Presidential Health Summit 2018
The aim of the summit was to bring together key stakeholders from various constituencies in the health sector, to deliberate and propose solutions to address the challenges facing the South African health system.
Delegates deliberated on issues aimed at strengthening the health system to ensure that it provides access to quality health services for all in line with the principles of universal health coverage through an inclusive process.
The Presidential Health Summit follows a Consultative Meeting held earlier this year, on the National Health Insurance (NHI) scheme, with a particular focus on the recently gazetted National Health Insurance Bill and the Medical Schemes Amendment Bill, where the President reiterated the commitment of the South African Government to strengthening the health system, including through the progressive implementation of NHI.
The theme for Summit: "Strengthening the South African Health System towards an integrated and Unified Health System"
Summary Notes of the Presidential Health Summit
Dates: 19 – 20 October 2018
Venue: Birchwood Hotel and Conferencing Centre, Boksburg
On behalf of the Premier, the MEC of Health (Gauteng), Dr Gwen Ramokgopa opened the Summit.
Dr. Motsoaledi took to the stage and gave some background, objectives and the process of the meeting going forward, calling the current summit the “CODESA” of Healthcare. He mentioned that during the course of next week there will be an event commemorating the Alma-Ata Declaration of 1978, re-dedicating the world to its ideals, where primary health care is the key to the attainment of the goal of Health for All.
Representatives from labour, business and community sectors gave opening remarks with each highlighting the opinions and challenges, their constituencies experience
First on stage was Ms. Tanya Cohen, CEO of BUSA who represented business. The key message from Ms. Cohen was that private sector acknowledged the challenges facing the healthcare system, calling for more collaboration between the private and public health sectors.
Speaking as a coordinator in Health Financing and Policy from the World Health Organisation (WHO), Mr Joe Kutzin, shared the WHO’s approach to health financing, coupled with lessons and experiences from other parts of the world. An overview on how to operationalise the concept of Universal Health Coverage, outlining the WHO approach, criteria and principles which will guide implementation, this being more directional than prescriptive in nature, was given Countries that were focusing on the 3 objectives of improving equity in services, improving quality and financial protection were mentioned. After aggressive analysis of the state of these objectives, countries (such as South Africa) are expected to come up with a model that will address these challenges and lay a foundation.
What is the implication of UHC on policy was a question at hand which was deliberated. Moving away from traditional ideas associated with the word “insurance” was suggested as there are many selections to choose from. He recommends that NHI be thought of as an organisational reform (which has technical imperatives) as opposed to a reforming of funding and not to be layered on the existing system. Five critical areas to pay attention to going forward were highlighted:
- Insuring accountability and consistent public reporting on the use of funds and results achieved. Data is key to achieving desired performance outcomes and encourages a central database system.
- Designing steps for equitable and universal system from the beginning.
- Addressing areas of potential conflict of interest in the system in trying to deal with the first two points.
- Recognise that each country in the world is entitled to only one healthcare system. He elaborated on the benefits of a single healthcare system e.g. purchasing power efficiencies.
- Recognise the limits of central planning – need central guidance of clear processes and goals through being more adaptable as the system evolves. A single payor system works well, if managed well, and should be a non-negotiable in the case of South Africa.
The following were noted:
- There is a need for a complementary and supplementary role of private insurance. Incentives are not aligned between public and private sectors and good public policies must be implemented that will protect the average South African.
- The private and public delivery and financing dimensions of the South Africa health system are not separate, and invariably influence each other from a technical point of view. The architecture of the financing system in particular has not changed since 1994. This needs to change.
- Discourages South Africa from setting up separate different schemes/pools for different population groups (e.g. formal sector) as it is difficult to overcome the unintended consequences thereof.
- Implementation needs to be accompanied by analysis, evaluation and learning. A foundation of a data driven adaptive system be implemented. This is important to improve quality in the public sector while managing cost in the private sector. Transparency and accountability being key.
The Director General at the WHO, Dr. Tedros Adhanom Ghebreyesus gave a video presentation on the matter of global universal health coverage programme, this programme being part of the Sustainable Development Goals.
Dr. Nkosazana Dlamini-Zuma (Minister in the Presidency: Planning, Monitoring and Evaluation), gave background on the state of healthcare mentioning amongst others:
- Inequality in the distribution of resources;
- The lack of outcomes health data to back up the high cost of treatment regimens and high cost technology interventions.
The morning was concluded by Mr. David Mabuza, the Deputy President of South Africa who stood in for the President, H. E. Cyril Ramaphosa.
The Deputy President spoke on 4 major issues that impact negatively on public health system and the challenges facing SA. The Summit should ensure that these will be addressed, and that robust plans must be sought to find solutions aimed at turning the health system around.
Each one of these four major issues were addressed in depth:
- Human resources – shortage of health professionals
- Procurement - i.e. supply chain systems -poor delivery processes and systems. Provision of preventative comprehensive primary healthcare is key and should receive priority attention. Excellence in service provision depends on good leadership which leads to increased clinical governance.
- Financial management – inequitable system of healthcare between public and private sectors, citing statistical examples of mal-distribution of finances, referring to the HMI report that has found that most medical aid schemes are not sustainable. One health system, not the current two-tiered system is needed for all our people, with a publicly financed system whereby services are delivered by both the public and private sectors. An integrated system under NHI, that does not negate the existence of medical scheme, is required for the additional care that will complement the services provided under the NHI. Participants attending this summit were invited to address these issues.
- Maintenance of equipment and infrastructure. A coordinated, integrated and shared health information systems to be built. An essential robust database for valid data and information for better decision making is required with seamless access to records at all facilities plus access to all doctors without compromising quality and confidentiality. Information communication technology platforms for improved quality to be improved upon. As Innovation in healthcare is key, the use of technology to back up a sustainable UHC is required
It is further noted:
- The Presidency has taken stewardship of the NHI process.
- According to WHO – the health work force is critical for the success of effective Healthcare systems.
- Focus on adoption of a healthy lifestyle will be the approach to healthcare through the National Wellness Campaign known as “Cheka Impilo”, which was launched at the Summit.
Transforming the Healthcare System and finding solutions to the challenges within the Healthcare System to give immediate benefits that will last for decades.
The remainder of the day was dedicated to the nine Commissions deliberating on the key identified areas of human resources for health, supply chain management, public financial management, infrastructure plan, private sector engagement, health service provision, leadership and governance, community engagement and information systems. Each Commission was tasked with providing recommendations for the short-term, medium-term and long-term periods to tackle the challenges currently facing the health system. The feedback from each Commission was given during day 2 of the Summit.
In response to some of the issues raised, Dr. Aaron Motsoaledi, the Minister of Health, acknowledged the many policies that had been developed after every summit or meeting had not been implemented. Most of the recommendations made on the public service, are contained in Chapter 10 of the National Development Plan (NDP). In light of this it was proposed that:
- from this forum, a team of about five individuals be tasked with analysing the NDP with a view to advise on what had been agreed to and the status of these actions in terms of implementation and which aspects can be implemented swiftly be recommended.
- on corruption there are many anti-corruption structures which retrospectively deal with corruption, referring to it as a “post mortem approach”, to handling corruption when the damage has already occurred. A proposal is to implement preventative mechanisms which will discourage the corruption from occurring in the first place.
- a small committee be formed to investigate the clinical and audit committee which will ensure a well-functioning Board or audit committee, that will guarantee sustainability and effective management of healthcare institutions.
- Senior personnel to make decisions at operational/hospital level i.e. purchasing of medical equipment for the institution should not await approval from national DoH.
- Implementation of health plans must be based on evidence-based policies as opposed to having political interference.
Dr. Akpaka Kalu gave a summary of key outcomes and the programme director summarised the way forward before the Summit officially closed.
Presentation slides from the Health Summit.
Slides of the way forward (practical steps) with clear timelines