidoo, founding director, Jehu Industries

journey in his early 20s after expanding his knowledge of business and the medical industry while working at his parents’ medical manufacturing factory.“During my short time at the factory, I learnt everything there was to know about the manufacturing process, ordering of raw materials, and quality testing. “As the years progressed, I learnt that being a business owner requires not only to have an understanding of the business process, but to also have a well-rounded knowledge of the multiple divisions encompassed within a business. This was when I approached my parents about allowing me to work with their sales team. “Once I was finally awarded the opportunity, I combined my knowledge

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Making provision for a vision

Hospital consumables Catheter solutions Flush Injection systems Infection prevention Hazardous drug safety Orthopaedic solutions Jehu Foundation

HOSPITAL EQUIPMENT

+27 (0)31 537 8045 ALMIKA TRADING (PTY) LTD

‘Living the future of healthcare now’

+27 (0)83 782 0800 info@jehuindustries.com www.jehuindustries.com


Jehu Industries | Profile

of the industry and manufacturing processes with my natural ability to approach people in order to become the best salesman I could be. After numerous visits to hospitals across Durban and a determination to grow within the sales team, I started developing relationships with various hospital buyers,” Naidoo explains. “In addition to the products I was offering, the buyers began to enquire about several surgical products that did not form a part of my parents’ product list. I conducted some research on the new products and discovered that it would be a viable expansion plan for my parents’ business. “I approached my father with the proposal and he had advised me that he had no plans to expand his product list, as he was well acknowledged in the industry for the products manufactured and sold by his company. “The number of requests for these other surgical products had increased as the months passed, yet my dad’s decision remained unchanged. He noticed my excitement towards this new venture and my desire for progression, so he approached me with the suggestion of starting my own business. “I decided that it was time to make my proposal into something more tangible and to put all the knowledge I had gained into practice. With only R7

90%

of Jehu’s surgical range is based purely on products that promote safety in the healthcare industry, such as safety IV catheter solutions, safety syringes, safety needles and more

500 to my name, I ventured out on my own. The rest, as they say, is history,” Naidoo recalls.

Staying afloat During the company’s initial stages, Naidoo’s prerogative was to keep the business afloat for as long as possible. Today, however, this has changed and Naidoo can now focus on making “provision for a vision”. “We do what is right! And that is why we strive to serve the industry with the best quality products at the best possible prices,” he continues.“I truly believe that one of our values as a provider to the healthcare industry is our duty to mankind, which means putting humanity first before compromising the quality of healthcare… Every human deserves uncompromised healthcare.

Promoting safety Jehu Industries’ surgical range comprises various products such as gravity lines and diagnostic machines. The company also recently became a distributor for world-renowned medical device manufacturer Becton Dickinson (BD), which is known for providing extremely high quality products.

Becton Dickinson BD is a leading global medical technology company that manufactures and sells medical devices, diagnostic systems and reagents. It focuses on improving drug therapy, enhancing the quality and speed of diagnosing diseases, and advancing research and the discovery of new drugs, vaccines and methods for their delivery. BD’s approach to sustainability is one of shared value. The company

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Making provision for a vision

ORTHOPAEDIC SOLUTIONS

Hospital consumables Catheter solutions Flush Injection systems Infection prevention Hazardous drug safety Orthopaedic solutions Jehu Foundation

ALMIKA TRADING (PTY) LTD

+27 (0)31 537 8045 +27 (0)83 782 0800

‘Living the future of healthcare now’

info@jehuindustries.com www.jehuindustries.com


Jehu Industries | Profile

identifies opportunities to address unmet health needs, grow markets and develop innovative products that advance global health outcomes, while also generating significant business value. Only by understanding the relationship between strong economic performance, social responsibility and respect for the environment can BD achieve its purpose of ‘advancing the world of health’. “We are able to provide comprehensive safety solutions geared towards both patient and healthcare worker safety. As a BD distributor partner, we are well placed to provide the highest quality healthcare products,” Naidoo states. “It is an honour to be associated with a company that has such high standards and strives to deliver only the best in healthcare,” he asserts. With safety top of mind, 90% of Jehu’s surgical range is based purely on products that promote safety in the healthcare industry, such as safety intravenous catheter solutions, safety syringes, safety needles and many other surgical consumables.“We are able to provide a full A-Z safety solution from the time patients enter a facility till they are ready to leave. Being one of BD’s distributors at this point puts us in a superior position to carry out our goal and our service to humanity, by providing the best healthcare products at the best possible prices, without compromising quality,” Naidoo explains.

pieces of scented condoms, which equates to just under a hundred 40-foot containers, have been imported and successfully distributed by Jehu Industries

Fighting HIV/AIDS “Our biggest client is the National Department of Health. We were awarded a tender in 2015 for the supply of the scented MAX male condoms. This project has undoubtedly been the most exciting in

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InterSystems Jehu Industries | Profile | Profile

my career,” shares Naidoo.“It sometimes feels surreal that Jehu Industries was entrusted by the South African government to provide such a vital product to the country.” To date, Jehu has imported and successfully distributed in excess of 460 million pieces of scented condoms, which equates to 132 40-foot containers. Through this tender, the company increased its knowledge of HIV/AIDS, and started taking a more philosophical approach to doing business.“It’s not all about the profits; it’s about being a soldier fighting one of mankind’s greatest threats: HIV/AIDS.

Saving lives “I have met amazing people who work or volunteer at the various NGOs that we

distribute to. These people live to help their fellow men, women and children. Everyone is working towards one common goal and that is to save lives,” he reiterates.“This experience has opened my eyes to the fact that Jehu Industries must provide healthcare at the most affordable rates possible. To the rest of the world, this may just be a tender for condoms; but to our team, it’s a mandate from above to help make a difference in saving our nation.”

Best in the business The success of Jehu’s products is dependent on quality. For this, the company has a team of clinicians who assist with R&D.“Our clinicians are extremely important because – while some of us may have

In the words of the father of our nation, Nelson Rolihlahla Mandela, ‘Overcoming poverty is not a gesture of charity; it’s an act of justice. It’s the protection of a fundamental human right – the right to dignity and a decent life’.”

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knowledge in other aspects of the business, such as logistics, manufacturing, and acquiring products cross-border – they are the gatekeepers when it comes to quality assurance,” Naidoo states. In fact, nothing at Jehu is developed or imported without the consultation of the R&D team. “They assist in identifying a need and finding the best solution. This way, the safety of the patient and healthcare worker is never compromised.”

The next steps Jehu Industries’ goal for 2018 is to establish a presence in Africa, which it is currently pursuing in Cameroon and Ghana. Looking ahead over the next two years, the company wants to break barriers and increase its commitment to mankind.“We have established our very own foundation called the Jehu Foundation, and it has really defined us as a company.” The Jehu Foundation is responsible for various outreach programmes and medical mobile clinics, and is solely reliant on funding from Jehu Industries. “We rely on no external financial support and the employees of the foundation fully understand this and are committed to making our vision a reality. If we do ask for assistance, it’s in the form of time, not money. Time carries the biggest contribution to this cause.” The foundation’s latest undertaking is to provide lunch to children at underprivileged schools.“As the owner of Almika Trading t/a Jehu Industries, I will continue to expand on the foundation and offer a safe house for many Africans,” says Naidoo. “In the words of the father of our nation, Nelson Rolihlahla Mandela, ‘Overcoming poverty is not a gesture of charity; it’s an act of justice. It’s the protection of a fundamental human right – the right to dignity and a decent life’.”


The Health Professions Council of South Africa (HPCSA) is a statutory body established by the Health Professions Act, 56 of 1974 (as amended). The HPCSA is committed to protecting the public and guiding the professions. In order to safeguard the public and indirectly the professions, registration in terms of the Act is a prerequisite for practising any of the health professions registerable with Council. The HPCSA has a mandate to regulate the healthcare professions in the country is aspects pertaining to education, training and registration, professional conduct and ethical behavior, ensuring Continuing

V M

V ISION Quality and Equitable Healthcare for All

M

ISSION

To enhance the quality of healthcare for all by developing strategic policy frameworks for effective and efficient co-ordination and guidance of the professions through:

Professional Development (CPD) and fostering compliance with

§

healthcare standards.

Setting contextually relevant healthcare training and practice standards for registered professions

§

Ensuring compliance with standards

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Fostering on-going professional development and competence

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Protecting the public in matters involving the rendering of health services

V §

Public and stakeholder engagement

§

Upholding and maintaining ethical and professional standards within the health professions

V ALUES In fulfilling its roles of regulator, guide & advocate and administrator, the HPCSA holds the following values central to its functioning

Contact Details:

Postal Address

553 Madiba Street

PO Box 205

Cnr. Hamilton and

Pretoria

Fax:

(+ 27) 12 325 5120

Madiba Street

0001

Email:

info@hpcsa.co.za

Arcadia

Tel:

(+27) 12 3389300 (+27) 12 338 9301

Website: www.hpcsa.co.za

0001

Protecting the public and guiding the professions


HPCSA | Profile

2018/19 annual fee renewal P The annual registration renewal period is upon us.

ractitioners will soon be receiving email notifications in the first week of March 2018, reminding them of an annual fee renewal. They are requested to please update their email and mobile number details with the HPCSA to ensure that they receive this reminder.

Online renewal and payment of 2018 fee Council launched its Online Renewal Portal in March 2017 to enable practitioners to renew annual fees online. The HPCSA urges practitioners to visit the online portal and create accounts before renewal starts. Call Centre agents are on standby to assist with this process and may be reached on +27 (0)12 338 9300 or +27 (0)12 338 9301. Once practitioners have gone through the renewal process online, including making the appropriate payment, they will be able to view and/or print their electronic QR-coded proof of renewal for 2018/19. The printout or electronic copy on a mobile device serves as the official proof of renewal, replacing the previous physical practitioner card.

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Exemptions from payment of 2018/19 annual fee

Should practitioners no longer be practising their profession due to ill health, they may be exempted from payment of the 2018 annual fee. A medical report, issued by a registered medical practitioner, must accompany such an application, which should reach Council’s offices before 1 April 2018. Exemption from paying the annual fee may be granted from the year in which a practitioner turns 71, if they turn 71 before 1 April 2018 – except for those registered with the professional boards for environmental health practitioners, medical technologists, radiographers and clinical technologists, dieticians and nutritionists, who may be granted exemption from the year in which they turn 66, if turning 66 before 1 April 2018.


HPCSA | Profile

Voluntary erasure

Allocation of monies received from practitioner

Written application for voluntary erasure under Section 19(1)(c) of the Health Professions Act (No. 56 of 1974) must be received by Council on or before 31 March 2018. If done, 2018/19 annual membership fees will not be due nor payable on the finalisation of the application by Council.

Monies received from practitioners will be allocated against oldest debt first. It is important that a practitioner, therefore, uses the Online Renewal Portal to ensure that there are no other monies due or payable.

Erasure from relevant register due to non-payment of 2018/19 annual fees The non-payment or partial payment of 2018/19 annual fees will result in a registered practitioner being suspended from the register. Restoring registration attracts a penalty fee in all cases.

Live since 1 March 2017

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HPCSA | Profile

CPD: What you need to know

C

PD has been described as intensive and collaborative; ideally, it includes an evaluative stage. The various types of professional development range from consultation, coaching and communities of practice to study lessons, mentoring, reflective supervision and technical assistance. It is thus a process during which a healthcare professional maintains and continuously improves the standards of healthcare practice through the development of knowledge, skills, attitudes and behaviour that will not only add measurable benefits to the professional practice of medicine, but also enhance and promote professional integrity. CPD is not just for the benefit of the practitioner; it also assures the public that their healthcare practitioner is both qualified and up to date with new developments. It is crucial, then, for all healthcare professionals registered in South Africa to comply with the set standard of CPD activities each year, including those of ethics, human rights and medical law.

The basic requirements In 2007, the HPCSA made CPD compulsory for all professionals registered with Council. Every healthcare professional is required to maintain an official HPCSA Individual CPD Activity Record. This comprises the individual’s CPD Portfolio, supported by documentary evidence, such as certificates of attendance.

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The concept of Continuing Professional Development (CPD), which has been around in some form for centuries, is essentially about learning to earn or maintain a professional’s credentials. This ongoing learning can take many forms – from academic degrees and formal course work to conferences and opportunities within the practice. In terms of the Health Professions Act (No. 56 of 1974), healthcare professionals are obliged to attend CPD activities. This is mandatory for continued registration with the HPCSA. Professionals who do not comply with CPD requirements may be suspended from the register, and the same restoration requirements as for non-payment of the annual fees are then applicable.

Maintaining your licence In 2011, the HPCSA resolved that practitioners will be required to have a licence to practise their professions. The primary purpose is to ensure that all practitioners, under the jurisdiction of the HPCSA, maintain competence and performance for the well-being, and in the best interests, of patients. The reasoning behind implementing the maintenance of licensure is to assure the public that healthcare practitioners are up to date with new knowledge and current trends, to improve the quality of care, to detect early healthcare performance that is not up to standard,

and to ensure professional accountability and responsibility. Licensure requires proof from practitioners that they are compliant with the requirements set by professional boards and/or the HPCSA, so that they can continue to practise. It also allows the HPCSA to maintain jurisdiction over practitioners. The generic domains in which practitioners should be compliant include: • professionalism • safety and quality • communication • knowledge, skills and performance. The identified requirements for licensure for practitioners are to determine an individual’s own learning needs, to devise a customised CPD programme that meets learning needs of the individual to improve their own practice, and to implement learning programmes. The maintenance of licensure is currently being discussed at professional boards’ level to finalise the proposed document and consult with stakeholders, including practitioners, professional associations and universities.


HPCSA | Profile

Compliance and enforcement: The Inspectorate Office The HPCSA has a responsibility to protect the public and guide the professions, by ensuring optimal health for all people through the provision of safe healthcare and practitioners that have been educated to the highest professional standards.

T

o enable the HPCSA to effectively carry out the mandate of fostering compliance in line with the provisions of the Health Professions Act (No. 56 of 1974), the HPCSA established the Inspectorate Office in 2015. The role of the Inspectorate Office is to ensure that registered practitioners comply with the provisions of the Act. Over and above the overarching responsibility of ensuring compliance, the Inspectorate Office is also responsible for the following duties: • conducting proactive inspections of premises to ensure compliance • assisting professional boards with inspections on clinical and professional compliance matters • ensuring compliance with penalties imposed by the Professional Conduct Committee • collecting outstanding fines and attending to criminal matters in respect of unregistered practitioners. The HPCSA Inspectorate Office assumes collective responsibility alongside other law enforcement and

regulatory institutions in the healthcare environment, as well as members of the public, to expose and ensure that all illegal practitioners are stopped and prosecuted. Since inception, the HPCSA’s Inspectorate Office has been involved in a number of cases where people who are neither trained (qualified) nor registered with Council have been practising as healthcare professionals, using forged documents such as bogus qualifications and falsified registration documents and registration numbers. Members of the public are urged to be vigilant of such illegal and bogus practitioners and are advised to report related suspicious activities to the HPCSA.

The HPCSA is stern on ensuring that illegal practitioners do not practise and put the lives of the public at risk. “We are warning those practitioners registered with Council to refrain from employing and allowing unregistered practitioners to utilise their practice rooms. We also warn bogus practitioners to refrain from masquerading as healthcare practitioners, as this has dire consequences for the public. The public is also advised to be vigilant and avoid consulting with unlicensed practitioners as far as possible, as this will put their lives at huge risk,” says Eric Mphaphuli, Senior Manager: Inspectorate Office, HPCSA.

Who can report complaints and referrals to the Inspectorate Office? • Members of the public • Employees of Council, members of professional boards and committees • The Inspectorate Office also accepts anonymous complaints regarding illegal practice by unregistered persons provided that sufficient details of the allegation are provided Where to find the inspectorate offices: National Office Pretoria: +27 (0)12 338 3984 Regional offices Gauteng (Pretoria) – This office deals with matters for Gauteng but also covers Limpopo, Mpumalanga and the North West: +27 (0)12 338 3984 Cape Town – This office deals with matters for both the Western Cape and the Northern Cape: +27 (0)21 830 5921 Durban – This office deals with matters for the whole of KwaZuluNatal province: +27 (0)31 830 5294 East London – This office deals with the Eastern Cape but also covers the Free State: +27 (0)43 783 9741

Eric Mphaphuli, Senior Manager: Inspectorate, HPCSA


Afrox compliant with new medical gas packaging regulations Afrox Healthcare is a leading supplier of medical gases and related services in the southern African region. Afrox supplies a comprehensive range of medical gas products, accessories and related services to hospitals in the public and private sectors, to dentists, private doctors and veterinarians, as well as to chronic obstructive pulmonary disease (COPD) patients in the comfort of their homes. At Afrox we value the health and safety of all who come into contact with our business, so our customers can be assured that all medical gases purchased from Afrox Healthcare meet the requirements in terms of safety, quality and efficacy. The packaging of medical gases into portable steel and aluminium cylinders is governed by South African National Standard SANS 10019. An amendment to SANS 10019, which was published in 2013, mandates that all medical gas cylinders with a water capacity of 10 litres or less shall be fitted exclusively with a pin-index valve. Previously customers had the choice to order medical gases in small cylinders that are fitted with any one of the following valve outlet types: pin-index, bull-nose and integrated valve regulator. Afrox has through the South African Compressed Gas Association undertaken to comply with this amendment by 31 December 2018. To this end, Afrox has started to systematically withdraw medical gas cylinders with 10L, 5L & 2L water capacity, that are fitted with a bullnose valve outlet, from the market and replace them with cylinders fitted with pin-index valve outlets. Afrox is committed to working with healthcare providers and regulatory authorities to promote the best practice use of its products.


Pin index valve

We therefore advise our customers to ensure that the Phased out

regulators are compatible with the pin-index value before the cut-off date. The compatible regulators can be purchased at an Afrox Gas & Gear or through the Afrox eShop www.afroxshop.co.za. Afrox is the first gases company in South Africa to have achieved registration of all its gases under the Medicines and Related Substances Control Act (101/1965), and Afrox medical gases comply with all applicable Medicines Control Council (MCC) regulations.

Leading the way in medical gas products The Afrox Integrated Valve Regulator (IVR) is designed specifically to address the needs of medical practitioners and respiratory therapists for the administration of medical oxygen in portable cylinders. IVR cylinders are ready to use as the valve, regulator, live contents gauge and flow controls are integrated into the cylinder. Therefore no separate regulator is required. The Afrox IVR complies with the South African National Standard SANS 10019 published in 2013. With the IVR, treatment is always ready.

Your partner for inspired healthcare. Afrox Hospital Care | 0860 020202

Afrox Homecare | 0860 030202

www.afrox.co.za


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2018/01/15 09:0


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Buhle Waste | Profile

Business beyond the bottom line Buhle Waste is a second-generation family business that is 100% black-owned and -managed. The company strives to achieve excellence in all its business activities in the communities in which it operates.

B

uhle Waste strives to be an embodiment of ubuntu – knowing that it takes a community to help raise a business. The business has been raised on the beliefs that homes and cities must be beautiful spaces, love for people and work should be fostered, and respect for the environment must be maintained. Buhle strives for beauty, love and respect in all that it does.

The road so far In 1997, family man and medical practitioner Dr PD Sekete recognised that the township in which he was living was plagued by poor service delivery; waste was piling up in the sewerage system and rubbish heaps were strewn along the streets – and these areas had become the playgrounds of children.

Dedicated to preventative healthcare, Dr Sekete committed himself to bringing efficient waste management to the townships around South Africa. In 1999, he progressed into the medical waste sector – a natural evolution into healthcare risk waste for a healthcare professional. Buhle Waste began in the dusty streets of Katlehong with a single truck and seven staff members, managing the waste of the local communities in an effort to bring a sense of beauty and pride to the environment. The company now operates nationally with over 350 staff and a fleet of over 70 trucks, with offices, warehouses and/or treatment plants in Gauteng, the Free State, Limpopo and Mpumalanga. Buhle Waste specialises in the management of healthcare risk waste through the: provision of relevant containers, collection of medical waste, transportation of waste, treatment and safe disposal of waste, and digital and real-time tracking of the waste containers. Today, the company is the market leader in the management of medical waste in South Africa.

Committed to success Sekete attributes much of the company’s growth to its dynamic nature. “Our success is largely due to our continued evolution and adaptation to the changing circumstances; like the environment we

serve, we have taken on its most resilient characteristics – innovation forms a pillar of our business, ensuring growth and success. As such, we invest in technologies that will assist us in achieving our zero-waste-to-landfill goals while simultaneously differentiating our value proposition in the healthcare industry. We are the first waste management company to have an incinerator and non-burn technology on the same premises – our capacity to treat waste is greatly increased while our transportation impact is reduced.” Buhle Waste’s commitment to environmentally sustainable technology and its benefits is further highlighted in its investment in a treatment technology at its flagship treatment site in Seshego, Limpopo. The converter, in using friction from rotating shredder blades in a sealed chamber, generates heat to sterilise and destroy hazardous waste, rendering it non-hazardous. The machine reduces the original input by about 70% in volume and 60% in weight. This technology is an essential component in Buhle’s mission of achieving zero-waste-to-landfill by 2025. “It is our mission to achieve our goals through investment in technology and our people. It is imperative that we, as a collective, collate our resources and intellect to achieve the great positive impacts on beautifying our communities and ensuring environmental sustainability. We need the pillars of our business to operate in a synergistic fashion if we are to continue to hold true to our values of beauty, love and respect,” Sekete concludes.

DOH 2018

147


Department of Health | INDEX OF ADVERTISERS

Afrox

144

Kingsgate Clothing Group

Almika t/a Jehu Industries

131

Lancet Laboratories

Anova Health Institute

30

Mediology

Bone SA

128

Meditech

Buhle Waste

146

Mylan

82

IBC

Compass Medical Waste Services

28

PEPFAR

Cupid Limited

91

Pharma Dynamics

IFC & 11

Day1 Health Dettol

33

148

DrTemp

24, 80 & 102

Draeger SA Focus Products

100

Halyard Health SA

126

Health System Technologies

20

HISP

54 48

InterSystems

DOH 2 0 1 8

139

Imperial Health Jembi Health Systems

50

HPCSA

148

6

National Medical Supplies

130

56

65

Clicks

4

124 2 22

88

Philips Health SA Project Portfolio Office SANAC

52

107

Satiba (South African Tissue Bank Association) Selfmed Medical Scheme

73 114 & OBC

South Africa Partners

112

South African Medical Research Council

115

Tecmed Africa

36

The Biovac Institute

74

Tower City Trading 319 cc

62

Vodacom Business

39


There are 7 billion reasons why we do what we do. At Mylan, we are committed to setting new standards in health care. Working together around the world to provide 7 billion people access to high quality medicine we: • Innovate to satisfy unmet needs • Make reliability and service excellence a habit • Do what’s right, not what’s easy • Impact the future through passionate global leadership

www.mylansa.co.za

Mylan (Pty) Ltd. Reg. No. 1949/035112/07. Building 6, Greenstone Hill Office Park, Emerald Boulevard, Modderfontein, 1645. Tel: (011) 451 1300. Fax: (011) 451 1400. www.mylansa.co.za M1525 Oct-17.


Self-confidence. Self-assured. Self-worth. Selfmed Medical Scheme is a South African medical aid that offers reliable medical aid cover to South Africans of all ages and health levels. Selfmed provides access to the highest quality healthcare, and this, combined with excellent personalised service, has made us one of the most experienced medical aids in South Africa. Affordable, reliable, medical aid, since 1965.

SMS “Health� to 45738 today!

www.selfmed.co.za

/ selfmed medical scheme

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