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Top Secret Presentation on the White Paper on the National Health

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Top Secret Presentation on the White Paper on the National Health PRESENTATION TO THE 3rd South African Nurses Conference National Health Insurance (NHI) Universal Health Coverage The Third Transition of Health 25 February 2016 WHAT IS NHI? • NHI is a health financing system that pools funds to provide access to quality health services for all South Africans based on their health needs and irrespective of their socio-economic status • This is the only way to guarantee Universal Health Coverage (UHC) as adopted in September 2015 as one of the United Nations Sustainable Development Goals, NDP, African Claims (1943), Gluckman Commission (1944), Freedom Charter (1955) 2 Historical Context of Health Care Financing Reforms South Africa has a rich history of several proposals and attempts to implement health financing reforms namely: • the 1928 Commission of Old Age Pension and NHI; • 1941 Collie’s Committee of Inquiry into NHI; • the 1943 African Claims that proposed equal treatment in the scheme of Social Security; • the Gluckman’s National Health Services Commission of 1943 to 1944 that proposed NHI (Dr Henry Gluckman); • The Freedom Charter as adopted by the Congress of the People, 1955; • Ministerial Committee on Health Care Financing, 1994; • the Ministerial Committee of Inquiry into NHI,1995 (Broomberg and Shisana Report); • Social Health Insurance Working Group 1997; • Taylor’s 2002, Committee of Inquiry into a Comprehensive Social Security System; • Ministerial Task Team on Social Health Insurance and now the current Ministerial Advisory Committee on NHI, 2009. 3 African Claims Under The African Claims in South Africa the Charter on Health states :- “a drastic overhauling and re-organisation of the health services of the country with due emphasis on preventive medicine with all that implies in modern public health sense.., strongly urged the establishment of free medical and health services for all sections of the population; …the establishment of a system of School Medical Service with full staff of medical practitioners, nurses and other health visitors… increased hospitals and clinic facilities both in the rural and in urban areas; Increased facilities for the training of African doctors, dentists, nurses, sanitary inspectors, health visitors (and) a coordinated control finance of health services for the whole Union.”(14 December, 1943). 4 Freedom Charter There shall be Housing, Security and Comfort for All: “A preventative health scheme shall be run by the state; Free medical care and hospitalisation shall be provided for All with special care for mothers and young children” 5 Declaration of Alma-Ata International Conference on Primary Health Care, Alma- Ata, USSR, 6-12 September 1978 Declaration: I The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector. II The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries. HEALTH FOR ALL BY THE YEAR 2000 6 National Development Plan 7 UN Sustainable Development Goals (SDGs) • Declaration: “On behalf of the People we serve, we have adopted a historic decision on a comprehensive, far-reaching and people-centred set of Universal and transformative goals and target. We commit ourselves to working tirelessly for full implementation of this agenda by 2030 • As we embark on this great collective journey, we pledge that no one will be left behind. Recognising that dignity of the human person is fundamental, we used to see the goals and targets met for all nations and people, and for all segments of society. And we will endeavour to reach the furthest behind first”. 8 UN Sustainable Development Goals (SDGs) contd. • “This is an agenda of unprecedented scope and significance. It is accepted by all countries and is applicable to all, taking into account different national realities, capacities and levels of development and respecting national policies and priorities. These are Universal goals and targets which involve the entire world, developed and developing countries alike” 9 UN Sustainable Development Goals (SDGs) contd. • Goal 3.8 “Achieve Universal Health Coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines, and vaccines for all”. 10 WHY UHC? But what is UHC? THE PURPOSES OF UNIVERSAL HEALTH CARE COVERAGE ARE: • to meet population health needs; • to remove financial barriers to health care; • to reduce incidence of catastrophic health expenditure • this should facilitate the attainment of national and internationally agreed health goals; and • ultimately contribute to better quality of life, poverty alleviation and human development 11 Global Structural Problems of Health Care Systems Dr Margaret Chan Director-General (WHO) • That is – (i) rising health care costs yet poor access to essential medicines, especially affordable generic products; (ii) an emphasis on cure that leaves prevention by the wayside; (iii) costly private care for the privileged few, but second- rate care for everybody else; (iv) grossly inadequate numbers of staff, or the wrong mix of staff; (v) weak or inappropriate information systems; (vi) weak regulatory control; and (vii) schemes for financing care that punish the poor. 12 WHAT IS WRONG WITH THE PRESENT SYSTEM? 13 WHAT IS WRONG WITH THE PRESENT SYSTEM?-WHOLE SYSTEM 100% 80% 60% 40% 20% 0% % share of benefit % share of need Poorest 20% of population Second poorest 20% Middle 20% Second richest 20% Richest 20% 14 WHAT IS WRONG WITH THE PRESENT SYSTEM? (Private Sector) 15 16 17 18 19 20 21 22 23 24 25 26 27 Cost per hospital day as a ratio of GHI (2012) 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 28 Cost of MRI Scan as a ratio of GHI (2012) 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 29 Cost of Hip Replacement as a ratio of GHI (2012) 80% 70% 60% 50% 40% 30% 20% 10% 0% 30 Cost of Angiogram as a ratio of GHI (2012) 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Canada Switzerland Spain France South Chile South U.S.A. Africa_Adj Africa 31 Cost of Bypass surgery as a ratio of GHI (2012) 32 Cost of Normal Vaginal Delivery as a ratio of GHI (2012) 33 Cost of Caesarean Section as a ratio of GHI (2012) 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 34 35 Charges (Complaints laid with the Minister) • R18,000 for D&C • R30,000 for peri-anal abscess • R67,000 for evaluation after a car accident (patient came into hospital walking) • R500,000 for a laparatomy for peritoneal abscess (in addition separate surgeon’s fee of R23,000; separate anesthetists fee of R3,000) Another R700,000 for repeat laparatomy (but patient died before that) 38 Some Practices Bordering on Criminality • For instance – Root canal treatment in a 10 year old child – Motive? – R20,000 procedure instead of R200 39 WHAT IS WRONG WITH THE PRESENT SYSTEM? (Public Sector) 40 What is wrong in the Public Sector 1. Human Resources: – Wrong people appointed in wrong places – Patronage and cronyism – Poor planning , development and management of HR 2. Financial Management - Unfavourable Audit outcomes except at National and 3 Provinces 3. Procurement / Supply Chain – Simplest of equipment and devices unavailable or out of order for long periods of time – Absence of most essential medicines and drugs due to corruption or non- payment of pharmaceutical companies – Huge tenders issued for non-essential equipment (wrong procurement choices) 4. Infrastructure – Poor or non-existent maintenance of infrastructure – Collapse of essential infrastructure due to corrupt procurement practices – Poor workmanship in the construction of new infrastructure 41 Developments in Post-Colonial Africa • Ghana – Kwame Nkrumah, 1957 • Angola – Augustinoh Neto, 1975 • South Africa – Nelson Mandela, 1996 42 Dr Sambo’s address • WE WISH TO PROPOSE FOUR MAJOR THRUSTS FOR ATTAINING UNIVERSAL HEALTH COVERAGE: • First, strengthening the capacities of public health infrastructure to provide effective, safe, and quality health services. Infrastructure includes “staffing, buildings, technologies; utilities such as power and water supply; waste management; transport and communication; and FINANCING investments, maintenance and recurring costs”. Health infrastructure entails public investments and Governments will have to explore innovative ways of harnessing the resources of the private sector, NGOs and communities. 43 Infrastructure Optimization Tool Kit applied for the selection of clinics to be built in four provinces of EC, FS, LP and MP NHI Districts 44 Infrastructure Audit-Prioritization of Clinics for replacement, upgrading and Repairs-NHI District, Vhembe LP 3- WEIGHTED 1 <20 Very poor 1- AVERAGE POPULATION CONDITION OF MORE THAN 5KM NATIONAL DEPARTMENT OF HEALTH 2 20 - 40 Poor 2 -TOTAL THE FACILITY FROM THE ANALYSIS OF THE NATIONAL HEALTH AUDIT DATA TO GUIDE THE NEED FOR NEW/REPLACEMENT CLINICS 3 40 - 60 Fair SPACE FACILITY Data sorted by district, average condition of the facilities, and total space score 4 60 -80 Good SCORE to select clinics that are in very poor condition for possible replacement. 5 >80 Very good Space External External Ceiling Plumbing Plumbing
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