A large proportion of babies born very early need intensive care, which can be painful. But the healthcare system fails to provide pain relief to the full extent. This is shown by the largest survey to date of pain in neonatal care, now published in the journal Pain.
Every day for 4.5 years, neonatal care staff have recorded the occurrence of pain, the causes of pain, and how pain is assessed and treated in premature babies in Sweden. The study covers 3686 babies born between 22 and 31 weeks of gestation from 2020 to 2024. The total observation time was just over 185 000 days of care. Data were collected in the Swedish Neonatal Quality register.
In the evaluation of the register data, the researchers found that babies born extremely early, in weeks 22 to 23, had the highest proportion of painful medical conditions and almost daily painful intensive care procedures throughout the first month after birth. However, this is not surprising.
“There is a strong correlation between acute morbidity and being born very early. The earlier a baby is born, the more intensive care it needs. Intensive care involves procedures that can be painful, such as ventilator treatment, tube feeding, insertion of catheters into blood vessels and surgical procedures. It also requires various tests and investigations that may involve pain,” says Mikael Norman, professor of paediatrics at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and lead researcher of the study.
90 percent of the most extremely preterm infants had to undergo painful procedures. Despite this, healthcare professionals reported that only 45 percent of babies experienced pain – which may be because pain was largely prevented or treated. However, a check of the drugs administered suggests other explanations may exist.
“Somewhat surprisingly, the smallest babies who were most exposed to pain had the lowest proportion of treatment with morphine. This may be a case of undertreatment,” says Mikael Norman.
Could not determine duration of pain
One limitation is that the study could not determine the duration or severity of pain for each day reported.
“The caregivers only answered yes or no to the question of whether the infant had experienced any pain in the last 24 hours. This could range from short-term, so-called procedural pain from for example a needle prick during a test to more continuous pain due to various medical conditions.
“Much is done to alleviate pain in babies. No child in neonatal care is left with severe pain untreated,” he continues.
However, it is a problem and a challenge that healthcare professionals are not always able to determine whether children are in pain.
“This involves developing better rating scales or physiological techniques to measure pain. Better pain treatments are also needed, perhaps with combinations of drugs with less risk of side effects,” says Dr Norman.
It is very important to improve pain management for premature babies, as we now know that their development is negatively affected by the strong signals in the brain that pain causes.
“The vision for all neonatal care is to be pain-free. The results of this survey will be of great importance for improving neonatal care and for future research in the field,” concludes Mikael Norman.
The Johannesburg Labour Court has ruled that community health workers, who for years have been employed by the health department on recurring fixed-term contracts, must be deemed permanent government employees.
The National Health and Allied Workers Union (NEHAWU), on behalf of its members, has successfully overturned a previous bargaining council ruling that the temporary contracts were legal.
There are an estimated 50,000 community health workers. The recurring fixed-term contracts left them without job security and other benefits of permanent employment.
The issue was first ventilated before the Public Health and Social Development Sectoral Bargaining Council in 2021. The commissioner found that the contracts were permitted by the Public Service Act, were concluded through collective agreements with unions, and were justified in terms of the Labour Relations Act (LRA) as they were funded by an “external source for a limited period” – the National Treasury.
NEHAWU took the ruling on review. The matter was argued before Johannesburg Labour Court Acting Judge Ashley Cook in October last year. He handed down his ruling on 23 January 2025, overturning the bargaining council’s findings.
On the issue of “external funding” – the legal justification in the LRA for fixing the contract terms – Judge Cook said the department had correctly submitted that it was not disputed that the funding for the employment of the community health workers was a conditional grant approved by national treasury on an annual basis.
“However, what was in dispute was whether the conditional grant was from an external source. The department receives all revenue from the National Treasury,” Judge Cook said.
As funding for all public servants was sourced from the Treasury, this meant that it was not an “external source”, and therefore the department could not rely on it as a “justifiable reason” to deviate from the provisions of the LRA.
The contracts of the community health workers were therefore, in terms of the Act, deemed to be of an “indefinite duration”, the judge said, setting aside the arbitration award.
He made no order as to costs.
NEHAWU welcomed the ruling. In a statement, it said community health workers had been on perennial contractual renewals without a clear explanation from the Department of Health.
“The court determined that it is common cause to all parties that there is a permanent need for the work tendered by community health workers as conceded by the counsel for the state.”
The union said it would continue to fight for the “permanent absorption” of all the workers and would be meeting with its members to advise on how it would ensure the implementation of the judgment.
By Henry Adams, Country Manager at InterSystems South Africa
In the healthcare sector, when people “fall through the cracks,” it often reveals deeper systemic issues: unmet health and social care needs. Vulnerable communities across the globe face these challenges, and traditional healthcare systems often struggle to bridge gaps in access to care.
A notable example of how collaboration and engagement technology can drive meaningful change in healthcare comes from Trust, formerly Harmony Health. By leveraging data, community networks, and established relationships, they illustrate how building trust can effectively close critical gaps in access to care. Their approach highlights the potential of combining technology and community engagement to reshape the delivery of health and social services.
Addressing a Crisis and Building a Solution
The COVID-19 pandemic, especially during its second wave, highlighted stark inequities in healthcare access. In the United States, during the pandemic’s second wave, vaccination efforts in underserved communities were hindered by mistrust. Health plans and government bodies struggled to reach people effectively. Recognising this failure, Trust developed a new approach centred around trust and the power of local, community-based organisations (CBOs).
Trust’s model focused on empowering trusted local figures – community health workers, faith-based leaders, and volunteers – with advanced technology. These figures already had deep, established relationships with the people they served, and the technology amplified their impact. Using a sophisticated app that supports text messaging, content sharing, and real-time language translation, CBOs could communicate effectively in over 100 languages. This approach personalised engagement using analytics and artificial intelligence (AI), ensuring each individual’s experience was meaningful and impactful.
The Power of Community Trust
The app’s success lies in its simplicity on the surface and its complexity behind the scenes. Community leaders used it to deliver critical health messages, monitor needs, and organise services. Starting as a vaccine outreach project, the model evolved to address broader issues, such as food security, mental health, and preventive health screenings. The result was a ripple effect: nearly 1.8 million people connected through a growing network of nearly 100 CBOs.
By receiving messages from known and trusted sources, community members were more responsive. Engagement rates rose by 35% to 40%, proving that trust and cultural relevance are fundamental to effective healthcare communication. This initiative transformed fragmented efforts into a cohesive, data-driven ecosystem of care, making a tangible difference in the lives of millions.
A Blueprint for South Africa
The challenges faced in underserved communities in the United States resonate deeply with South Africa’s own healthcare landscape. Here, systemic barriers, resource limitations, and deep-seated mistrust also hinder efforts to provide equitable healthcare. However, the model pioneered by Trust provides a compelling blueprint for South Africa. By empowering local organisations and community leaders with the right technology, we can bridge critical gaps in our healthcare system.
Imagine a scenario where CBOs in South Africa—organisations focused on community health, food security, or mental wellness—could leverage similar technology to connect with individuals in multiple languages, provide real-time support, and ensure critical health and social needs are met. The potential for impact is enormous, particularly in rural and underserved urban areas where traditional healthcare systems struggle to keep up with demand.
Interoperability and Scalability in a South African Context
A core strength of the solution lies in Trust’s use of InterSystems IRIS for Health, which enables seamless integration of data collected from every interaction into electronic health records and government systems. This ensures continuity of care and streamlines processes, from enrolling uninsured individuals to improving access to preventive services. In South Africa, where healthcare data often sits in silos, a similar system could break down barriers, making healthcare more efficient and comprehensive.
The model’s scalability is crucial for addressing the needs of South Africa’s diverse and expansive population. By connecting disparate systems and enabling CBOs to work together, the approach creates a support network that adapts and grows based on the needs of each community. Whether it’s addressing food insecurity, supporting maternal health, or connecting individuals to mental health resources, the technology ensures that no one is left behind.
Beyond Fragmented Healthcare in South Africa
Trust’s success in the United States demonstrates that technology when combined with the power of community trust, can transform healthcare delivery. South Africa has the opportunity to adapt and implement similar solutions, leveraging local networks and cultural dynamics to address unmet needs.
By investing in scalable, data-driven technology and empowering local organisations, we can close the gaps in our healthcare system and ensure that more people receive the care and support they deserve. Healthcare in South Africa doesn’t have to remain fragmented. With the right approach, we can build a more connected, equitable, and responsive healthcare system.
Visual information has long been proven to affect balance – for example, strobe lights and swirling images can cause instability – but a new study published in PLOS ONE shows that sounds can also be a disruptive factor for those who have vestibular hypofunction, a vestibular system disorder resulting in impaired balance.
“People with vestibular hypofunction have difficulty in places like busy streets or train stations where the overwhelming visual information may cause them to lose balance or be anxious or dizzy,” says lead author Anat Lubetzky, associate professor of physical therapy at NYU Steinhardt School of Culture, Education, and Human Development. “Sounds are not typically considered during physical therapy, making our findings particularly relevant for future interventions.”
The researchers conducted an experiment with 61 participants divided into two groups: healthy controls and individuals with unilateral vestibular hypofunction (affecting one ear).
Participants wore a virtual reality headset that simulated the experience of being in a New York City subway. As they experienced the sights and sounds of the “subway,” they stood on a platform that measured their body movement, while the headset recorded their head movement, two indicators of balance known as sway. Participants were provided with different subway scenarios: static or moving visuals paired with silence, white noise, or recorded subway sounds.
The results revealed that for the group with vestibular hypofunction, the moving visuals accompanied by audio (either white noise or subway sounds) resulted in the greatest amount of sway. This sway was evident on the body’s forward and backward movements, as well as head movements left to right, and head tilts upward and downward. Audio conditions did not affect the balance of the healthy individuals.
“What we’ve learned is that sound should be included as part of both the assessment of balance and intervention programs,” says Lubetzky. “Because balance training is known to be task-specific, ideally, these should be real sounds related to patients’ typical environments and combined with salient and increasingly challenging visual cues. Portable virtual headsets are a promising tool for both assessing and treating balance problems.”
The Hospital Association of South Africa (HASA) remains unequivocally committed to working with all stakeholders to build a healthcare system that sustainably benefits all citizens of South Africa and urges all involved parties to engage in a solution-oriented approach.
HASA believes the National Health Insurance is neither sustainable nor affordable and that dialogue and collaboration between all stakeholders is critical to finding and developing solutions to achieve universal health coverage.
HASA has thus far deferred filing a legal challenge to the NHI Act as it firmly believes that sustainable and affordable solutions, to achieve universal health coverage for all South Africans, are within reach. However, the government’s lack of response to several constructive and practical proposals, including those of Business Unity South Africa (BUSA), and the Minister of Health’s recent public statements concerning the NHI, including regarding the imminent publication of NHI regulations, have necessitated that HASA move forward with its legal challenge to the NHI legislation.
Even though HASA has decided to proceed with legal action, it remains hopeful that the Presidency will respond positively to the constructive proposals that have been made.
HASA remains open to engaging with the Government on the way forward in parallel to the legal process. Reiterating the time-critical nature of the matter, Melanie Da Costa, Chairperson of HASA, today said, “We remain firmly committed to participating constructively while the legal process unfolds. As an organisation, we have always preferred to resolve matters through dialogue, and we believe that effective healthcare solutions are urgently needed and achievable through a reasonable and collaborative approach.”
Ischaemic and haemorrhagic stroke. Credit: Scientific Animations CC4.0
A new study by researchers at the Department of Molecular Medicine at SDU sheds light on one of the most severe consequences of stroke: damage to nerve fibres – the brain’s “cables” – which leads to permanent impairments. The study, which is published in the Journal of Pathology, used unique tissue samples from Denmark’s Brain Bank located at SDU, may pave the way for new treatments that help the brain repair itself.
The brain tries to repair damage
Following an injury, the brain tries to repair the damaged nerve fibres by re-establishing their insulating myelin sheaths. Unfortunately, the repair process often succeeds only partially, meaning many patients experience lasting damage to their physical and mental functions. According to Professor Kate Lykke Lambertsen, one of the study’s lead authors, the brain has the resources to repair itself. “We need to find ways to help the cells complete their work, even under difficult conditions,” Prof Lykke said.
The researchers have thus focused on how inflammatory conditions hinder the rebuilding. The study has identified a particular type of cell in the brain that plays a key role in this process. These cells work to rebuild myelin, but inflammatory conditions often block their efforts.
How researchers used the brain collection
-Using the brain collection, we can precisely map which areas of the brain are most active in the repair process, explains Professor Kate Lykke Lambertsen.
This mapping has enabled researchers to analyse tissue samples from Denmark’s Brain Bank and gain a deeper understanding of the mechanisms that control the brain’s ability to heal itself.
Through advanced staining techniques, known as immunohistochemistry, the researchers have been able to detect specific cells that play a central role in the reconstruction of myelin in the damaged areas of the brain.
The samples were analysed to distinguish between different areas of the brain, including the infarct core (the most damaged area), the peri-infarct area (surrounding tissue where rebuilding is active), and tissue that appears unaffected.
The analysis provided insight into where repair cells accumulate and how their activity varies depending on gender and time since the stroke.
Women and men react differently
An interesting discovery in the study is that women’s and men’s brains react differently to injuries.
-The differences underscore the importance of future treatments being more targeted and taking into account the patient’s gender and individual needs, says Kate Lykke Lambertsen.
In women, it seems that inflammatory conditions can prevent cells from repairing damage, while men have a slightly better ability to initiate the repair process. This difference may explain why women often experience greater difficulties after a stroke.
The brain collection at SDU is key to progress
The researchers behind the study emphasise that the discoveries could not have been made without the Danish Brain Bank at SDU. The collection consists of tissue samples from humans, used to understand brain diseases at a detailed level.
With access to this resource, researchers can investigate the mechanisms behind diseases like stroke and develop new treatment strategies.
Researchers have found that a newly developed diet inspired by the eating habits of non-industrialised societies can significantly reduce the risk of a number of chronic diseases typical of processed, low-fibre industrialised diets – and are to share recipes with the public.
Their paper, published in Cell, shows that a newly developed diet that mimics eating habits in non-industrialised communities led to significant metabolic and immunological improvements in a human intervention study. In just three weeks the diet:
Promoted weight loss
Decreased bad cholesterol by 17%
Reduced blood sugar by 6%
Reduced C-reactive Protein (a marker of inflammation and heart disease) by 14%
These improvements were linked to beneficial changes in the participants’ gut microbiome, the home to trillions of bacteria that play a vital role in our health, influencing digestion, immunity, and metabolism. The research was conducted by an international teams of scientists led by Professor Jens Walter, a leading scientist at University College Cork. The human trial was performed at the University of Alberta in Canada, Prof Walter’s previous institution.
“Industrialisation has drastically impacted our gut microbiome, likely increasing the risk of chronic diseases.” explained Prof Walter, who is also a Principal Investigator at APC Microbiome Ireland, a world-renowned Research Ireland centre
“To counter this, we developed a diet that mimics traditional, non-industrialised dietary habits and is compatible with our understanding on diet-microbiome interactions. In a strictly controlled human trial, participants followed this diet and consumed L. reuteri, a beneficial bacterium prevalent in the gut of Papua New Guineans but rarely found in the industrialised microbiomes.”
The study demonstrated that the new diet entitled NiMeTM (Non-industrialised Microbiome Restore) diet enhanced short-term persistence of L. reuteri in the gut.
However it also improved microbiome features damaged by industrialisation, such as reducing pro-inflammatory bacteria and bacterial genes that degrade the mucus layer in the gut. These changes were linked to improvements in cardiometabolic markers of chronic disease risk.
Although participants did not consume fewer calories on the NiMe diet, they lost weight, and the diet alone led to considerable cardiometabolic benefits.
In previous research, Prof Walter’s team, studying the gut microbiome in rural Papua New Guinea, found that individuals there have a much more diverse microbiome, enriched in bacteria that thrive from dietary fibre, and with lower levels of pro-inflammatory bacteria linked to western diet. This information was used to design the NiMeTM diet.
The NiMeTM diet shares key characteristics of non-industrialised diets:
Plant-based focus, but not vegetarian: Primarily made up of vegetables, legumes, and other whole-plant foods. One small serving of animal protein per day (salmon, chicken, or pork).
No dairy, beef, or wheat: Excluded simply because they are not part of the traditional foods consumed by rural Papua New Guineans.
Very low in processed foods that are high in sugar and saturated fat.
Fibre-rich: Fibre content was 22 grams per 1000 calories – exceeding current dietary recommendations.
“Everybody knows that diet influences health, but many underestimate the magnitude”, said Prof. Walter.
Commenting on this study, Prof. Paul Ross, Director of APC Microbiome Ireland, said: “This study shows that we can target the gut microbiome through specific diets to improve health and reduce disease risk. These findings could shape future dietary guidelines and inspire the development of new food products and ingredients, as well as therapeutics, which target the microbiome”.
“The recipes from the NiMe Diet will be posted to our Instagram ( @nimediet ) and Facebook pages, and they will also be included in an online cookbook soon. It is important to us to make these recipes freely available so that everyone can enjoy them and improve their health by feeding their gut microbiome,” said Dr Anissa Armet from the University of Alberta, a registered dietitian that designed the NiMe diet and one of the lead authors of the publication.
Antibiotics, antivirals, vaccinations and anti-inflammatory medication are associated with reduced risk of dementia, according to new research that looked at health data from over 130 million individuals.
The study, led by researchers from the universities of Cambridge and Exeter, identified several drugs already licensed and in use that have the potential to be repurposed to treat dementia.
Dementia is a leading cause of death in the UK and can lead to profound distress in the individual and among those caring for them. It has been estimated to have a worldwide economic cost in excess of US$1 trillion dollars.
Despite intensive efforts, progress in identifying drugs that can slow or even prevent dementia has been disappointing. Until recently, dementia drugs were effective only for symptoms and have a modest effect. Recently, lecanemab and donanemab have been shown to reduce the build-up in the brain of amyloid plaques – a key characteristic of Alzheimer’s disease – and to slow down progression of the disease, but the National Institute for Health and Care Excellence (NICE) concluded that the benefits were insufficient to justify approval for use within the NHS.
Scientists are increasingly turning to existing drugs to see if they may be repurposed to treat dementia. As the safety profile of these drugs is already known, the move to clinical trials can be accelerated significantly.
Dr Ben Underwood, from the Department of Psychiatry at the University of Cambridge and Cambridgeshire and Peterborough NHS Foundation Trust, said: “We urgently need new treatments to slow the progress of dementia, if not to prevent it. If we can find drugs that are already licensed for other conditions, then we can get them into trials and – crucially – may be able to make them available to patients much, much faster than we could do for an entirely new drug. The fact they are already available is likely to reduce cost and therefore make them more likely to be approved for use in the NHS.”
In a study published today in Alzheimer’s and Dementia: Translational Research & Clinical Interventions, Dr Underwood, together with Dr Ilianna Lourida from the University of Exeter, led a systematic review of existing scientific literature to look for evidence of prescription drugs that altered the risk of dementia. Systematic reviews allow researchers to pool several studies where evidence may be weak, or even contradictory, to arrive at more robust conclusions.
In total, the team examined 14 studies that used large clinical datasets and medical records, capturing data from more than 130 million individuals and 1 million dementia cases. Although they found a lack of consistency between studies in identifying individual drugs that affect the risk of dementia, they identified several drug classes associated with altered risk.
One unexpected finding was an association between antibiotics, antivirals and vaccines, and a reduced risk of dementia. This finding supports the hypothesis that common dementias may be triggered by viral or bacterial infections, and supports recent interest in vaccines, such as the BCG vaccine for tuberculosis, and decreased risk of dementia.
Anti-inflammatory drugs such as ibuprofen were also found to be associated with reduced risk. Inflammation is increasingly being seen to be a significant contributor to a wide range of diseases, and its role in dementia is supported by the fact that some genes that increase the risk of dementia are part of inflammatory pathways.
The team found conflicting evidence for several classes of drugs, with some blood pressure medications and anti-depressants and, to a lesser extent, diabetes medication associated with a decreased risk of dementia and others associated with increased risk.
Dr Ilianna Lourida from the National Institute for Health and Care Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, said: “Because a particular drug is associated with an altered risk of dementia, it doesn’t necessarily mean that it causes or indeed helps in dementia. We know that diabetes increases your risk of dementia, for example, so anyone on medication to manage their glucose levels would naturally also be at a higher risk of dementia – but that doesn’t mean the drug increases your risk.
“It’s important to remember that all drugs have benefits and risks. You should never change your medicine without discussing this first with your doctor, and you should speak to them if you have any concerns.”
The conflicting evidence may also reflect differences in how particular studies were conducted and how data was collected, as well as the fact that different medications even within the same class often target different biological mechanisms.
The UK government is supporting the development of an Alzheimer’s trial platform to evaluate drugs rapidly and efficiently, including repurposed drugs currently used for other conditions.
“Pooling these massive health data sets provides one source of evidence which we can use to help us focus on which drugs we should try first,” said Dr Underwood. “We’re hopeful this will mean we can find some much-needed new treatments for dementia and speed up the process of getting them to patients.”
Whether or not the ANC and DA can find common ground on the future of medical schemes is set to be a major test of South Africa’s Government of National Unity. Ahead of a Cabinet lekgotla where the issue is expected to be on the agenda, momentum has been gathering behind a compromise option.
Little more than a month after President Cyril Ramaphosa signed the National Health Insurance (NHI) Act into law in May last year, the ANC entered into a government of national unity (GNU) following a large drop in their share of the vote in South Africa’s 2024 elections. This raised questions over the future of NHI, given that the second largest party in the GNU, the DA, is vehemently opposed to NHI.
The NHI Act has not yet been promulgated and could be amended if the ANC and DA agree to do so. But whether the parties can agree to a compromise remains unclear, especially since there appears to be a hardline faction in the ANC that is committed to NHI as currently encapsulated in the NHI Act. As it stands, the Act foresees a dramatically reduced role for medical schemes whereby they will not be allowed to cover services that are already covered by the NHI fund.
Also in play are at least four High Court challenges to NHI legislation – by the Board of Healthcare Funders (BHF) challenging Ramaphosa’s assent to the NHI Bill just before the elections last year, Solidarity, and the SA Private Practitioners Forum, both claiming government overreach which impacts on people’s right to choose their own health cover and run their own businesses. The South African Medical Association (SAMA) is also preparing a legal challenge.
Two proposals
Meanwhile, momentum has been growing with two compromise proposals: one from Business Unity South Africa (BUSA), the country’s apex business organisation broadly representing the banking, mining and retail sectors, but more pertinently here, the Health Funders Association, the Hospital Association of South Africa, and the Innovative Pharmaceuticals Association of SA. The other is from the United Healthcare Access Coalition (UHAC), a large coalition of healthcare worker groups including, among others, SAMA, the South African Private Practitioners Forum, and the Progressive Healthcare Forum.
BUSA last year met with Ramaphosa and, on his request, provided a detailed yet currently “confidential” proposal, wanting key sections of the NHI Act amended and/or thrown out to enable medical schemes to remain in play by punting mandatory health insurance.
“The BUSA proposal is being processed by the Department of Health and National Treasury. Once processed, a response to BUSA will be formulated accordingly,” presidential spokesperson Vincent Magwenya told Spotlight this week.
The fundamental difference between the two objecting groups is that the UHAC thinks the NHI Act should be thrown out completely and replaced with their detailed blueprint, while BUSA wants the existing Act amended to accommodate private funders. In its proposal, the UHAC urges implementation of long delayed fundamental systemic reform in both healthcare sectors to enable what they say would be efficient, pragmatic and more politically neutral, consultation-driven universal healthcare measures.
We understand that in a meeting between the two groups, shortly before BUSA lodged its proposal with the Presidency, not enough common ground could be found to join forces.
But there are significant overlaps in their proposals. Both groupings embrace mandatory health insurance and dismiss a single central fund as envisaged under NHI as dangerous and financially unfeasible.
DA spokesperson for health, Michelle Clarke, said her party backs mandatory insurance. She also said the party agrees with the UHAC proposals – and would not hesitate to mount a legal challenge should the NHI go ahead without substantial amendments.
Mandatory health insurance was part of government’s longer term health reform plans until the pendulum swung in favour of NHI at the ANC’s national conference in Polokwane in 2007 when Jacob Zuma became president of the party. The idea was placed back in the spotlight last September when Dr Richard Friedland, immediate past CEO of the Netcare Hospital Group and a key member of BUSA’s health delegation, made the case for it at the HASA conference.
Under mandatory health insurance, everyone who is in formal employment, or who earns above a certain threshold, would be forced by law to be a member of a medical scheme. This, it is argued, would result in medical scheme membership swelling substantially and pressure being taken off the public healthcare system. It is also expected to result in medical scheme premiums being reduced because more healthy, younger people will join the schemes. People who are unemployed or who cannot afford health insurance will still be taken care of by the public healthcare system, which would also take paying medical aid members.
Friedland said at the time that mandatory healthcare insurance would triple the medical scheme market from 9.2 million to potentially 27.5 million beneficiaries over time and reduce those dependent on the state from 53.8 million to 35.5 million.
This week Friedland declined to reveal the contents of the BUSA proposal, saying it was with Ramaphosa and thus confidential.
Meanwhile, Health Minister Dr Aaron Motsoaledi last week rubbished media reports that the cabinet lekgotla scheduled for month end would be taking on board the BUSA proposal. He did however confirm that he will shortly announce which of the far-ranging and long-outstanding recommendations of the Competition Commission’s Health Market Inquiry (HMI) into the private healthcare sector will be implemented, something many have been calling for in recent years.
Far-reaching reforms
Adjunct Professor Alex van den Heever, Chair of Social Security Systems Administration and Management Studies at the University of the Witwatersrand, who with Dr Aslam Dasoo, founder and chair of the Progressive Health Forum, forms part of the UHAC, said their fundamental point of departure is that the status quo is unacceptable.
According to the UHAC report, irregular provincial health expenditure levels provide a proxy indicator for corruption. The combined irregular expenditure for eight of the nine provinces from 2017/18 to 2022/23 consistently averages around 12.3% (around R9 billion per annum) of non-personnel expenditure compared to 0.1% for the DA-run Western Cape.
“The difference in performance between the Western Cape and the other eight provinces is reasonably attributable to governance differences,” the report reads.
Observes Van den Heever: “We’re losing an enormous amount of performance in the public sector because of political appointments into the system. It compromises leadership and results in a massive waste of resources. The Western Cape shows you the difference governance can make.”
He said that in the “dismally” regulated private sector, funding the pooling system was identified as a problem even before 1994, “but you don’t now disrupt the system to amalgamate into a monopoly fund to solve this (i.e. NHI). Risk equalisation would force medical schemes to compete on the value of what they cover, and nobody would be discriminated against in accessing healthcare.”
Van den Heever says the NHI intention to increase taxes and move funding money from the private to the public sector is “unworkable”.
He added: “The way to address pooling problems is to separate pooling from purchasing. The NHI process has pooling and purchasing in the same organisation, centralising everything – which is highly inefficient, unworkable and with negative consequences all the way through.
“The UHAC proposal separates them out with the provinces and medical schemes remaining as purchasers while strategic pooling or resource allocation is a national function. So, risk equalisation and taxation form part of strategic national pooling functions, while the purchasing and provision of health services are protected from political appointments – including national ministers and provincial MECs.”
Dasoo, who is also a founder member of trade union NEHAWU, said the UHAC collaborative proposal draws on all the research developed over several decades including the Taylor Commission, which made recommendations on an effective social security system for South Africa, the HMI, and numerous other official inquiries.
Dasoo described the UHAC report as “everything that the NHI is not. This health pathway requires easy legislative changes and is within current fiscal constraints. We can start the process immediately. It requires a change in governance structure of the provincial health systems where politicians relinquish all direct authority they have over health care institutions and instead focus on strategic policy.”
BHF hearing in March
A spokesperson for the BHF, Zola Mtshiya, confirmed their NHI legal challenge, set for hearing in March, but said the BHF was only invited to sign up to the UHAC proposal after it was made public. The BHF represents most medical aid schemes – except for the largest, Discovery Health.
BHF Managing Director, Dr Katlego Mothudi, said his organisation is “engaging the association [UHAC] on the document”. he added: “We welcome the willingness to collaborate as an industry as strengthening health systems is everybody’s business.”
Cabinet lekgotla next week
Despite all these developments, whether the ANC is open to a potential compromise on NHI remains unclear. On the one hand, the presidency says they have asked Treasury and the Department of Health to consider the BUSA proposal, on the other, Motsoaledi has rubbished suggestions that the ANC’s position on NHI has shifted and appears committed to an NHI system that dramatically limits the role of medical schemes. His position is thus incompatible with that of the DA.
According to media reports, things got very heated between Motsoaledi and DA ministers when NHI and the future role of medical schemes were discussed at a Cabinet meeting last October.
The matter is likely to again be on the agenda at the Cabinet lekgotla set to take place next week.
Asked about how the GNU might eventually influence universal healthcare, Clarke said: “ANC arrogancy has tapered down a lot compared to what I’m used to. There’s a lot more transparency – but we cannot allow for a very badly written law with huge implications for people’s lives and the economy to go ahead.”
Foster Mohale, spokesperson for the national health department, declined to provide comment for this article, referring Spotlight to the Presidency and Motsoaledi. “What I can say is we’re still working on the Health Market Inquiry recommendations and will let you know when there’s an announcement,” he said.
Magwenya did not provide responses to most of Spotlight’s questions, other than saying that both Treasury and the health department are considering the BUSA proposal and confirming that the President had met with BUSA.
A brain-computer interface, surgically placed in a research participant with tetraplegia, paralysis in all four limbs, provided an unprecedented level of control over a virtual quadcopter – just by thinking about moving his unresponsive fingers.
The technology divides the hand into three parts: the thumb and two pairs of fingers (index and middle, ring and small). Each part can move both vertically and horizontally. As the participant thinks about moving the three groups, at times simultaneously, the virtual quadcopter responds, manoeuvring through a virtual obstacle course.
It’s an exciting next step in providing those with paralysis the chance to enjoy games with friends while also demonstrating the potential for performing remote work.
“This is a greater degree of functionality than anything previously based on finger movements,” said Matthew Willsey, U-M assistant professor of neurosurgery and biomedical engineering, and first author of a new research paper in Nature Medicine. The testing that produced the paper was conducted while Willsey was a researcher at Stanford University, where most of his collaborators are located.
While there are noninvasive approaches to allow enhanced video gaming such as using electroencephalography to take signals from the surface of the user’s head, EEG signals combine contributions from large regions of the brain. The authors believe that to restore highly functional fine motor control, electrodes need to be placed closer to the neurons. The study notes a sixfold improvement in the user’s quadcopter flight performance by reading signals directly from motor neurons vs. EEG.
To prepare the interface, patients undergo a surgical procedure in which electrodes are placed in the brain’s motor cortex. The electrodes are wired to a pedestal that is anchored to the skull and exits the skin, which allows a connection to a computer.
“It takes the signals created in the motor cortex that occur simply when the participant tries to move their fingers and uses an artificial neural network to interpret what the intentions are to control virtual fingers in the simulation,” Willsey said. “Then we send a signal to control a virtual quadcopter.”
A screenshot of the game display shows the quadcopter following a green path around the rings. The inset shows a hand avatar. The neural implant records from nearby neurons and algorithms determine the intended movements for the hand avatar. The finger positions are then used to control the virtual quadcopter. Image credit: Nature Medicine
The research, conducted as part of the BrainGate2 clinical trials, focused on how these neural signals could be coupled with machine learning to provide new options for external device control for people with neurological injuries or disease. The participant first began working with the research team at Stanford in 2016, several years after a spinal cord injury left him unable to use his arms or legs. He was interested in contributing to the work and had a particular interest in flying.
“The quadcopter simulation was not an arbitrary choice, the research participant had a passion for flying,” said Donald Avansino, co-author and computer scientist at Stanford University. “While also fulfilling the participant’s desire for flight, the platform also showcased the control of multiple fingers.”
Co-author Nishal Shah, incoming professor of electrical and computer engineering at Rice University, explained, “controlling fingers is a stepping stone; the ultimate goal is whole body movement restoration.”
Jaimie Henderson, a Stanford professor of neurosurgery and co-author of the study, said the work’s importance goes beyond games. It allows for human connection.
“People tend to focus on restoration of the sorts of functions that are basic necessities – eating, dressing, mobility – and those are all important,” he said. “But oftentimes, other equally important aspects of life get short shrift, like recreation or connection with peers. People want to play games and interact with their friends.”
A person who can connect with a computer and manipulate a virtual vehicle simply by thinking, he says, could eventually be capable of much more.
“Being able to move multiple virtual fingers with brain control, you can have multifactor control schemes for all kinds of things,” Henderson said. “That could mean anything, from operating CAD software to composing music.”
