Summary of health news: May/June 2011

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Minister discusses new health plan with delegates from private sector

SAPPF press release, May 2011

A new concept to prevent the high mortality rate among mothers and their new-borns, was the point of discussion between a delegation of the National Department of Health (including dr. Aaron Motsoaledi, the DoH’s director-general, ms. Precious Matsoso) and delegates from the private sector representing gynaecologists, obstetricians, paediatricians and doctors from the family medicine sector. This was held on 7 May at OR Tambo Airport. Among the delegates were dr. Chris Archer, CEO of SAPPF, and dr. Humphrey Lewis, president of SAPA.

The new concept will be based on the Brazilian model of health wards, said Motsoaledi.

A core team of five specialists will be appointed in each of South Africa’s 52 districts. The Team of Five will consist of a Principle Specialist (PS) gynaecology, a PS paediatrics and a PS family medicine, a PS midwife and a PS healthcare nurse. Each team will have access to between six to ten hospitals in its area. One of the key priorities of the ward system is the central coordination of the functions of aids workers, and home based care workers spread all over the country.

Motsoaledi reiterated that this strategy can’t be implemented without the help from the highly skilled people from the private health system. He also announced that R600 million has been allocated to fill the almost thousand vacant posts in the public sector, in the hope of attracting more specialists, doctors and nurses from the private sector.

During the meeting ways of involving the private health sector in the new strategy were discussed, as this sector could play an important role in overhauling the existing structure of the public system as well as providing skills. More meetings of this kind are to be held in future.
Child, maternal mortality reach crisis levels

BusinessLive, 25 May 2011

South Africa's maternal mortality rate is high and increasing, and stood at 625 per 100 000 live births in 2007. Health Minister Aaron Motsoaledi told a parliamentary committee the Millennium Development Goals (MDGs), with regard to curbing child and maternal mortality, and improving maternal health SA was in deep trouble. The eight goals were adopted in 2000 by members of the United Nations, and intend to tackle pressing issues including poverty, disease, hunger, and gender inequality by 2015. By signing the MDGs, South Africa pledged to reduce this rate to 38 per 100 000 live births, but under-five mortality in South Africa had risen to 104 in 2007. The target set by the MDGs is 20. The good news is that the new universal HIV approach stated that all pregnant women living with HIV were treated with anti-retrovirals and prevention of mother-to-child transmission now started at 14 weeks instead of 28 weeks.

National health scheme document due 'soon'

Business Report, 4 May 2011

The government will release the National Health Insurance (NHI) document for public comment "soon". The DoH is waiting for the cabinet to give it the go ahead to publish the document. The release of the document was expected last month. Through the NHI, the government wants to ensure that everyone has a form of medical cover. It is estimated the plan will cost R128bn. in the first year (2012). The only document in the public domain on the NHI is the one released by the ANC last year.


AIDS: A tale of tragedy and hope

AFP, 29 May 2011

Nearly 30-million people have been killed by acquired immune deficiency syndrome (AIDS) and more than 33-million others have the virus that causes it.

As early as 1983, French doctors pinpointed the cause: a pathogen which became known as the human immunodeficiency virus (HIV). Transmitted in semen, vaginal secretions, breast milk or blood, HIV hijacks key immune cells to reproduce itself, destroying the cell in the process. In 1996 the first effective anti-HIV drugs were available at last. The "cocktail" represses HIV to below detectable levels, although it is not a cure and can have hefty side-effects.

The charge to help stricken poor nations was led by the Global Fund to Fight AIDS, Tuberculosis and Malaria, US President George Bush and Bill Gates. Today, more than five million people in low- and middle-income have grasped the lifeline, but 10-million more await treatment, according to UNAIDS. By 2015 - when the UN has set a target of "zero new infections, zero discrimination and zero deaths" - it will be 13-million. "Unless there is a game-changer like a vaccine, there probably will still be one million new infections a year in 2031", according to Peter Piot, former director of UNAIDS.

A wake-up jab

The Financial Mail, 27 May 2011

The outbreak of measles two years ago underlined the role that vaccinations could play in preventative medicine. Keeping people healthy cuts health costs and reduces loss of production in the economy in the longer-term. Since the measles outbreak, the DoH has increased the budget for immunisation and vaccination programmes from R120m to R850m. This allows for the inclusion of the pneumococcal and rotavirus vaccines as part of the expanded programme on immunization (EPI) to prevent deaths from pneumonia and diarrhoea. Pneumonia is fast emerging as a killer disease, particularly where a patient may already have HIV/AIDS.

HIV-testing targets not being reached

The Times, 16 May 2011

The government's campaign to give 1,5million people HIV counselling and testing has almost reached its end, but most provinces are behind schedule. On April 25 last year, President Jacob Zuma and Health Minister Aaron Motsoaledi launched the campaign and urged people to "know your status". North West is the only province on target - 89% tested. Except for Western Cape, which provided figures to the end of March, the provincial backlogs at the end of April were: KwaZulu-Natal has tested about 2,3million of the targeted 3 million; Eastern Cape has tested just over 1million of a targeted 2 million; Western Cape has tested 770 000 of the targeted 1,6million; Free State has tested 702 630 of the targeted 963 087; Mpumalanga 735 750 of the just over 1 million; Northern Cape 196 870 of 337 941; and, North West 892 497 of the targeted 998 859 in only 12 months. Health departments of Gauteng and Limpopo were unable to provide up-to-date data. According to last year's World Bank report, an estimated 5,7million South Africans were living with HIV - more than any in other country.

Courage to find a cure

Editorial Comment The Star, 16 May

The news that taking ARVs early reduces the risk of transmission to HIV-negative partner by 96% percent can partly be ascribed to the commitment of those who agreed to test that theory. A trial designed to study whether ARV treatment is effective in preventing sexual transmission of HIV in couples where one is HIV-positive and the other negative, was conducted on 46 couples at Helen Joseph Hospital and 51 at Chris Hani Baragwanath. The 97 South African couples were among the 1 763 from Africa, Asia and North and South America who participated. The clinical evidence, as opposed to only epidemiological and observational studies, showed that, of that total, only 28 HIV transmissions were recorded. Another 11 were not linked. This trial also confirmed that giving ARVs earlier can only be a good thing.

School HIV tests on hold

The Times, 12 May 2011

The introduction of the government's HIV tests on schoolchildren has been delayed by legal and confidentiality concerns, but officials insist a pilot project will kick off “any time this year". The pilot project to test pupils, voluntarily, was due to start at several schools in February. But it was shelved because crucial ethical and legal questions had not been answered. A team was set up to test the feasibility of the project, but it has still not completed its research and consultations. Most teachers' unions and parents' organisations supported the proposal in principle. Parents must consent to tests and counselling must be provided by the schools.

Johannesburg clinics running low on AIDS drugs

SAPA, 11 May 2011

The Gauteng DoH says it is dispatching an antiretroviral drug to clinics around Johannesburg that has run low on stock. According to spokesman Simon Zwane, the clinics had not kept sufficient records. Many clinics were running out of Efavirenz (Stocrin) - a vital part of a drug cocktail used to treat AIDS patients. Instead of giving a 30-day supply, patients were only giving a 10-day supply, and had to come back. It has been suggested that one of the suppliers, Aspen Pharmacare, was restricting supplies as it was owed money by the Gauteng DoH. Zwane said the shortage was due to poor communication with the suppliers.

Cost of malaria fight 'offset by benefits'

Business Day, 6 May 2011

Private sector investments in malaria control are good for the bottom line and benefit society, improving productivity and saving lives, according to a report released by Roll Back Malaria. The report has been endorsed by the World Economic Forum (WEF). Malaria is preventable and curable, yet kills almost 800 000 people each year, 90% of them in Africa, costing the continent $12bn a year in direct costs alone. The report analysed the economic effect of malaria control and prevention programmes implemented by several companies, including JSE-listed AngloGold Ashanti, and shows that the costs of malaria programmes are offset by the benefits. For example, AngloGold Ashanti's $2,1m malaria programme in Ghana's Obuasi district saw the number of malaria cases at its mine hospital plummeting 76% from 6 800 cases a month to 1 000 between 2005 and last year, while lost man-hours fell from almost 7 000 a month to 163. AngloGold Ashanti was awarded $133m by the Global Fund to expand its malaria control programme to another 40 districts in Ghana.

Compulsory contraception proposal for girls slammed

The Cape Times, 2 May 2011

Child rights groups have slammed a proposal contained in an ANC Youth League discussion paper calling on the government to introduce compulsory contraception for girls as young as 12. The paper calls for the government to introduce a programme that will combine both abstinence from sex and mandatory initiation into contraception for all adolescent girls from the age of 12. But Joan van Niekerk, advocacy and training manager for Childline SA, said compulsory birth control for adolescent girls would place them under greater pressure to engage in unwanted sex. She said mandatory contraception would make adolescent girls far more vulnerable to sexually transmitted diseases and HIV/AIDS. Molo Songololo director Patrick Solomons said the proposal contradicted the Children Act, which gave children the right to choose whether to be put on birth control.


SA short of paediatric surgeons

The Times, 26 May 2011

South Africa has a "grave shortage" of paediatric surgeons, according to the SA Association of Paediatric Surgeons. The association said there were only 27 registered paediatric surgeons in the country, but added that some of them had already retired and that 2 worked only in private practice. The available surgeons are forced to delay scheduled operations when emergency procedures are prioritised The UK has a relative "oversupply" of paediatric surgeons and Europe has 1 for every 300 000 children. In the US, there is 1 for every 400 000 children, but in South Africa there is just 1 specialist paediatric surgeon for every 2 million children. These include: about 10 in Western Cape,6 in Gauteng 1 in the Free State; 5 in KwaZulu-Natal; and, 3 in the Eastern Cape.

Medical schools' race bar

The Times, 19 May 2011

Medical school admission policies extend from a strict, race-based system in use by the University of Cape Town (UCT) to a "definite effort to accommodate candidates from a disadvantaged academic background" at Free State University. At UCT black students need to obtain 534 out of 900 points, whereas white and Indian candidates have to achieve 700 out of 900 marks, coloured pupils have to score 578 points and Chinese 660 to make their "admission probable". But at Walter Sisulu University's medical school, in Mthatha, Eastern Cape, officials are battling to find enough white students. The admission policy stipulates that of the first-year intake, 75% of students, has to be black, 15% Indian, 5% coloured or white, and 5% from Lesotho.

Merger of Medunsa, University of the North to be reversed

Business Day, 17 May 2011

Higher Education and Training Minister Blade Nzimande and Health Minister Aaron Motsoaledi announced that the Medical University of SA (Medunsa) would be expanded and form a single-purpose institution, reversing the 2005 merger with the University of the North. The merger, creating the University of Limpopo, was widely criticised as impractical as Medunsa is 30km from Pretoria and almost 300km from Polokwane. The government seems to have finally responded to pressure to unbundle Medunsa, amid concern that the merger had affected the output of doctors. The government departments said in a joint statement they would now focus on establishing what would become SA's ninth medical school at the University of Limpopo's Polokwane Campus.

Challenge in our hospitals is to restore the nurse-patient relationship

The Cape Times, 12 May 2011 (Estelle Jordaan, nursing executive)

In April this year the Minister of Health, Dr Aaron Motsoaledi, pledged his support to restoring the dignity of the nursing profession at the National Nursing Conference. This was reiterated on Nurses’ Day (12 May) with the commemoration of Florence Nightingale’s birthday and her contribution to the profession. South Africa has an ageing nursing population (in 2010 only 23% of registered nurses were under 40) and one of the greatest nursing leadership challenges lies in creating an environment where the older nurses can act as role models to mentor and guide younger nurses. The greatest challenge lies in restoring the nurse-patient relationship to its former status and, encouraging students with the necessary attributes to enter the profession.

Newbabies to get tagged at hospital

The Star, 10 May

Tygerberg Hospital plans to tag babies electronically as one of several security measures to beat baby-snatching. The device is activated if a tagged baby is removed from a specific area. The infrastructure for the plan is expected to be completed next year. In some UK hospitals, babies have a personalised, electronically programmed tag attached to their ankle. In Life Kingsbury Hospital in Claremont, Cape Town, a waterproof barcode is placed on the baby's back.

Telemedicine criticism unfair

SAPA, 7 May 2011

Following the condemnation by the Health Professions Council of SA (HPCSA) of certain telemedicine practitioners, the Hello Doctor organisation (one of those named) said it was disappointed that council had claimed telemedicine was unethical without contacting them. Spokesperson Andy Milne said the HPCSA had not returned any of its telephone calls or replied to its letter requesting a meeting to discuss the Hello Doctor business model and the protocols developed by the doctors working on the Hello Doctor telemedicine infrastructure. He said Hello Doctor fully supported the HPCSA's initiative to regulate telemedicine and would be more than happy to work with them in ensuring that patients and consumers, from all income groups, had the opportunity to receive access to high quality, cost effective and accessible healthcare. Hello Doctor's clinical director, Steven Holt, said they were striving to improve clinical quality and convenience for consumers and patients by developing technologically advanced, yet locally developed medical processes and protocols of the highest standards. The HPCSA called on practitioners not to participate in telemedicine practices and the public not to use them.

Most users of public hospitals satisfied with services

Business Day, 6 May 2011, Business Report, 6 May 2011

Contrary to media coverage of the failings of the public sector, the vast majority of South Africans who use public clinics and hospitals say they are satisfied with the services, according to the 2010 General Household Survey, published by Stats SA. More than 25 000 interviews were conducted across all the provinces. Stats SA found 84,6% of users of public hospitals and clinics were satisfied with the services they received, while 97,3% of users of private facilities were happy with the care they got. Wits health economist Alex van den Heever cautioned against comparing satisfaction ratings between the public and private sectors. The fact that almost a quarter of the people surveyed said they turned first to private-sector GPs when they were ill, suggested a significant proportion of South Africans were not happy the public sector.

Hospital groups keep close eye on public sector wage negotiations

Business Day, 11 May 2011

Life Healthcare MD Michael Flemming is keeping a close eye on the current round of public sector wage negotiations. Unions are demanding above-inflation pay increases. The state's current offer to its 1,3 million employees stands at 5,2%, while the unions want 9%. The issue worries private hospitals like Life Healthcare because the wages they offer nurses generally track those of the public sector. Flemming said Life Healthcare spends 33c in the rand on salaries, 75% of which goes to nurses. (Private hospitals are prohibited by law from employing doctors, so their salaries don't feature.)

Public Service wage negotiations reach a deadlock

Press release, 6 May

The Public Sector unions in the Public Service Co-ordinating Bargaining Council (PSCBC) reached a deadlock with the employer on 6 May 2011 on wage negotiations. This happened after Labour lowered its initial 10% wage increase demand to 9%, representing a 1% compromise. The employer responded by moving from their initial 4,8% percent wage increase offer to a 5,2% offer. The result of a deadlock means that if the employer fails to revise its offer and return to the negotiation table with a significant offer, Labour may proceed to file a dispute on the matter and have it conciliated by an independent conciliator.

Scandal-prone CEO excised from hospitals

The Times, 4 May 2011

The axe has finally fallen on one of Eastern Cape's most controversial hospital bosses, accused of being at the centre of a baby-deaths cover-up. East London Hospital Complex CEO Vuyo Mosana has been removed as head of the complex, which has been hit by a series of scandals. Mosana is the first CEO to get the chop following the implementation of the government's new policy of insisting that all hospital bosses have a medical background. Mosana's reign has been marred by repeated scandals. In 2007, it was revealed that thousands of newborn babies died at the hospitals complex because of under-staffing, lack of infection control and life-saving equipment, and inexperienced and inadequate management. Despite having no medical background, Mosana enjoyed political protection for more than five years. Dr Kobus Coetzee has taken over from Mosana as acting CEO.

Motsoaledi calls for more emphasis on disease prevention

SAPA, 29 April 2011

Health Minister Aaron Motsoaledi has said that South Africa's healthcare model needs to shift from being "hospi-centric" to more preventative if the country is to win the fight against the burden of diseases. He was addressing the First Global Ministerial Conference on healthy lifestyles and non-communicable diseases in Moscow. He said the hospi-centric model of health delivery in South Africa was too expensive and not sustainable. South Africa was now shifting focus to primary healthcare (PHC) and the country had embarked on an extensive programme to re-engineer PHC services, focusing on prevention of diseases and health promotion.


Think smart - be aware of what you are buying

Business Report, 31 May 2011

A hospital plan is an ideal, affordable entry level way to get into the system for people seeking medical cover. However, members need to be very aware of what they are buying. Katy Caldis, principal officer of Fedhealth, said the term "hospital plan" is a bit of a misnomer in that all medical schemes are required by law to provide certain benefits out of hospital under prescribed minimum benefit regulations. “Hospital plan" in this context is generally taken to mean a plan that only provides savings and it may have significantly less generous chronic benefits than a more comprehensive plan. They are generally designed to cover up to the level of prescribed minimum benefits and thus often have more restrictive formularies of drugs available. Caldis said the knock-on effect for the affordability of medical schemes of consumers buying down to the cheapest options is of great concern in that those individuals suffering from chronic conditions push up the price of these options making them unaffordable for the younger healthier members they were designed to attract.
Confusion reigns about benefits

Alf James: Business Report, 31 May 2011

Insurance products, like hospital cash plans, are often confused with hospital plans or benefit options offered by medical schemes, a misconception that often leads to the policyholder unexpectedly being left with large uncovered medical bills. According to Andrew Edwards, executive principal officer of Liberty Medical Scheme, a medical scheme hospital plan will generally pay the hospital account in full and will always provide some level of cover for specialist consultations, procedures performed in hospital and medication dispensed while the member is hospitalised. However, some hospital cash plans may even exclude cover for certain hospital procedures, leaving members to pay for these out of their own pocket, he explained. Edwards said it is important to note that a cash plan should never be considered as an alternative for medical cover through a medical scheme.
Prevention better than cure

BusinessLive, 27 May 2011

Health Minister Aaron Motsoaledi issued an ultimatum last month to South African medical schemes to voluntarily adopt preventative rather than curative health policies, or be forced by government to do so. Jan Howell, consulting actuary from OMAC Actuaries & Consultants, agreed that a shift to preventative healthcare was necessary, but pointed out that this needed to be accompanied by incentive programmes to encourage members to make use of these benefits as well as improved communication with healthcare providers. Howell said that, unless schemes introduced some kind of incentive for members to make use of preventative benefits, adding more preventative benefits would not necessarily result in increased savings for the schemes. The recent OMAC Actuaries & Consultants Healthcare Survey 2010 showed that the 63% of open schemes and 18% of closed schemes that already offer some form of preventative benefits did not attribute much value to the benefits because members generally did not make use of them. Howell said schemes needed to offer members lower premiums or increased benefits for preventative behaviour in order to see a real change. However, he said the current Medical Schemes Act did not allow medical schemes to do this, therefore benefits must be offered outside of the scheme - as in the case of the Discovery Vitality programme.

Beware medical scheme mergers

BusinessLive, 25 May 2011

The increasing trend of mergers in the medical aid industry often has a negative impact on members of the schemes concerned as a result of a significant reduction in the benefits and type of cover available to them, according to Clayton Samsodien, MD of Genesis Healthcare Consultants. Many members who belonged to these affected schemes had had their benefits cut, as well as disease management programmes cancelled. Over the past two years, no less than 13 medical schemes have been liquidated or have merged with larger schemes. Purehealth and Gen-Health were liquidated and their membership taken in by Discovery, the Government Employees Medical Scheme (Gems), Liberty, Bestmed, Medshield, Thebemed, Momentum and Topmed. Meanwhile Medicover, Telemed, Medcor, Afrisam, Umed, Oxygen, Suremed, Clicks, Ingwe and Bepmeds merged with larger schemes.

Former members of Protea Medical Scheme protected

Circular CMS, 25 May 2011

The CMS send out a circular, announcing that all open medical schemes are legally obliged to admit former members of Protea Mecical Scheme (in liquidation) without any form of discrimination. The Medical Schemes Act 131 of 1998 determines that members must be allowed to be admitted to the open medical scheme of his/her choice. The only limitations to the open enrolment principle are that waiting periods may be imposed where a member has not been a member of a scheme for the 90 days preceding the date of application; and a conditioning waiting period of up to 12 months may be imposed in certain circumstances.

Medical schemes object to rise of nearly 25% in regulator's annual levy

Personal Finance, 14 May 2011

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