The fulcrum of this program must be primary healthcare. Here we need to galvanise support to promote this level of care in a third world environment and within a constrained economy. The Deputy Director-General of Health, Dr Anban Pillay led this discussion.
He reminded us of the South African Constitution and the Bill of Rights which enshrines the right to healthcare. Section 27 of the Constitution provides that: Everyone has the right to have access to healthcare services including reproductive health. The state must take reasonable legislative and other measures within its available resources to achieve the progressive realisation of each of these rights. No one may be refused emergency medical treatment. The state has a clear obligation to ensure access to health for all.
He also proposed that the current context was inequitable. Prior to 1994 the South African health system was fragmented and designed along racially discriminated policies and fragmented between levels of care. There was systematic unequal financing and delivery of health services.
One system was highly resourced and designed to serve the white minority, while the other, for the black majority was under-resourced. This constitution abolished this fragmented healthcare systemwith a vision to establish a simple seamless healthcare system. Inadvertently a two-tiered healthcare system developed- the public and private.
The WHO recommends that countries should spend 5% of GDP on health. SA spends 8.5% of GDP on health. The private sectors spend 4.4% of GDP on health to service 16% of the population, while the public sector spends 4.1% of GDP on health and services for 84% of the population. However, we need to factor in that a number of Public Sector patients pay out of pocket to access the Private Sector.
In South Africa, another challenge is that the focus is on curative care with preventive and promotive care lagging far behind.
In South Africa, the greatest spend is on hospitals and specialist care and with the absence of price regulations. The GP expenditure has declined. Private hospitals have shown an exponential growth in expenditure over the last few years. NHI is what SA needs. It is essentially a Health financing system. It seeks to provide access to quality health services for all South Africans based on their health needs and irrespective of their socio-economic status.
This represents a substantial policy shift that necessitates a massive reorganisation of both public and private sector. This is in line with the theme of this conference, “the need for health care re-engineering”.
The rest of the IPAF conference was about the initiatives by the private sector to manage costs and promote quality. There was a strong emphasis on the needs to manage wastage in healthcare i.e. fraud, waste and abuse. This is often stated to be about 30% of the healthcare spent. If harnessed back into healthcare it will give more people access to quality basic health care without struggling to finance this initiative.
This was a call for a relationship change in which funders and government begin working with the healthcare professionals. It is with this focus and ethos we can be part of the solution. There was also a message that the future healthcare can be developed by reflecting on the mistakes of the past.
The rest of the weekend was a focus on the use of data, its appropriate use to collate information, data analytics, and predictive analytics to measure and shape the future of healthcare. There was also a message from many speakers and at the Discovery workshop on information technology; its use and how it will shape the future of healthcare.
Also, an important sub-theme was to “demystify healthcare costs”. There was a lot of information why general CPI differed from medical CPI. This was due to the contribution of tariff measures, demand side costs, supply side costs and even supplier induced demand. Where the average CPI was 6.1%, the medical inflation was at 11.4%. The message was loud and clear that to survive the escalating costs in times of economic stresses there was a need for innovation and serious cost management. If this is not possible the solvency at the private medical sector is at stake.
Another focus amongst all presenters was the need to recognise patient/person centricity. Our patients are a valuable resource, it is free and underused. The focus on empowering, engaging with and informing patients will mobilise patients into shared decision making which has proven to lead to better compliance, adherence and cost management.
There was a call for healthcare leaders to adopt a more integrated and patient and family centred approach. The video message from Dr Peter Lachman, CEO of ISQua facilitated interest and stimulated discussion on the forgotten patient in the healthcare value chain.
There was a lot of interest in the method discussed to measure risk in Cardio-Vascular Disease and to help increase the role of the primary care practitioner to manage low risk and co-manage medium risk Patients.
The rest of the weekend was spent on clinical upskilling viz diabetes management, hypertension, HIV/AIDS and TB, Pneumonia and COPD and Asthma, Metabolic syndrome and management of burns in the
The ethics evening focused on:
POPI Act and information privacy
Rights of Medical Professionals
The forgotten Ethics with a focus on ethics, professionalism, collegiality, communication and professional rivalry.
Dr Amit Thakker from Kenya discussed the business aspects of the healthcare and how in East Africa through this initiative they improved the healthcare delivery.
At the Gala Dinner, the attendees were graced by the presence of the Deputy Minister of Health of SA, Dr J Phaahla, who delivered the keynote address on the state of health in SA, the concept and benefit of NHI and where the country was with the progress of the NHI program.
This was a well-attended Conference with capacity crowds at each session.