primary

A poisonous snake slithering through a district hospital, badly cracked walls and rooms filled to the roof with broken equipment were some of the challenges facing researchers as they conducted the first national audit of public health facilities.

For most of last year, 20 data collection teams visited 3 880 public health facilities, throughout the country, ranging from tiny clinics to national central hospitals. The vast majority – 3 074 – were clinics.

The aim was to assess all public health facilities according to six criteria so that problems could be identified and addressed.

The KwaZulu-Natal Department of Health is to set up Cuban medical schools in the province to boost its delivery of primary health services, a key feature of the country’s new National Health Insurance (NHI) plan.

Making the announcement at this week’s Provincial Consultative Health Forum in Pietermaritzburg, KZN Health MEC, Dr Sibongiseni Dhlomo, said a departmental delegation would visit Cuba later this month to explore the options.

“We know that as a country we are not producing enough doctors. The demand far exceeds our current output of doctors each year,” Dhlomo told conference delegates, which included senior government officials.

Department of Health would guarantee the payment of private general practitioners (GPs) who worked in public clinics in the National Health Insurance (NHI) pilot districts, Health Minister Aaron Motsoaledi said yesterday.

The NHI envisions private practitioners being involved in public health institutions, and this is the first time that Dr Motsoaledi has fleshed out the proposal and guaranteed the payment of such medical officers.

The thinking is that private sector health resources will improve referral systems, as well as increase patients’ confidence in primary healthcare facilities.

Dr Motsoaledi was addressing journalists on the sidelines of the South African Medical Association’s (Sama ’s) conference.

South Africa will increasingly move towards nurse-initiated treatment for multidrug-resistant tuberculosis (MDR-TB) in the next five years, and a programme in KwaZulu-Natal Province, which has a high HIV/TB burden, is already training nurses to manage MDR-TB patients.

Faced with a chronic shortage of doctors, South Africa moved to nurse-initiated antiretroviral treatment (NiMart) in April 2010. Now, government plans to roll out nurse-initiated MDR-TB treatment, and to make it and NiMart available at all primary healthcare, antenatal, TB and mobile outreach clinics by 2016, according to the National Strategic Plan on HIV, STIs [sexually transmitted infections] and TB.

Simon Puttergill* is a clinical manager at a state hospital in an isolated part of the Eastern Cape. His colleagues describe him as exceptionally competent.

Over the past seven years he has been instrumental in reducing by half the number of babies dying in the first week of their lives. He has helped to increase the number of infants delivered in hospital instead of the mothers giving birth at home by more than 50%.

LONG queues at Gauteng healthcare facilities were an indication that health services in the province faced huge demand, Premier Nomvula Mokonyane said yesterday as she toured health facilities.

Ms Mokonyane visited the Kliptown Clinic and the Chris Hani Baragwanath Hospital in Soweto, where she found long queues of patients in the waiting rooms, some claiming to have been waiting to be served for more than four hours.

"The perception that primary healthcare in Gauteng was not functional is incorrect," said Ms Mokonyane. The overcrowding indicated that residents still had confidence in primary healthcare services in the province, she said.

For National Health Insurance (NHI) to be successful the quality of public healthcare must improve “tremendously” and a stop must be put to the pricing of private health “which is running away with us”, health minister Dr Aaron Motsoaledi told the Healthcare in Africa meeting last night (TUES).

“In fact it is non-negotiable,” the minister told The Economist sponsored meeting, which will today discuss the challenges of health systems in Africa.

The gap between South African public and private health expenditure is narrowing as the public sector plays catch up. Public spending is expected to exceed private sector spending in the future, the 2011 South Africa health review released yesterday showed.

According to the report compiled by the Health Systems Trust, public hospital spending on average has increased by 5.4 percent a year over the past three years.

Treasury officials have criticised the health department’s lack of detail about how it aims to transform public hospitals in preparation for the National Health Insurance (NHI) scheme.

“It is of concern that the NHI documents did not provide sufficient detail on a credible strategy for public hospital reform, with the exception of the important Office of Health Standards Compliance (OHSC),” according to Treasury officials Mark Blecher, Aparna Kollipara, Nomkhosi Zulu and academic Pieter de Jager.

The OHSC will set norms and standards for hospitals.

THE announcement by Health Minister Aaron Motsoaledi on Friday that the Department of Health is to embark on a joint venture to invest R1bn in the construction of a factory to produce antiretroviral ingredients is another example of the minister’s obvious commitment to improving the South African public health system.

The purpose of the joint venture with Swiss pharmaceutical manufacturer Lonza is to reduce SA’s dependence on imported drugs used to treat HIV/AIDS, while at the same time promoting domestic manufacturing. This is a prime example of state intervention in the economy as not only justified but necessary.