Update
‘Weak leadership’ hinders RSA
Researchers have identified a set of key issues facing healthcare in South Africa, drawing particular attention to previous government and the standard of leadership in the country
The research, which has been printed in a series of dedicated articles in The Lancet, focuses on the HIV/AIDS epidemic, child mortality, domestic violence and the challenges faced in the wake of apartheid’s end.
It describes how “pivotal facets” of primary healthcare are not in place because of failings in leadership, meaning that otherwise good policies – that have worked successfully towards creating an integrated national service – have not been implemented properly. There is also a “crisis” within human resources that has been aggravated by the HIV epidemic.
According to the research, between a quarter and a half of maternal, neonatal and child deaths were contributed to by an avoidable factor within the health system itself. This is based on results of national audits.
Mortality rates for children have actually increased since the baseline of the Millennium Development Goals from 1990 – meaning that South Africa is one of only 12 countries to have seen this happen.
In particular, one of the greatest challenges faced in post-apartheid South Africa was control of the epidemics of HIV and tuberculosis. Increasing pressure on acute and chronic healthcare services, as a result of non-communicable diseases emerging in rural and urban areas, is another problem. It is a pressure that is predicted to increase as people live longer, with HIV mortality being successfully tackled through rolled-out antiretroviral drugs.
Weaknesses are also identified within the primary healthcare system, based in districts nationwide. A national surveillance unit is mooted, with additional national resources recommended for the establishment of “sites of service excellence”, for the trial, assessment and implementation of integrated care interventions.
Finally, the researchers referred to a “conspicuous absence” of government leadership while describing how violence and injuries have become the second leading cause of death in the country. They allude to poverty, unemployment, misguided notions of masculinity, child abuse, and firearms and alcohol misuse as root causes, but at least mention improvements in services for victims as a sign of progress.
National health insurance scheme planned
The secretary general of the African National Congress (ANC), Mr Gwede Mantashe, has announced plans to have a national health insurance scheme (NHIS) in place in South Africa within 12 months.
The plans have been met with scepticism by the healthcare industry as a whole, which argues that it will take much longer than a year to develop a working insurance system. It also says that rushing through the process could cause problems for the economy, as it will mean changing the existing tax system and upgrading all state health facilities.
A meeting of the 10th Annual Conference of the Board of Healthcare Funders, held in early September, drew a general consensus that the current two-tier healthcare system was not sustainable.
Deputy Minister for Health, Dr Molefi Sefularo, has also said that a Green or White Paper could be ready for public comment and consultation by the end of 2009. www.doh.gov.za
HPCSA strikes off 13,000 non-registrants
Failure to pay registration fees has led the HPCSA to strike off almost 13,000 doctors, dentists, occupational therapists, psychologists, optometrists, emergency care practitioners and other healthcare professionals.
They were struck from the HPCSA register in August after failing to pay their fees by 1 April. The action also came with a firm reminder that practising without the appropriate HPCSA registration is a criminal offence, as laid out in the terms of the Health Professions Act, 1974.
It was also emphasised that erasures can take place within three months of the deadline passing.
In advice issued to healthcare workers, the HPCSA said: “Once erased from the register for non-payment of annual fees, practitioners who pay within six months will face a penalty fee of twice the annual fee as well as the outstanding fees.
“Those who apply for restoration after six months, but within 12 months of the erasure date, will pay four times the usual annual fee plus the outstanding amount, and for periods exceeding 12 months of the erasure date, an amount equivalent to five times the applicable.” www.hpcsa.co.za
Boost for rural healthcare
A new project has been launched which is intended to improve the standard of healthcare in the country’s rural areas.
The Centre for Rural Health is a project of the Witwatersrand Faculty of Health Sciences, and will operate through centres situated within health districts. It will mainly focus on rural areas in Limpopo, Mpumalanga and North West provinces.
The remit of the Centre is human resources – and it will aim to assist in recruiting and retaining staff for health services in rural areas.
Deputy Minister for Health, Dr Molefi Sefularo, said: “We appreciate the launch of the Centre, particularly because it supports the recruitment and retention of personnel for rural health services. There are huge inequities in the human resource availability between the private and public sectors, as well as between urban and rural areas in South Africa.”
The director of the Centre, Professor Ian Couper, added that a long-term, co-ordinated approach was needed to achieve their aim of producing a rural workforce for South Africa. He also said: “I believe the university cannot ignore the needs of the country, but instead has a mandated duty as a public institution to train health professionals for its needs.
“The needs of the healthcare system are our responsibility to address and not that of the government alone. We have demonstrated as a university that we are up to the challenge of producing a home-grown rural health workforce.” www.doh.gov.za
Production of doctors ‘must increase’
Sibongiseni Dhlomo, Member of the Executive Council (MEC) for health in KwaZulu-Natal, has set a target of 8,000 for the number of doctors the country must produce annually.
Dr Dhlomo, speaking at Durban’s Inkosi Albert Luthuli Central Hospital, said that universities were not producing enough doctors – setting the 8,000 target to tackle the shortage in public hospitals.
“Producing 200 doctors per university per year is not good enough,” said Dr Dhlomo. “We will be speaking to deans and pushing universities to produce at least 2,000 doctors annually, starting in the next year or two.”
New dispensing fees for doctors
Revised documentation on the dispensing fee for doctors and other non-pharmacists has been published. The new fees take into account the VAT that is added on to the single exit price (SEP) of medication.
Doctors are now allowed to charge 30% more than the SEP for items below R65 – the dispensing fee is capped at R20 thereafter. The National Convention on Dispensing (NCD) has branded the cap as “woefully inadequate”, arguing that it does not allow doctors to provide appropriate care for patients who require more expensive medicines.
The Department of Health has been locked in a battle with doctors regarding this matter for over five years, culminating in threats of litigation, which have since been withdrawn following publication of the new dispensing fees. www.samedical.org
HPCSA reminds locums about prescribing
The HPCSA has reminded doctors, particularly locums, of the importance of including all contact details on prescriptions.
The guidance has been reissued following complaints from the community pharmacists sector of the Pharmaceutical Society of South Africa (PSSA), stating that some prescriptions do not specify the name, address, and telephone and practice numbers of the issuing doctor. It is urging all doctors to ensure they have a name stamp with their full name, qualifications, BHF practice number and telephone number.
Missing contact details can mean it takes longer for patients to receive their medication, as it is harder to contact the prescribing doctor for verification. www.hpcsa.co.za