Why the NHI may take softer approach

Cabinet subcommittee to vote on revised health insurance plan, which Health Minister Aaron Motsoaledi says will initially let private plans continue.  Health Minister Aaron Motsoaledi says he will present a revised version of the National Health Insurance (NHI) white paper to a cabinet subcommittee on Tuesday. If the subcommittee approves the blueprint, it will then be considered by the Cabinet. If the Cabinet approves the plans, the legislative process to enact the policy will begin. A key aspect that will be scrutinised is the future role of SA’s medical schemes and administrators. The paper proposes mandatory membership of NHI and a reduced role for medical schemes to providing only “complementary services”….more

Public health is in critical condition, and the NHI cannot save it

Aaron Motsoaledi deflects attack by Cosatu on national health scheme

Health Minister Aaron Motsoaledi moved on Tuesday to defend his position on National Health Insurance (NHI) after Cosatu accused him of betraying voters by offering medical schemes a lifeline. The NHI white paper released in 2015 says a single NHI fund should be established to pay for services and relegates medical schemes to providing “complementary” services. Health director-general Precious Matsoso and Motsoaledi have recently signalled a potentially softer approach, in which medical schemes would continue to exist…..more

No matter what, Motsoaledi determined to win NHI ‘war’

No matter what the opposition from the private health sector, SA‘s National Health Insurance plan will be implemented, said Dr Aaron Motsoaledi, Minister of Health, and Naledi Pandor, Minister of Science and Technology. Both ministers formed part of the ANC national executive committee subcommittee on health, education, and science and technology, reports IOL. Earlier, in Pretoria, Motsoaledi said that the government had a constitutional responsibility to provide affordable healthcare to all citizens, irrespective of their economic status.

He said the World Health Organisation recommended that countries spend 5% of its gross domestic product on healthcare, but that South Africa spends more than the recommended amount, and in a disproportionate manner. “South Africa currently spends 8.5% of GDP on health.” “The private sector spends 4.4% of GDP on health but only provides care to 16% of the population.” “The public sector spends 4.1% of GDP on health but has to provide care to 84% of the population,” he said. “So this current financing system is unjust and needs to be reorganised so we can pool public and private sector funds to provide quality and affordable healthcare to all South Africans,” he argued…..more

Debt and patronage lay waste Gauteng’s health budget

Gauteng Health’s R40bn health budget is insufficient and the department cannot carry out the tasks it is required to do because of its sizeable debt and questionable contracts.

Health MEC Gwen Ramokgopa says that the budget of the province’s health department grew from R37.6bn in 2016 to R40.2bn in 2017. It is the department with the second-largest allocation in the province’s total budget, reports  Business Day.

The budget of the province’s health department grew from R37.6bn in 2016 to R40.2bn in 2017. It is the department with the second-largest allocation in the province’s total budget.

At the province’s Health Consultative Forum, Ramokgopa is quoted as saying the challenges that plagued the public health system included high equipment prices, poor-quality services and inadequate human resources. Of the total budget, R23.8bn was earmarked for compensation of employees and R16.3bn for goods and services, while an estimated R6bn was allocated to accruals, she said. ….more

Motsoaledi denies ‘sell out’ of NHI over medical schemes

SA‘s Department of Health has done an apparent U-turn on its plan to scrap medical aid schemes, saying they should work with the state when it rolls out National Health Insurance instead, reports Business Day. However, Health Minister Dr Aaaron Motsoaledi denies any ‘sell out’.

The NHI policy documents wanted all 80 or so medical aid schemes merged into one state-run fund. About eight million South Africans – or 17% of the population – have medical aid cover and use private hospitals and doctors.

Department director-general Precious Matsoso met leaders of the medical aid plan sector and asked that they work together to reform healthcare in South Africa.

“This is big news,” said Graham Anderson, principal officer of Profmed.

In a further Business Day report, Motsoaledi has moved to defend his position on NHI after Cosatu accused him of betraying voters by offering medical schemes a lifeline.

Cosatu accused the Department of Health of prioritising the needs of what it called ‘private health profiteers’ over those of poor people. “The Department of Health is betraying NHI by handing over the NHI to private hands, and is also betraying the voters who were promised a single-payer NHI in the 2014 (ANC) election manifesto,” it said. ….more

Pharmacists to have key role in NHI – PSSA

Pharmacists are gearing up to play a key role under National Heath Insurance (NHI) when South Africa enters the second phase of implementing the universal health coverage policy, reports Business Day. Pharmacists are important in the healthcare system because of the role they play in under-resourced areas, where they provide affordable diagnosis, education and screening.

The Pharmaceutical Society of SA’s (PSSA’s) Lorraine Osman said that following a meeting with Department of Health director-general Malebona Matsoso to discuss the next steps for pharmacists in terms of the NHI, introduced by Health Minister Aaron Motsoaledi in 2015, a task team has been formed to develop practical proposals for pharmacists’ involvement in the system.

The PSSA, which has more than 8,000 members, is the biggest representative body for pharmacists, pharmacists’ assistants and pharmacy students in the country and has been asked to work with Dr Anban Pillay, deputy director-general for health regulation and compliance management, to map the way forward. The organisation is to host a combined conference in July to identify ways in which pharmacists can prepare themselves to participate in NHI, the report says…..more

10 breakthroughs to shape Europe for the next 60 years….relevance for Africa?

mosaic-1-983pxThis year marks the 60th anniversary of the Treaty of Rome, which established the European Economic Community, the predecessor of the EU. During that time, the EU has provided more than EUR 200 billion to advance our understanding of the world around us and develop innovations to tackle the challenges faced by our society. At the halfway point of the EU’s biggest research and innovation funding programme, Horizon 2020, we explore a selection of EU-funded projects whose breakthroughs could help to shape Europe during the next 60 years…..more

‘Microscopic Lego’ to keep scientists busy ‘for next 50 years’

2d20materialsAtom-scale building blocks that have been compared to microscopic Lego are allowing researchers to play with the properties of common materials, and the possibilities are so great that it could keep scientists busy for the next 50 years.  From the Stone Age to Silicon Valley, materials have defined the technological capabilities of civilisations.

Professor Andre Geim at the University of Manchester in the UK is well acquainted with the toolbox available today. In 2010, he was awarded the Nobel Prize in Physics for extending it with an exotic form of carbon known as graphene.

Unlike materials sourced from nature, graphene is a creation of science. It is peeled off graphite in honeycomb motifs as thin as a single atom. The quantum laws prevailing at these tiny scales cause electrons to move through graphene in unusual ways. ‘Graphene can be stronger than steel, more conductive than copper and as transparent as glass,’ said Prof. Geim. ‘It is unlike any substance found in nature.’……more

What Type of Leader Do I Wish to Be?

We have all heard the expression of praise that a person “is a born leader.” Despite the admiration captured in these words, they imply that excellent leadership is innate only to a few, and that the rest of us not born with such talents must accept, with grace, a second-class standard.

Throughout my career as a practicing physician (SBK), I have observed various styles of compelling leadership. Those with whom I work teach me, model for me, the complex array of what it means to be a fine leader. I respect and value what I have witnessed. I try to assimilate their admirable qualities, combine their best attributes, and then apply them to my own skills and personality. And I have come to see that great leaders are not born. They model and learn and grow…..more

Five Changes Great Leaders Make to Develop an Improvement Culture

Care Redesign Survey: What Data Can Really Do for Health Care

Over the past few years, physicians and provider leaders have been frustrated with the limitations of health care data. Much like the anticipation over EMRs in the early days, providers expected big data to solve all of health care’s problems. When it didn’t, disillusion set in.

In our newest NEJM Catalyst Insights Report on Care Redesign, we took a read on the effectiveness of health care data, both today and in five years. We found that the landscape is shifting from one of despair over the unfulfilled promises of big data to a more realistic vision of what sophisticated analytics can do to transform health care delivery…..more


No one yet realises what the quantum internet will enable us to do – Prof. Ronald Hanson

ronald20hanson_cropThe quantum internet, which connects particles linked together by the principle of quantum entanglement, is like the early days of the classical internet – no one can yet imagine what uses it could have, according to Professor Ronald Hanson, from Delft University of Technology, the Netherlands, whose team was the first to prove that the phenomenon behind it was real.

You are famous for proving that quantum entanglement is real, when in 2015 you linked two particles that were 1.3 kilometres apart. But the main objective of your work has always been to connect entangled particles into a quantum internet. What could such a network enable us to do?

‘One of the things that we could do is to be able to generate a key to encode messages with. (Using the quantum internet) the security of that key would now be based on this property of entanglement, and this is basically the properties of the laws of physics. ‘You will get a means of communication whose security is guaranteed by physical laws instead of (by) assumptions that no one is able to hack your code…..more

Rooibos research gets funding boost

The SA Rooibos Council (SARC) will invest a further R3m this year to commission additional research into rooibos’ health-enhancing properties.

Already known for its myriad of health benefits, most of the research done on rooibos has been limited to laboratory work and animal studies. The next tranche of investment will enable researchers to build an even more solid foundation for human trials, and in some instances, to move forward with clinical studies.

Ernest du Toit, spokesperson of the SA Rooibos Council says since research on the Aspalathus Linearis plant was first conducted, science has proven its therapeutic ability to help prevent cancer, protect the liver and heart against disease, boost the immune system, reduce hypertension, relieve allergies and thwart the effects of aging….more

Funding stymies placement of medical interns

Limited funding for medical intern posts has left nearly 100 medical graduates without jobs and the situation could worsen when about 1,000 graduates return from studying in Cuba.

The public health system suffers from a shortage of medical staff and a study by research group Econex shows that SA has fewer doctors per 100,000 people compared with other middle-income countries.

South African Medical Association vice-chairman Dr Mark Sonderup said there were graduates who had applied to be placed in 2016 who had still not been placed by April. He said while the posts were available, there were no funds made available to fund the posts….more

Clinical management of children with fever

CITATION: Clinical management of children with fever: a cross-sectional study of quality of care in rural Zambia
Karsten Lunze, Godfrey Biemba, J Joseph Lawrence, William B MacLeod, Kojo Yeboah-Antwi, Kebby Musokotwane, Toyin Ajayi, Simon Mutembo, Chilunga Puta, Duncan Earle, Rick Steketee & Davidson H Hamer.
Bulletin of the World Health Organization 2017;95:333-342. doi: http://dx.doi.org/10.2471/BLT.16.170092

Correspondence to Karsten Lunze (email: karsten.lunze@post.harvard.edu).


Objective: To evaluate current practices and standards of evaluation and treatment of childhood febrile illness in Southern Province, Zambia.

Methods: From November to December 2013, we conducted a cross-sectional survey of facilities and health workers and we observed the health workers’ interactions with febrile children and their caregivers…

Findings: This study included 24 health facilities, 53 health workers and 161 children presenting with fever. Facilities were insufficiently staffed, stocked and equipped to adequately manage childhood fever. Children most commonly presented with upper respiratory tract infections (46%; 69), diarrhoea (31%; 27) and malaria (10%; 16). Health workers insufficiently evaluated children for danger signs, and less than half (47%; 9/19) of children with pneumonia received appropriate antibiotic treatment. Only 57% (92/161) were tested for malaria using either rapid diagnostic tests or microscopy.

Conclusion: Various health system challenges resulted in a substantial proportion of children receiving insufficient management and treatment of febrile illness. Interventions are needed including strengthening the availability of commodities and improving diagnosis and treatment of febrile illness.

Comment (Neil PW): As always, poor quality care is due to failure to address the basic SEISMIC needs of frontline health workers:
• Skills
• Equipment
• Information
• Structural support
• Medicines
• Incentives
• Communication facilities.
A SEISMIC shift is needed to address the needs of front-line healthcare providers in low-income countries. For too long their needs have been ignored.

Join HIFA: www.hifa.org/joinhifa
Join CHIFA: http://www.hifa.org/join/join-chifa-child-health-and-rights
Join HIFA-Zambia: http://www.hifa.org/join/join-hifa-zambia

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare information – Join HIFA: www.hifa.org

Health justice partnerships: initial insights into the delivery of an integrated health and legal service for youth in regional Victoria

Health Justice Partnerships (HJPs) provide an innovative service model offering an integrated health and legal service for a community. HJPs are particularly well suited to meet the needs of young people and those in regional locations experiencing complex legal issues. This paper presents interim findings from research examining the impact on young people, and the implications on practice for staff in the partner organisations, of an HJP in a large regional area in Victoria, Australia…..more