Madlala-Routledge at the Healthcare Structure conference held in
Johannesburg
13 March 2006
I must start by thanking the organisers of this conference, for this
opportunity to address an audience that I believe shares the same sentiments as
I have on the contribution that our health system can make towards the
realisation of a better health for all. I believe that after 11 years of
deliberation, we are now poised to begin the implementation of our social
health insurance system. I will confess that there have been occasions when the
goals seemed far and unrealisable, but recent events have led me to believe
that our health system is on track.
We have now begun a real dialogue about how to ensure that all citizens have
access to essential healthcare services. We have been encouraged by the
extensive participation and interest shown by the private sector in debating
the Social Health Insurance (SHI) policy. As for government, the SHI policy was
approved by our National Health Council, led by the Minister of Health. We
agreed that we will pursue three components of the SHI policy, in a stepwise
approach:
Firstly, we will address risk solidarity by implementing the Risk
Equalisation Fund. Secondly, we will address income solidarity, by redesigning
various aspects of the tax system. Obviously, this has to be agreed with our
colleagues in the national Ministry of Finance, and you will have noted the
announcement made by Minister Manuel in his Budget Speech. Clearly, our work is
still not finished in this area.
I am pleased to confirm that Cabinet approved the implementation of the
first step in July of last year. One of my reasons for optimism is the
contribution that was made by the private health sector in helping us to
deliberate and design the Risk Equalisation Fund (REF). The excellent quality
of your input and the commitment you gave to the consultative process has
culminated in the approval of a truly groundbreaking policy intervention in our
healthcare system.
The REF will be used to address the residual risk rating that still exists
in the medical schemes industry, and will thus contribute to improving the
efficiency of the private healthcare sector, by encouraging competition on the
basis of quality of services. As we have previously stated, the Department
views this as an essential first step towards the implementation of a Social
Health Insurance system.
The Council for Medical Schemes has already been mandated to begin with the
testing of the formula and other technical aspects of the REF. Aside from
testing many technical aspects of the REF, this yearâs shadow run will be
essential to enable schemes to understand how their pricing will be affected
once the financial transfers begin. We will spend the whole of this year
refining the systems, with full industry participation, with the intention to
begin full financial transfers in January 2007. As the testing proceeds, the
Council will also be establishing the required institutional framework for the
full implementation of the REF.
As we have promised, we will be releasing the draft amendments to the
Medical Schemes Act in the near future and to ask for your input in finalising
the legislative provisions to accommodate the REF. On income solidarity, we
have completed some technical work based on our current market and tax
dispensation. Of course, we have also taken note of international health
systems. Of specific interest to us is the finding that income solidarity is
deeply entrenched in most European health systems that have achieved universal
access. In developing countries, in particular South Africa, we need to grapple
with this question quite carefully, taking into account our particular economic
circumstances.
Statistics show that income inequality in South Africa, as measured by the
Gini Co-efficient, was at 0.59 when social transfers are excluded but it
declined to 0.35 when social transfers are included. Given such huge income
disparities, it is of critical importance to incorporate income solidarity
especially in the design of any government transfers. This is the conversation
we are currently engaging in to finalise our design of the second leg of our
SHI proposal.
Obviously, this conversation will not only be between ourselves and the
Ministry of Finance, but also between government and our stakeholders in the
health sector. I have noted that your conference programme will go into some
depth on this subject, so I will not deliberate much further on this except to
inform you that we will take particular interest in the impact of the new tax
treatment of medical scheme contributions and consider our income solidarity
proposals in this context.
The third and final step is further in the future, when we will mandate
certain income groups to belong to medical schemes. Mandatory medical scheme
membership aims to prevent free riding on the system, so that we close
loop-holes that enable people to only enter the market when they are sick and
need to be cross subsidised, and then leave when they no longer need health
care.
Ultimately, we want to encourage lifetime enrolment, but this cannot be
forced on the market at the moment. Because of the high cost of healthcare we
face, we want medical scheme membership to increase on a voluntary basis as we
improve the fairness of the system before imposing mandatory membership.
However, we also want the industry to win membership by offering value for
money, and really tackling cost escalation from their side.
In his State of the Nation Address last month, President Thabo Mbeki
announced that the Operational Plan for Comprehensive Prevention, Treatment and
Care of HIV and AIDS has resulted in the upgrading of hundreds of facilities.
To date, over 100 000 patients are receiving Antiretroviral Treatment and,
combined with patients in the private sector, South Africa has one of the
largest such treatment programme in the world. For 2005/2006 our budget for
HIV/AIDS was R1.5 billion, a R3 million increase from the previous year.
With the increasing challenge of HIV/AIDS we are continuing with monitoring
and evaluating our interventions in order to measure our successes and
implement remedies where necessary. The national Department of Health (NDOH)
has also developed an accelerated HIV prevention plan which will address the
following;
* Increase voluntary counselling and treatment (VCT) coverage, including opt
out strategy (needs wide consultation and preparation before
implementation);
* Increase coverage of prevention of mother to child transmission (PMTCT),
including opt out strategy;
* Social mobilisation is the backbone of the accelerated HIV prevention
programme
* Communication strategy to be finalised by the end of March;
* Include greater focus on life-skills in schools, especially primary schools
in the prevention plan (also youth clubs, tertiary institutions);
* Prevention programme needs to be focused - target vulnerable groups such as
women with targeted messages; and
* Need to better understand what levels of awareness exist and how to translate
knowledge and awareness into behaviour change.
In August 2005 we had a challenge during the outbreak of typhoid in Delmas,
Mpumalanga. Water samples were taken and bacteriological testing revealed a
high coliform and E.coli count in a number of the water testing points
including a number of boreholes. Residual chlorine concentration was very low
at numerous water points tested. The causative agent was salmonella typhi
[causes typhoid fever].
Major risk factors were contaminated water with bacteria found in faecal
matter, poor sanitation and hygiene. The National Outbreak Response team (NORT)
visited Delmas and offered technical support. Meetings in the field were
attended by the Ministers of Health, and Water Affairs and Forestry. Patients
were managed at Samuel Bernice Hospital and Botleng and Dumat Clinic in
Delmas.
Measures that were put in place included water provision and purification.
Health Promotion officials were deployed to different parts of Delmas to
conduct social mobilisation. Communities were provided with information on
typhoid fever and other diarrhoeal diseases. We acknowledge the importance of
infection control measures that should be strictly adhered to in all health
facilities. It is for such outbreak that we launched the washing hands campaign
late last year.
As the Department we are encouraged that during the financial year 2005/06
there was no outbreak of cholera reported. However, we continue to strengthen
our epidemic preparedness and training of provincial outbreak response teams.
The Water Affairs Department continues to monitor water sources for any
possible contamination by epidemic prone pathogens. Government is working in an
integrated manor to combat the emergence and re-emergence of waterborne
diseases, hence the country has not experienced any major outbreaks since
November 2005.
We are working hard to ensure that we deliver on our constitutional
obligations. We are in the process of finalising our 2006/11 Strategic Plan to
accordingly respond to our priorities. For this financial year we will focus on
the following:
* Human resources (HR) - As personnel consumes over 60% of the budget
consistently across all parts of the health system, the HR plan is the most
important part of the service transformation plan. The objective is to
restructure the service platform and the modes of delivery in such a way to
achieve 100% staffing in all disciplines (clinical specialties) in all
facilities offering tertiary, secondary and primary healthcare (PHC)
services.
* Service transformation plan - The core message that comes out of the review
of outcomes is the need for a comprehensive review of the service delivery
platform and the development of service transformation plans in each province.
This will be achieved through the strategic planning and budgeting process in
2006/07 leading to allocations for activities from 2007/08.
* Physical infrastructure - As the distribution of facilities fundamentally
affects the staffing requirements, rationalisation of the service delivery
platform and matching these two resource components is the next priority.
* Quality of care - Improved quality of care in the restructured service
platform is essential to the delivery of the required outcomes and the
Departmentâs vision and mission.
* Priority health programmes - Whilst efforts will continue to strengthen all
health programmes, the two critical communicable disease programmes should
enjoy additional priority during the next two to three years. These are:
accelerated prevention of HIV and implementation of the tuberculosis (TB)
crisis plan. In addition the key preventative initiatives relating to illnesses
of lifestyle must also receive special attention.
* Move for Healthâ was launched last year to mobilise South Africans to adopt
healthy lifestyles and thus improve their health and prevent lifestyle diseases
such as diabetes Type II, obesity, some cancers, heart disease, hypertension
and arthritis.
Before concluding my presentation, I would like to quickly touch on
challenges that the information and communications technology (ICT) revolution
brings to our health systems. These challenges can be divided into two broad
areas. The first has do with participation in the information society; the
second considers how ICT's impact on access, cost effectiveness and quality of
information. The context within these challenges present themselves is that of
globalisation and polarisation, in a world of increasing disparities between
the rich and poor and within nations. The scale of disparities in basic social
services remains daunting. Bringing ICT connectivity to our health sector needs
to happen. It is a task that needs to occur alongside the provision of basic
health information infrastructure and adequately trained personnel, which is
the responsibility of government. Extensive provision of ICT is, however,
beyond the financial and human resources of government alone. Partnerships with
donors and the private sector are a critical success factor.
We are committed to working with all stakeholders to reduce the burden of
disease while developing and implementing policies that will bring
comprehensive health care to all South Africans. We look forward to your
recommendations. I wish you well in your deliberations.
Thank you.
Issued by: Department of Health
13 March 2006
