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Press Release 8 of 2019: Advocate Tembeka Ngcukaitobi to chair investigation into allegations of racial profiling by medical schemes

PRETORIA, June 11, 2019 - The Council for Medical Schemes (CMS) said on Tuesday Advocate Tembeka Ngcukaitobi hasagreed to chair the investigation into allegations of racial profiling against Black, Coloured and Indian private medical practitioners. The investigation, to be called the Section 59 Investigation follows allegations by members of the National Health Care Professionals Association (NHCPA) that they were being unfairly treated and their claims withheld by medical aid schemes based on race and ethnicity.

pdfPress Release 8 of 2019: Advocate Tembeka Ngcukaitobi to chair investigation into allegations of racial profiling by medical schemes

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Council for Medical Schemes says inquiry will probe bullying, 'use of hidden cameras'

The Council for Medical Schemes (CMS) has announced that Advocate Tembeka Ngcukaitobi will chair a four-month investigation into allegations of racial profiling against black and Indian private medical practitioners by medical aids, including allegations of the "use of hidden cameras".

The CMS regulates private health financing though medical aid schemes.

In mid-May, the council announced that it would be moving forward with the investigation, after members of the National Health Care Professionals Association complained they were being unfairly treated and their claims "withheld by medical aid schemes based on the colour of their skin and ethnicity". The NHCPA is a body that represents medical practitioners.

In a statement on Tuesday Dr Sipho Kabane, the chief executive officer and registrar of the CMS, described Ngcukaitobi as a "respected legal mind". He will be assisted by advocates Adila Hassim and Kerry Williams.

The investigating panel will probe allegations of racial profiling, blacklisting for payments, blocked payments, demands of confidential clinical information, "bullying and harassment, coercion, entrapment and use of hidden cameras".

"Our mandate is to measure the quality and outcomes of relevant health-care services by medical schemes, and to investigate complaints and settle disputes in relation to the affairs of medical schemes as provided for in the Medical Schemes Act," said Kabane. 

The inquiry will take place under section 59 of the Medical Schemes Act.

The probe will receive written submissions from interested parties until June 2019. Interviews and public hearings will be conducted between July and September 2019. The final report will be delivered by the Investigating Panel on November 1, 2019.

  • source MAMM clips | HFAssociation

Politics & power: Why Zweli Mkhize may be a new dawn for health in SA — or not?

Will Ramaphosa’s new health minister wield enough power to bring recalcitrant MECs to heel?

Shot-caller, calculated, master of survival. This is who South Africa’s new health minister, Zweli Mkhize is, analysts say.

“The appointment of Mkhize is an important and unexpected development because he’s one of the ANC’s top six [leadership], which suggests an unprecedented prioritisation of health,” says the social justice activist and former director of the public interest law organisation Section27, Mark Heywood.

“Because of his seniority within the ANC and the perception that health is a lower down level of Cabinet responsibility, the announcement came as a surprise — it signifies the political prioritising of health.”

The former KwaZulu-Natal premier, has, according to Heywood, “exactly what [former Health Minister Aaron Motsoaledi] didn’t”: the political authority within the ANC to “crack the whip on health MECs, to phone premiers and say, ‘sort your shit out’”.

While Motsoaledi grew South Africa’s HIV treatment strategy to the largest antiretroviral programme in the world, he has been criticised for his inability to exercise authority over the implementation of health policies in provinces.

During his decade of reign between 2009 and 2019, more than half of provincial health departments were placed under either national or provincial administration. Problems were particularly rife in the Free State and Northwest, where Motsoaledi had extremely limited political influence, and as a result, very little decision-making power.

LISTEN: Aaron Motsoaledi was one of the few cabinet ministers prepared to stand up against former President Jacob Zuma. Mia Malan talks to Mark Heywood. 

Under section 100 (1) of the Constitution, the national government may intervene in a province — or put it under administration — if it does not fulfill its “executive obligations”, but there are limits to ministers’ legal powers in the sense that MECs report to their respective premiers and not to national ministers.

Until now, the ANC has had an implicit “gentleman’s agreement” between its officials in Pretoria and those in the provinces to keep the peace, political analyst Ralph Mathekga told Bhekisisa in 2017. It was party dynamics, not legislation, that provided for this.

He explains: “It’s important to understand that things have been smooth not because institutionally they are provided to be that way, but because there was a consensus within the ANC.”

In today’s factionalism, the soft power of political authority experts ascribe to Mkhize may be the only way to ensure the country’s policies move from paper to reality.

For instance, when allegations of corruption and poor healthcare delivery sparked deadly protests in the North West last year, Motsoaledi complained that “there is no mechanism for me to intervene before these things happen”.

Heywood explains: “One would hope that Mkhize uses his authority, because, with a few exceptions, the newly announced health MECs are a mediocre, unknown and dubious bunch of whom some have already been implicated in corruption.

“We expect, across Ramaphosa’s Cabinet that we would see a getting away from this idea that somehow a province is a country that can do its own thing.”

Aaron Motsoaledi has been replaced as health minister following last night's . How would you rate his time in office?

Mkhize’s past reflects a calculated ability to toe the party line publicly for political survival while operating in often unseen ways to get what he wants.

His tenure as the country’s longest-running health MEC from 1994 to 2004 in KZN, for instance, overlapped with one of the biggest health battles of the era: that to provide ARVs to HIV-positive pregnant women and their babies to prevent mother-to-child transmission of the virus.

By 1999, almost one-in-four pregnant women in the country were infected with HIV, according to a 2008 health department survey. Tens of thousands of babies were contracting HIV either before or shortly after birth each year.

A 2001 court case of the HIV lobby group, the Treatment Action Campaign (TAC), was meant to force then President Thabo Mbeki’s HIV denialist state to provide women with the drugs they needed to save their babies — but seven of the nine provincial governments opposed the case.

The KwaZulu-Natal Premier and IFP member Lionel Mtshali supported the TAC application, but Mkhize, his ANC health MEC, opposed it.

“This was the province with the highest number of people living with HIV and the most infants at risk of infection,” former TAC activist and editor for Ground Up news service Nathan Geffen writes in a 2016 article.

“[Mkhize] could not bring himself to break ranks with Mbeki publicly, not then anyway. The prevention-of-mother-to-child case was an occasion when it was necessary for Mkhize to speak out, but he didn’t.”

But, at the same time, Mkhize allowed an HIV researcher to provide antiretroviral treatment to patients in a state — HIV treatment that was against government policy at the time. That happened in the early 2000s, when the head of the Centre for the Aids Programme of Research, Salim Abdool-Karim, asked Mkhize for space in a Vulindlela clinic in the KwaZulu-Natal Midlands to conduct treatment trials. Abdool-Karim explains: "I find Mkhize a very decisive person who doesn’t waffle around and someone who takes a stand based on what he thinks is the right thing to do.” 

But, Geffen writes, the province’s Tara KLamp — a male circumcision device that had not been approved by the World Health Organisation — which was introduced during Mkhize’s time as premier, was yet another missed opportunity for him to publicly put patients before politics.

In 2010, the KwaZulu-Natal health department, then under MEC Sibongiseni Dhlomo,bought tens of thousands of the device meant to help make medical male circumcision easier.

By then, studies had shown that medical circumcision could reduce a man’s risk of contracting HIV through vaginal sex by about 60%. But South Africa faced a dilemma: there weren’t enough doctors to spare for the surgical procedure.

A simple tool that would let nurses do the job instead could be a game changer. And the plastic Tara KLamp promised to be that. Once placed over the penis, the plastic device cuts off circulation to the foreskin, causing the tissue to supposedly die and fall off.

But in 2009, half the men asked to participate in research on how well it worked in adults said no because they feared it. Those who braved the Malaysian-made contraption were drastically more likely to report bleeding, injuries to their penises, infections, swelling, difficulties urinating and heavy pain than those circumcised via the usual method involving forceps, a South African Medical Journal study found.

As a result, the TAC launched a massive campaign to warn men and convince KZN to pull the clamps.

Geffen remembers meeting Mkhize in Pietermaritzburg to discuss the matter:

“We saw a disturbing side to him,” he writes. “He entered the room and then spoke for 1 hour 20 minutes of the next 1 hour 35 minutes before leaving. This seemed to be a tactic to avoid having to answer difficult questions.

“He told us the matter had received more publicity than it warranted, that TAC’s response was disproportionate, and that no one had died. He said he was suspicious of our motives.”

Motsoaledi eventually established a medical male circumcision steering committee. The country’s 2016 guidelines recommend the use of two types of clamps — the Tara KLamp is not among them.

In an open letter to Mbeki in 2016, Mkhize admits that the era is not without regrets.

He explains that his resistance to the PMTCT court case was less about conviction than about logistics: “Our argument was that the government needed to finalise the [drug] trials and expand the treatment to all centres, hence a court order was not necessary.”

Today, Mkhize’s particular brand of staying power is one that will serve Ramaphosa well in a highly factional environment where isolation is akin to a political death knell, argues political analyst Ralph Mathekga. 

“He’s Ramaphosa’s close ally, similar to what Gwede Mantashe [the ANC’s national chairperson and South Africa’s minister of mineral resources and energy] is to the president. Ramaphosa needs strong political backing. Mkhize is a very senior person that you want on your side.” 

  • source MAMM clips | HFAssociation

NHI is Mkhize’s biggest challenge

The private healthcare industry and civil society will be looking to new health minister Zweli Mkhize to provide clarity on where the government is going with its long-awaited National Health Insurance (NHI) policy, which made little progress under his predecessor Aaron Motsoaledi. All eyes on him: New health minister Zweli Mkhize has a huge NHI challenge on his hands; how to implement this in a crumbling public health system. He will also need a buy-in from the private health sector and cooperation from the provinces.

Driving through the reforms necessary to breathe life into the government’s ambitions to introduce universal health coverage on the back of an ailing public health system will be Mkhize’s biggest challenge. Given Mkhize’s experience working with business, and his reputation for being a pragmatist rather than an ideologue, hopes are high in the private healthcare industry that the days of a minister of health openly hostile to the sector are over.

Mkhize, 63, is a medical doctor with experience in public health and finance. He is widely regarded as a good listener who gets things done, characteristics critics say Motsoaledi lacked. Despite his passion for his portfolio, Motsoaledi presided over a series of catastrophic service breakdowns in public health during his 10-year tenure. He made little progress in getting the NHI past the policy stage. The cabinet is still to approve the first piece of legislation required to bring into effect the reforms spelt out in the NHI white paper published in June 2017. Mkhize has risen steadily through the ranks of the ANC since returning from exile in 1991. He was KwaZulu-Natal’s MEC for health from 1994 to 2004, before becoming provincial finance minister and then premier. In 2012 he took up the position of ANC treasurer-general and emerged as a potential presidential candidate in the contest to succeed former president Jacob Zuma in 2017. That political weight will be put to the test when he starts dealing with provincial health departments and MECs, who are given extensive powers by the constitution and do not take kindly to orders from the minister and his department.

Motsoaledi complained that he was held accountable for service delivery failures in the provinces that he was powerless to address. Whatever Mkhize manages to achieve with the provinces will cast a spotlight on Motsoaledi’s claim that his hands were tied. Mkhize, who has a reputation for being no pushover, faces an even more challenging task with provincial health departments when it comes to implementing NHI, as it envisages a purchaser-provider split that will effectively diminish their powers. Services for patients will be purchased by an NHI fund, which will bypass provincial health departments and contract with accredited public and private-sector providers.

Observers will closely watch the path the new health minister navigates with the NHI “war room” in the presidency, headed up by Olive Shisana.

The key question is whether he will allow the war room to retain the initiative and delegate to him the role of implementer, or whether he will find a way to bring that capacity into the department with him at the helm.

31 May 2019 Business Day TAMAR KAHN: 

  • source MAMM clips | HFAssociation

New cabinet must implement NHI - NEHAWU

NEHAWU statement on the announcement of the Cabinet

29 May 2019

The National Education, Health and Allied Workers’ Union [NEHAWU] welcomes the announcement of the incoming Minister and Deputy Ministers as announced by the President of the Republic, Honourable Cyril Matamela Ramaphosa.

Firstly, we welcome the reduction of ministries as a means to have a leaner and efficient government that will be preoccupied with prioritising service delivery. However, we want to outright caution against any loss of jobs as a result of this move by the President. Furthermore, these measures must not lead to budget cuts in terms of the existing programmes which ultimately leads to job losses.

Secondly, our view is that this should be about the closure of ministries as opposed to departments. The latter must be absorbed or integrated in the related existing departments. We hope this would not lead to a job blood bath of the coal-face public service jobs. Should jobs be lost in this fashion we will fight fire with fire. As NEHAWU, we are more than ready to wage a relentless war should any of our members and workers lose jobs because of this move.

The new administration must immediately focus on the speedy implementation of the National Health Insurance [NHI] and comprehensive social security, implementation of free higher education, reindustrialization of the South African economy and the intensification of the fight and defeat corruption and state capture. We welcome the inclusion of unemployment as part of the Department of Labour. Unemployment is at a crisis level with 27.6% of the population without any job. We hope the department will come up with creative means to end unemployment as part of the triple challenges.

We are elated that the President has prioritised the monitoring and evaluation of the performance of those deployed to serve in the well balanced Cabinet drawn from different sectors of society. It is our firm view that service delivery can only be speed up by women and men who are more determined to go beyond the call of duty and who are more than willing to serve the people of South Africa with distinction. We hope the President will keep his word and get rid of Minister and Deputy Minister who will not be pulling their weight in the new administration.

We congratulate all those appointed especially our former General Secretary, Cde Fikile “Slovo” Majola, who has been appointed as Deputy Minister of Trade and Industry. We also congratulate Cde Senzo Mchunu for being appointed the Minister of Public Service and Administration and we hope to have a good working relationship with him in transforming the public service. At the top of our agenda is the filling of vacant posts in the public service and the continuation of the work done in relation process of ensuring that more than 850 000 public servants are able to access their own homes through the GEHS driven scheme.

We also note the return on the former Minister of Finance which we hope that in this term he will abide by the vision of the African National Congress [ANC] and not deviate from it. The national union is vehemently opposed to his misguided view that the public service is bloated and must be cut down. If he persist with this view we are more than ready to meet fire with fire. Our members are at the coalface of service delivery and on a daily basis they have stories to tell on how they are overstretched to perform tasks that are not part of their job description without being remunerated for it.

As a union organising in the state we are looking forward to work with all the new Ministers and hope that we will work hand in glove in ensuring that service delivery is upscaled, workers are paid decent wages and they work in improved working environment. In this regard, we will urgently meet all ministers to discuss a speedily implementation aimed at improving service delivery to our people and working conditions of our members and workers in general.

Issued by Khaya Xaba, Media Liaison, NEHAWU, 30 May 2019

  • source MAMM clips | HFAssociation

What you need to know about Health Minister Zweli Mkhize

Dr Zweli Mkhize will take over as the new Minister of Health, President Cyril Ramaphosa announced on Wednesday.

Mkhize is the former Minister of Cooperative Governance and Traditional Affairs and served as the Treasurer-General of the African National Congress between 2012 and 2017. He obtained a degree in medicine from the Univerity of Natal at the age of 26.

Ramaphosa has reduced the number of ministers from 36 to 28, by merging several departments such as Water and Sanitation and Human Settlements.

According to Political Analyst Tasneem Essop, Mkhize’s appointment doesn’t come as a surprise.

She explained: “He has been a key figure within the ANC for a while and especially coming from KwaZulu-Natal. He’s been circulating in the top echelons of ANC politics for some time now and a deployment of this kind for him was expected much earlier.”

Additionally, Essop told Health-e News that the factional politics within the ANC played a role in his appointment, as well as the fall of some of former president Jacob Zuma’s loyalists after the party’s 2017 elective national conference held in Nasrec.

But some fear that Mkhize’s appointment could curtail women’s access to comprehensive healthcare even more.

“We desperately need a minister who doesn’t need to be convinced of the importance of sexual reproductive justice. We need someone who will prioritise the health of young, black women,” founder of Nalane for Reproductive Justice Dr Tlaleng Mofokeng said.

Dr Joe Phaahla retains his position as the Deputy Minister of health.

Motsoaledi’s tenure

Meanwhile, Former Health Minister Aaron Motsoaledi has been moved to the Department of Home Affairs. He headed the health department for a decade and has been lauded for achieving victories in HIV and tackling of non-communicable diseases through supporting the Health Promotion Levy, also known as the sugary drinks tax.

He also championed the National Health Insurance (NHI) scheme — South Africa’s iteration of universal healthcare — which was moved out of the health department and into to a “war room” within the Presidency under Ramaphosa’s special advisor Professor Olive Shisana. Civil society and public health experts have criticised the current version of the NHI, labelling it as a “pipe dream” if the problems regarding the shortages of health professionals and the equal distribution of labour aren’t resolved.

Motsoaledi’s term was plagued with crises, such as the Life Esidemeni tragedy and the collapse of health services in the North West province which was put under administration.

It’s not clear why Ramaphosa would feel pressured to retain Motsoaledi in Cabinet, Essop said. “Ramaphosa could be looking for people who appear to be competent to the public and have years of experience in Cabinet. But Motsoaledi is not a key figure that has the influence to lobby within the ANC,” she explained.

On the other hand, Mofokeng said it would have been great for a woman to be appointed as health minister.

She said: “I was expecting a woman who has feminist politics and understands the urgency and the level of crisis that affects women’s health. Whether we’re talking about the continuous contraceptives stockouts, or the issue of unsafe abortion that continues without any plan of action, or any sense of urgency whatsoever.” 

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