SA's healthcare requires a whole system overhaul, experts at the recent Hospital Association of SA (HASA) conference agreed, offering a range of practical solutions, including public-private partnerships, to tackle some of the most pressing issues, writes Ufrieda Ho for Spotlight.
Tackling the question of pragmatic steps to address existing divides and failings, they put forward a range of solutions, models and case studies while highlighting the looming crises as more people fall through the cracks.
Around 15% of South Africans belong to private medical aid schemes, leaving 85% of the population largely reliant on the strained public healthcare system (though some do pay out-of-pocket to visit private sector doctors).
A recent suggestion from HASA was that medical scheme membership be compulsory for everyone in formal employment, which is estimated could triple the number of people with medical scheme coverage and result in a 25% reduction in premiums.
Delegates also heard that an integrated and co-ordinated whole systems approach is necessary. Speakers stressed that implementable interventions and innovations must kick in with urgency.
Some argued that more political will is required, along with greater corporate commitment if effective public-private partnerships are to be established. Such partnerships were a key theme of the conference.
Kidney care example
Dr Chevon Clark, chief executive of National Renal Care, a private renal therapy provider, outlined the stark reality of an enlarging public health crisis as more people face kidney dysfunction.
“Globally, 850m people have chronic kidney disease, acute kidney injury or are on renal replacement therapy. This signals a significant public health issue – twice the number of individuals estimated to have diabetes, and 20 times higher than the number of people affected by HIV/Aids.
“There has also been a 29.3% increase in reported chronic kidney disease over the past three decades. Not only is this increase deeply concerning, but so is the ability of our healthcare system to manage and treat these patients,” said Clark.
Last week marked Kidney Awareness week in South Africa, and Clark said this country fell behind other middle income countries in having enough nephrologists and nephrology nurses for their populations. There were 147 facilities for treatment and care in the public and private sectors – a shortfall, she said.
Smarter public-private partnership initiatives are needed, and these should be focused on stronger stakeholder engagement, innovative funding mechanisms, advocacy and refining weak policy frameworks, she added.
She presented a case study of National Renal Care partnering with the Western Cape Department of Health & Wellness to establish a dialysis clinic at the Vredenburg Provincial Hospital. The hospital services a rural community. Before the unit was opened, patients had to travel long distances for care – all the way to Cape Town.
A benefit of the partnership, she said, was that they have been able to introduce newer technologies, with a system that enables online and remote monitoring of patients. Records can be updated continuously and are maintained digitally.
Patients have also been enrolled on a mobile app, making them “active partners in their healthcare and to drive compliance for better outcomes”.
Tele-health to track diabetes patients
Dr Atiya Mosam, a public health consultant and founder of Mayibuye Health, highlighted the importance of getting the basics right. She presented a case study of a public-private partnership in which a ‘tele-health doctor’ called diabetes patients from the Hanover Park Clinic daily for two weeks to monitor their glucose levels, adjust their medication when needed, and offer health advice.
Mosam said 74% of the patients contacted had to have their medication adjusted, indicating the need for this kind of immediate monitoring and treatment management. The intervention saw improvements in patients’ conditions and improvements in those staying in targeted ranges for their glucose readings, she added.
“One man said he had a new lease on life… Very interesting too was that many patients said that by having this contact with the ‘tele-health doctor’, they felt that the government cared for them.”
Cancer care
One area where efforts at a public-private partnership appears to have failed is cancer care in Gauteng.
As widely reported, the Gauteng Department of Health set aside R784m early in 2023 for radiation oncology services, which would have included the outsourcing of some services to the private sector. That outsourcing hasn’t yet happened and the Cancer Alliance has since taken the department to court over the ongoing cancer treatment backlogs.
Health activist Mark Heywood, speaking at the conference on behalf of the Cancer Alliance, said a hearing has been scheduled for 21 November.
Heywood drew parallels between HIV and cancer to illustrate how the fight for cancer treatment looks likely to evolve, but also where wins could be achieved.
“Cancer treatment and medicines, like HIV medicines two decades ago, are inordinately expensive, meaning that while cancer can be cured, for most people it is unaffordable and inaccessible. For the vast majority of people in our country, a cancer diagnosis is often a diagnosis that indicates a vastly shortened lifespan and the beginning of a journey to severe illness, very often indignity and death – and that is not how it should be.”
Heywood said the government had an obligation to follow the constitutional framework to ensure access to cancer treatment as a basic health right. He also said private healthcare providers had to do better.
“There have been complaints of discrimination by medical schemes of only partial coverage of the costs and needs of care. This leaves patients unable to complete treatment. There are allegations of overcharging by hospitals and specialists.
“There’s also a lack of collaboration between the private and the public sector, a lack of monitoring and a lack of a determination of healthcare outcomes when it comes to cancer.”
However, Heywood said, the long – but ultimately successful – fight for access to treatment for HIV positive people in the country held important lessons that could be applied to cancer.
“What we learned with HIV was that with political will and with resource mobilisation, it is possible to dramatically alter the landscape of care and to tip the balance towards greater equality and social justice in healthcare.
“The question remains for the Hospital Association of South Africa and private health providers – what can you do to make cancer care more affordable, more accessible, and to build on public private partnerships to take them to scale to reach a greater number of people in a shorter period of time?”
See more from MedicalBrief archives:
HASA urges mandatory medical aid enrolment to reduce public load
The rights and wrongs of the South African health system
Cancer Alliance explores legal options to compel public/private treatment partnership
Private/public partnership opens Bara paediatric out-patient facility