Programme Director,
Dr. Stephanie Weber, Co-Chair of the World Health Organisation (WHO)–Family of International Classifications Council and Head of the WHO-FIC Collaborating Centre in Germany;
Ms Majorie Greenberg, Co-Chair of the World Health Organisation (WHO)–Family of International Classifications Council and Head of the North American WHO-FIC Collaborating Centre;
Dr. Bedirhan Ustun, Co-ordinator, Classification, Terminology and Standards (CTS),
Health Statistics and Informatics, WHO Geneva;
Dr. Derege - Representative of the WHO Afro Region;
Dr. Lars Berg – the incoming Co-Chair of the WHO-FIC Council, and Head of the WHO-FIC Collaborating Centre in Norway;
Ms MP Matsoso, Director-General of the National Department of Health in the Republic of South Africa;
Representative of the Office of the, Statistician General in the Republic of South Africa
Members of WHO-FIC from across the globe
Dr. Ali Dhansay, Acting President of the Medical Research Council (MRC)
Senior Managers from Government Departments
Local and International Development Partners
Members of the Health Data Advisory and Coordination Committee (HDACC)
Distinguished guests,
Ladies and gentlemen
Good morning!
It is indeed a great pleasure for me to welcome our distinguished guests, members of the WHO Family of International Classification Collaborating Centres and other colleagues to the wonderful City of Cape Town for this significant conference. I welcome you on behalf of the South African Government, and we are indeed proud to be able to host you and hope that the conference will be fruitful.
I understand that many of you have been in Cape Town since Saturday and have been working hard in various Technical Committees and Reference Groups to coordinate the development and implementation activities around the WHO classifications. These classifications are the bedrock for internationally comparable statistics.
Brief Profile of the Republic of South Africa
This year's WHO-FIC Conference takes place in a very beautiful country, with friendly people, and a relatively strong economy, but which is also afflicted by ill-health. We face a quadruple burden of diseases consisting of HIV, AIDS and TB, high maternal and child mortality, non-communicable diseases and high rates of violence and injuries. This burden has caused our average life expectancy to decrease over the last two decades, and has made us relook at our health care strategies and review our health system. We are in the process of re-engineering primary health services and have developed a strategy to introduce a National Health Insurance system over the next 14 years to ensure that all citizens will be afforded a basic package of quality health care. This is being done in the context of Outcome-Based Planning, which has been introduced across Government.
The South African Government has adopted a set of 12 key outcomes, which includes the vision of "A long and healthy life for all South Africans". The health sector has been assigned the responsibility for harnessing the country`s efforts towards the attainment of this outcome. Four outputs have been identified and are directing our strategic efforts.
These are:
Output 1: Increasing Life Expectancy
Output 2: Decreasing Maternal and Child Mortality rates
Output 3: Combating HIV and AIDS and Tuberculosis
Output 4: Strengthening Health Systems Effectiveness.
Health Information is Vital
The theme of your conference Health Information is Vital is so pertinent.
Having set targets that we are aiming to reach in the Negotiated Service Delivery Agreement, we are in the process of ensuring that we have the data systems to track progress on these goals, as well as the health related Millennium Development Goals (MDGs).
We note that many countries are currently grappling with this challenge which led to the recent UN Commission on Information and Accountability for Women's and Children's Health. Some of their key recommendations are extremely relevant to this two-day conference. In particular:
National governments, with the support of partners, must prioritise and harmonise investments for building robust health information systems to monitor women's and children's health – an initiative referred to as Vital Registration by 2020. These investments must be channeled into data gathering, together with the human and institutional capacities to support these systems of data gathering.
Countries must support the development and implementation of an expanded, integrated system of routine health information and health surveys to provide timely national and subnational data to document progress in core health indicators, including measures of women's and children's health outcomes, coverage and equity.
Broadband technologies offer opportunities to accelerate progress towards comprehensive health information for improving women's and children's health. However, the Commission re-iterated that ICT is a means to an end, not an end in itself.
South Africa does have many of the fundamentals for a health information system. You may be aware that Statistics South Africa has just completed the 2011 Census. This counted people through an operation involving more than 120 000 enumerators who went to each and every household in the country. The count is expected at around 50 million, but it is important to know and understand the population dynamics for proper planning, and health service delivery. We are pleased that the representatives of our Statistician-General, Ntate Padi Lehohla are here with us today, and also believe that they will provide the conference with some highlights of our Census. We are also pleased that the Census has included the internationally proposed questions on disability, which we understand have been influenced by the International Classification of Functioning, Disability and Health – a member of the WHO Family of Classifications.
Development of the National Health Information Systems Strategy
In April 2009, using the Health Metrics Network assessment tool, South Africa reviewed its Health Information System. This process identified the need for South Africa to develop an integrated National Health Information Systems Strategy, which outlines comprehensive strategies to improve: civil registration systems; vital statistics; population-based information; health service based information; and data from transversal (government-wide) support systems. The National Department of Health has commenced with plans in this direction.
As you have been informed by presentations to this conference, South Africa has made good progress with the development of the civil registration and vital statistics system. Over the past 10 years, we have increased birth registrations to almost 80% and we have increased death registration to about 90%. We do face several challenges to enhance the performance of the system to provide the reliable statistical information that we need, including subnational statistics to track progress in different regions of the country. We note with gratitude that Statistics South Africa has taken a lead role in enhancing the coding of cause of death statistics and we are working with them to improve the quality of medical certification.
Health Data Advisory and Coordinating Committee
In October 2010, the National Department of Health established a Health Data Advisory and Coordinating Committee, and gave it a mandate to improve the quality and integrity of health outcome data, establish consensus on indicator values; and identify reliable data sources to be used by the country in future. This Committee consists of eminent South African experts from the Human Sciences Research Council; Medical Research Council (MRC); School of Actuarial Sciences at the University of Cape Town; School of Public Health at WITS University; Health System Trust (HST); Financial & Fiscal Commission (FFC); Hospital Association of South Africa (HASA); Wits Institute for Sexual and Reproductive Health and the Board of Health Care Funders. The Committee has representation from the public and private sectors, as well as from independent institutions.
In May 2011, the Health Data Advisory and Coordinating Committee had a one-day workshop with international experts from multiple UN Agencies, including WHO South Africa; UNAIDS; UNICEF and UNFPA. The aim of this gathering was to create a platform for South African experts and experts from the UN Agencies to jointly review the health indicator values reflected in the Negotiated Service Delivery Agreement (NSDA) 2010-2014, the methodology used to arrive at each set of figures; and the assumptions made. The UN Agencies acknowledged all the key milestones that the country has made towards strengthening its health information systems. However, with regard to the lack of consensus on indicator values, the final message from the UN Agencies to the country was crisp and clear. This is a key message I wish to convey to this conference this morning: "South Africa must solve its own data quality problems, and present to the UN a set of agreed upon figures, which will then be examined by the international experts for integrity. Once this has been achieved, these will be accepted as the health outcome indicators of the county, and used by the international community.
I am quite pleased, ladies and gentlemen, that later this morning, we will be receiving the Report of the Health Data Advisory and Coordinating Committee from the Chairperson, Dr. Khangelani Zuma and the Deputy Chairperson, Dr. Debbie Bradshaw.
Vital role of good quality data for National Health Insurance
In August of this year, we released a watershed Green Paper on National Health Insurance (NHI), after extensive technical work informed by evidence. The Green Paper outlines our policy proposals for NHI, and outline of how this health sector reform could best be implemented. It outlines a 14 year programme and highlights the essential role of information systems.
The Green Paper on National Health Insurance highlights the need to adopt a coding system that allows providers to uniformly report on the services rendered or goods provided for the purpose of reimbursement. Therefore, the Department of Health notes with great interest the work being done within the WHO-FIC network on the development of the International Classification of Health Interventions (ICHI). It is also important that the coding system provides the necessary health information on the burden of disease for the purposes of planning and decision making. The reimbursement system for inpatient services will be according to disease related groups. A case mix or grouper system will be adapted for the South African drawing on good practices that are internationally accepted and have been implemented in other jurisdictions.
South Africa adopted ICD-10 as a diagnosis coding standard in the late 1990s. We have had excellent cooperation between the private and public sector in terms of implementing ICD-10 morbidity coding – and the recent formalisation of the national ICD-10 Implementation Task Team reflects its recognition as an important resource to support the effective use of ICD-10 for both morbidity and mortality coding. Up to now, ICD-10 morbidity coding has largely been used to support re-imbursement but, particularly in the private sector, excellent risk assessment work using diagnosis related groups (DRGs) has also been carried out.
The process of setting up a National Health Insurance system has started with an audit of all public health facilities. District clinical support teams and ward based primary health care agents are in the process of being set up as well as school based health services. A national health data repository has been set up and will be rolled out to provinces. However, it has also been recognized that there is a need for 3500 data capturers are being employed and deployed across the country.
Designation of the Medical Research Council as WHO-FIC Collaborating Centre
Programme Director, we wish to congratulate the MRC, for being accorded the status of a WHO-FIC Collaborating Centre. This is the first WHO-FIC Collaborating Centre in the WHO AFRO region. This is a significant achievement. We also wish to convey our gratitude to the WHO-FIC Council for this confidence and trust placed in our country. We pledge our support to the MRC as it performs this important role.
Conclusion
In conclusion, you will realise that we take the theme of this conference very seriously. We believe that health information is vital and that coded data has a critical role to play in strengthening the effectiveness of health services and improving the health of our people. We are grateful that the network has chosen to meet in our country. We think that this will help to build much needed capacity in our country and the region.
I wish you fruitful deliberations over the next two days and look forward to receiving updates on the progress of the network and the development of ICD-11 and ICHI.
Thank you.
