A fire broke out yesterday, Thursday 5th December, at Netcare Pretoria East Hospital in Moreleta Park, prompting the evacuation of hundreds of patients. City of Tshwane firefighters promptly arrived on the scene, quickly getting the blaze under control. No injuries were reported.
Speaking to Newzroom Afrika, Netcare spokesperson Lynne O’Connor said that the fire was under control and with the Fire Marshal declaring that parts of the hospital to be safe, patients were being returned to their wards. As to the extent of damage and the cause, she said that “We know that the fire broke out somewhere near the theatre complex.”
As per the disaster management protocols, Netcare evacuated every single one of the approximately 200 patients in the hospital as soon as the alarm went off. The procedure was precautionary and none of the patients were harmed. O’Connor praised the swift response of the Tshwane emergency services. She said the cause of the fire was being investigated, and the extent of the damage would still need to be evaluated, News24 reports.
“We are grateful that everyone was brought to safety and sincerely apologise to the affected patients and their families for the inconvenience.”
JOHANNESBURG, 26 November 2024 – Life Healthcare Group has delivered a robust operating performance for the year ended 30 September 2024, marked by a strong second-half (H2-2024) performance in its southern Africa operations and exceptional growth in its international Life Molecular Imaging (LMI) business. Group revenue grew by 12.7% year-on-year.
In southern Africa, Life Healthcare experienced a strong second half performance, particularly within its acute and complementary business. Acute-hospitals paid patient days (PPDs) grew 1.6% and occupancies reached 68.7% for the year with the second half delivering occupancies of 70.7%. This positive momentum resulted in a 7.7% increase in revenue, with H2-2024 revenue growth of 9.3%. Strategic partnerships with funder networks further cemented Life Healthcare’s position as the preferred hospital network for leading medical schemes.
Peter Wharton-Hood, Chief Executive of Life Healthcare Group, commented, “Our Group maintains a solid financial foundation, characterised by a fortress balance sheet and minimal gearing, which allows us to strategically invest in expansion opportunities across our diversified portfolio. We are particularly encouraged by our second-half results in southern Africa and the ongoing success of LMI as well as the extraordinary distribution to shareholders over the year. Our focus remains on delivering superior patient care and broadening access to essential and complementary healthcare services.”
Group revenue from continuing operations reached R25.5 billion (2023: R22.6 billion), with southern African revenue contributing R23.7 billion (2023: R22.0 billion), and international operations R1.8 billion (2023: R656 million).
Life Healthcare’s net debt to normalised EBITDA is at a healthy 0.45 times. Cash generated from continuing operations was R4.3 billion and available undrawn bank facilities amounted to R2.3 billion.
The Group’s total EPS increased by more than 1000% to 328.8 cents per share but this does include the profit on the disposal of Alliance Medical Group (AMG) (a profit of R2.8 billion). Excluding this profit and some small impairments the HEPS increased by 73.4% to 152.9 cents (2023: 88.2 cents). The best measure to reflect the Group’s strong financial performance for the year is normalised EPS excluding the benefit from the RM2 transaction, this reflected an increase of 14.5% to 132.3 cents per share.
The Group received R10.2 billion in net cash proceeds from the disposal of AMG, after the settlement of all offshore debt and transaction costs. A special dividend of R6 per share (R8.8 billion) was paid on 8 April 2024 from these proceeds.
The Life Healthcare Group board declared a final cash dividend of 31 cents per share, an increase of 14.8% over the prior year, and a special dividend of 70 cents per share. Total distributions for the year, including special dividends, amount to R10.6 billion.
“We are delighted with our progress in the acute, complementary, and pharmaceutical sectors,” remarked Wharton-Hood. “Our strategic funder network partnerships position us as the preferred choice among leading medical schemes. Our robust financial assets and prudent cost management will continue to support our capital expansion initiatives across all business areas. Exciting times lie ahead for Life Healthcare Group, and these results reflect that promise.”
A study led by researchers at the University of Colorado Anschutz Medical Campus reveals that both patients and providers have more positive overall care experiences when the entire healthcare team is a part of bedside interdisciplinary rounds (BIDR).
The findings showed that BIDR, when the team meets at a patients’ bedside in the hospital to discuss care plans, helps build trust between patients and their healthcare providers and within healthcare teams by allowing everyone to observe and work together more closely. The study is out now in the Journal of General Internal Medicine.
“Traditional interdisciplinary rounds (IDR) consist of a clinical care team that coordinates a patient’s care together to help promote collaboration in hospitals. BIDR takes this process a step further by taking the team to the bedside and involving patients and their families,” said lead author Katarzyna Mastalerz, MD, associate professor of hospital medicine at University of Colorado School of Medicine. “BIDR transforms this traditional healthcare model by fostering trust through transparent communication, team collaboration and patient-centred care where every voice is heard, and every goal can be shared.”
The study interviewed 14 patients and 18 members of a interdisciplinary teams that included nurses, pharmacists and care coordinators.
Patients who participated in BIDR expressed positive feelings about being involved in their healthcare plans, which enhanced their trust in providers. Healthcare professionals reported improved respect and trust among colleagues, which contributed to better patient care.
While results were mostly promising, patients and providers said there is room for improvement to make the process more streamlined.
For example, some patients reported being uncomfortable due to the use of technical jargon and unclear communication regarding their treatment plans. Meanwhile, the providers said they faced challenges related to lack of supportive structures for interprofessional collaboration and lengthy presentations by physicians.
“To build effective BIDR, we suggest healthcare teams use transparency by sharing goals with patients, employing accessible patient-centred language, clearly delineating team roles for each team member, and actively addressing team input in real time” said Mastalerz. “With the professional siloes and hectic workflow that often characterise hospitals, it’s especially important for hospital leadership to recognise, support, and create opportunities for collaborative work by interprofessional teams.”
Johannesburg’s first general hospital was built on the “brow of the hill” in 1890. The building is now abandoned and derelict. (Photo: Courtesy of WRHI)
Hillbrow started out as Johannesburg’s first health hub in the late 1880s. It’s also been a suburb associated with pimps and prostitution, a middle finger to the Nationalist Party, and a key site of the HIV crisis. Today, it’s the forgotten flatlands of inner city decay … but in small pockets it stays true to its heritage of bringing healthcare to the city’s most overlooked.
Putting some distance between people and disease can sometimes be a smart idea. It’s what early Johannesburg town planners had in mind when they decided that the city’s first hospital should rise on the “brow of the hill”, looking north away from the gold-flushed, but malady-stricken, mining centre.
Johannesburg’s first general hospital opened in 1890. It was four years after Johannesburg was proclaimed a city under the Transvaal government with Paul Kruger at its head. With the hospital as an anchor in the suburb, Hillbrow would grow to become the health node of the city as it rushed into the new century with heady intentions to become a modern metropolis.
The Johannesburg General Hospital would treat miners arriving with crushed limbs and broken bodies from mining accidents, which were frequent. Other patients were admitted with respiratory illnesses and ruined lungs from breathing in silica dust as the angled reef under the Witwatersrand was drilled and crudely blasted for its yellow treasure.
From the shanties and old mining camps came those burdened with diseases of absent hygiene and sanitation and overcrowding. Typhoid, tuberculosis (TB) and dysentery were common. There would be malaria and smallpox. In 1905, the Rand Plague Committee published a report detailing outbreaks of pneumonic plague and bubonic plague in those first years of the new century. There would be waves of influenza as the “Spanish Flu” of 1918 swept through the country.
Author of Johannesburg Then and Now Marc Latilla writes that the first Johannesburg hospital located in Hillbrow was described as “lofty with handsome fireplaces”. He writes that the hospital had 130 beds for black and white patients. More wards would come with expansion plans, but so would racially segregated healthcare. By 1895, a separate wing would be built for black patients.
Tumult and gold fever
The new city was being constructed against a backdrop of tumult and gold fever. Social tensions, divisions, and politics were also always in play. In 1896, there would be the abortive Jameson Raid, an insurgency meant to usurp Kruger’s government. The raid failed but it would ratchet up tensions between the Afrikaners and the British till the outbreak of the South African War in 1899. The war continued till 1902. By the end of the decade, in 1910, the country would become a union, uniting the four old colonies of South Africa. In another four years, World War I would break out.
Medical and health historian Professor Catherine Burns, of the University of Johannesburg’s Department of Historical Studies, says a more textured history reveals a story of whose health priorities ranked higher in the young city.
Joburg’s first medical officer of health, Dr Charles Porter, arrived from Scotland and he would have looked at Johannesburg framed against his Glaswegian childhood. “He would have encountered Johannesburg mining slums with Glasgow on his mind – seeing the conditions of crippled children and terrible miasmas; and an atmosphere of steam and filth as people staggered from the mines,” says Burn.
But importing a system of healthcare would have its limitations. Burns points out that even as the Johannesburg General Hospital would count as modern advancement for medicine, the melting pot of people drawn to early Joburg brought with them vastly different beliefs on healing, on warding off sickness, and the meaning of wellness.
“Throughout the city – even today – we see the venerable men and women who seek out hilltops and high places to perform the rituals and prayers of healing and wellbeing. And of course many of these spots are in Hillbrow or Yeoville. It means we can’t flatten everything, ignoring the layers upon layers of health history in the city,” she says.
The melting pot was growing and “Hospital Hill” with it. The early part of the new century would see the establishment of facilities for nurses’ accommodation, a fever hospital, a children’s hospital, a mortuary, an operating theatre, nursing homes, maternity hospitals, medical research facility and a medical school. Most ominous was the establishment of the “non-European” hospital built to further entrench racially segregated healthcare.
Kathy Munro, emeritus professor and heritage expert with the Johannesburg Heritage Foundation, says of particular significance was that the first Johannesburg hospital was built on state owned land and with the intention of service. These were the nascent ideals of a public health service for the city. The hospital was run by the Catholic Church’s Holy Family Sisters until 1915.
The front and back view of Johannesburg’s first general hospital, featuring the prominent laundry chutes that spiralled down the building. (Photo: Ufrieda Ho/Spotlight)
Munro says: “You then had a clustering of private hospitals like the Florence Nightingale, the Colin Gordon and the Lady Dudley Gordon around the state hospital complex that ran from the top of the hill to the bottom. The South African Medical Research Institute, founded in 1912 and housed in a fine Herbert Baker building, also came up along Hospital Road.
“The health authorities would have had to deal with the fragmentation in society and the separated services for the Non-European hospital and a whites-only hospital,” she says.
By the time apartheid was written into the statute book with the Nationalist Party coming to power in 1948, Munro says segregation would further shape the distribution of medical services in the city in the way Wits University had to deploy its medical students across the city.
“One of the inadvertent consequences of the apartheid system was that the university’s medical faculty had to service many hospitals that were fragmented on the basis of race. But it also meant that more specialist professors in each discipline came to be stationed at these hospitals,” she says.
By the mid-1960s and the 1970s, Hillbrow as a health hub shifted. The new Johannesburg General Hospital – now Charlotte Maxeke Academic Hospital – would rise as a concrete hulk in Parktown in 1978 and the original Johannesburg Hospital was renamed the Hillbrow Hospital.
In these decades, Hillbrow also became the flatlands made up of residential highrises, distinct from the rest of suburbia. Its residents were mostly young European expat professionals, recruited to work in a South Africa that was in an era of economic boom. According to The Joburg Book, edited by Dr Nechama Brodie, the new arrivals from Europe boosted the white population in the country by 50% between 1963 and 1972.
Hillbrow was now a high density suburb with different pressures on health services. It was also a suburb, Brodie writes, that “acquired a cosmopolitan Bohemian character … and nurtured a subculture that incorporated elements of ‘swinging London’ and America’s hippie culture”.
Under the two iconic city landmarks of Ponte Towers and the Hillbrow Tower (Telkom Tower), Hillbrow was an unbounded playground, freer from the hang-ups of racial segregation and largely managing to evade the heavy hand of apartheid-era law enforcers and morality policing.
But by the mid-1980s, South Africa was in various States of Emergency and Hillbrow changed once again. White flight came on fast as more black people moved from the townships to Hillbrow, which was central, affordable and also anonymous. Hillbrow’s slide to urban decline came at the same time as the anxious steps towards democracy. Landlords absconded; the city council failed on upkeep, maintenance, and bylaw enforcement. Banks redlined the area, leaving Hillbrow to become an urban slum.
Professor Helen Rees, founder and executive director of the Wits Reproductive Health and HIV Institute (WRHI), picks up the story from the mid-1990s. She says: “I had set up the Institute in 1994 and it was at the same time when HIV was just exploding. We started out in Soweto but worked with a public clinic dedicated to treating sexually transmitted infections (STIs) on Esselen Street in Hillbrow.
“I remember one morning when I got to the clinic the queue stretched around the corner, with about 100 people waiting. Of course, what we hadn’t appreciated fully was that HIV was driving up the level of STIs hugely,” she says.
Hillbrow’s population included groups not easy to link to and retain on care. They were young people, migrants and sex workers. It was enlarging the HIV challenge, Rees says.
Rees didn’t baulk. She doubled down and decided that the WRHI should be located in Hillbrow, right next to the Esselen Street Clinic, one of the first clinics in the country to offer HIV testing.
Staying in Hillbrow means the WRHI has to invest in infrastructure, to have back-up for basics like water supply, generators, and security. These things are needed if the institute is to function as a global leader of science, innovation and research in fields like infectious and vaccine preventable diseases, sexual and reproductive health, antimicrobial resistance, and health in a time of climate change.
The Institute was involved in COVID-19 vaccine trials, studies of the CAB-LA HIV prevention injection, and now they are involved in research on Mpox vaccines and on trials of the experimental M72 tuberculosis vaccine.
WRHI sits at the heart of that which survives of the Hillbrow health precinct. The Shandukani Centre for Maternal and Child Health that opened to the public in 2012 is also here. Other WRHI facilities include a clinic for sex workers as well as a clinic for transgender people. Their neighbours are the Esselen Street Clinic, that endures in the distinctive Wilhelm B Pabst designed building from 1941, and the Hillbrow Clinic, that runs a 24-hour service. Along Hospital Street, the forensic pathology and national laboratory services still function.
Throbbing to a different pulse
But beyond the WRHI’s electric fencing and street corners monitored by private security, much of Hillbrow life throbs to a different pulse. Most noticeable is that one of the WRHI’s immediate neighbours is the condemned building of the one-time Florence Nightingale Maternity Hospital. The building is now a so-called dark building, simply not considered fit for life. The first Johannesburg Hospital stands derelict and abandoned, as does the chapel and the house the Catholic nursing sisters lived in when they tended to patients in the hospital.
And the Hillbrow streets live up to much of its bad reputation. It’s overcrowded with people and garbage. Drug users curl up slumped against urine-soaked concrete benches as hawkers are forced to retrieve water from the city’s smashed water pipes and it seems every bylaw is ignored.
Rees is clear though that WRHI, which marks its 30-year anniversary this year, is exactly where it needs to be. She says the coming needs for healthcare globally will focus on healthcare in slums and healthcare on society’s periphery because more people’s lives are precarious and more people will call slums home.
“The work we do is defined by the context and the needs of the population. But we have created a hugely professional context and run a state of the art institute,” she says. “You cannot do clinical research for the things that affect the majority of communities unless you’re actually working in those communities.”
It means some of WHRI’s budget does go into fixing things in their neighbours’ buildings – repairing pipes or cleaning up backyards turned to garbage dumps. It’s not technically their responsibility but it is a response that helps them remain a relevant and durable pillar. And in a place like Hillbrow, where so many people survive by transience and invisibility, something that holds firm a little longer can make a big difference.
A new study reveals widespread resistance of a major bacterial pathogen to the active ingredients in cleaning agents commonly used in hospitals and homes. The American Chemical Society Infectious Diseases published the research led by chemists at Emory University. It demonstrates the surprising level of resistance to cleaning agents of multidrug-resistant Pseudomonas aeruginosa, a pathogen of particular concern in hospital settings.
The study also identifies biocides that are highly effective against P. aeruginosa, including a novel compound developed at Emory in collaboration with Villanova University. The researchers describe how these biocides work differently than most disinfectants currently in use.
“We hope our findings can help guide hospitals to reconsider protocols for the sanitation of patient rooms and other facilities,” says William Wuest, Emory professor of chemistry and a senior author of the study. “We also hope that our findings of a new mechanism of action against these bacterial strains may help in the design of future disinfectant products.”
First authors of the study are Christian Sanchez (who did the work as an Emory PhD student in chemistry and, following graduation, joined the faculty at Samford University) and German Vargas-Cuebas, an Emory PhD candidate in microbiology through Laney Graduate School.
“Resistance of pathogens to cleaning agents is an area that’s often overlooked,” Vargas-Cuebas says, “but it’s an important area of study, especially with the rise in antibiotic-resistant pathogens worldwide.”
Kevin Minbiole, professor of chemistry at Villanova, is co-senior author of the paper.
Workhorse disinfectants losing steam
Quaternary ammonium compounds, or QACs, are active ingredients commonly seen in household and hospital cleaners, including some disinfectant sprays and liquids, antibacterial sanitizing wipes and soaps.
“There are a handful of QACs that have been the workhorse disinfectants for around 100 years, on the frontline of most homes and hospitals,” Wuest says. “Very little has been done to modify their structures because they have long worked so well against many common bacteria, viruses, molds and fungi and they’re so simple and cheap to make.”
The Wuest lab is a leader in studies of QACs and other disinfecting agents. One issue Wuest and his colleagues have identified is that some bacterial strains are developing resistance to QACs. That trend could cause serious problems for sanitation in hospitals.
A pathogen of critical priority
More than 2.8 million antimicrobial-resistant infections occur in the United States each year, leading to more than 35,000 deaths, according to the Centers for Disease Control and Prevention (CDC).
The CDC names multidrug-resistant P. aeruginosa as one of seven pathogens causing infections that increased in the United States during the COVID-19 pandemic and remain above prepandemic levels.
Worldwide, P. aeruginosa causes more than 500,000 deaths annually and has been named a pathogen of critical priority by the World Health Organization.
P. aeruginosa is commonly found in the environment, including in soil and freshwater. Reservoirs in hospital settings can include drains, taps, sinks and equipment washers.
While the bacterium generally does not affect healthy people it can cause infections in individuals with cystic fibrosis and those who are immunocompromised, such as patients with burns, cancer and many other serious conditions. Patients with invasive devices such as catheters are also at risk due to the ability of P. aeruginosa to form biofilms on the surfaces of these devices.
P. aeruginosa, like other gram-negative bacteria, is enclosed in a second, fatty outer membrane that acts as a protective capsule, making it more difficult to kill.
How QACs kill
QACs have a nitrogen atom at the center of four carbon chains. In simplest terms, the positively charged head of the nitrogen center is drawn to the negatively charged phosphates of the fatty acids encasing P. aeruginosa and many other bacteria and viruses. The heads of the carbon chains act like spearpoints, stabbing into both protective fatty membranes and inner cellular membranes and causing pathogens to disintegrate.
The researchers tested 20 different drug-resistant strains of P. aeruginosa collected from hospitals around the world by the Walter Reed National Military Medical Center as part of the Multidrug-Resistant Organism Repository and Surveillance Network.
The results showed that all 20 strains were at least partially resistant to QACs — the common active ingredient in most front-line cleaning agents — and 80% of the strains were fully resistant to QACs.
“This mechanism has worked for 100 years essentially by slicing into the outer and inner membranes of a pathogen and destroying them,” Wuest says. “We were surprised to see the level at which that appears to no longer be the case.”
Improper use of cleaning agents may be one factor leading to resistance, Wuest theorizes.
“QACs don’t immediately kill,” he explains. “After application, it’s important to wait four or five minutes before wiping these cleaning agents away. It’s also important to use the right concentration. If used inappropriately, some bacteria can survive, which can lead to them developing resistance.”
Greater use of cleaning agents during the COVID-19 pandemic may have given P. aeruginosa and some other hard-to-kill pathogens more opportunities to develop resistance, he adds.
A new method that ‘works surprisingly well’
For the current paper, the researchers also tested the resistance of the panel of multidrug-resistant P. aeruginosa strains against a new quaternary phosphonium compound, or QPC, developed in the Wuest and Minbiole labs. The results showed that the compound was highly effective at killing all 20 of the resistant P. aeruginosa strains.
“It works surprisingly well even at a low concentration,” Vargas-Cuebas says.
The researchers demonstrated that their novel QPC works not by piercing the protective outer capsule of a P. aeruginosa bacterium but by diffusing through this outer membrane and then selectively attacking the inner cellular membrane.
“It’s counterintuitive,” Wuest remarks. “You would think that the approach of conventional biocides, to take out both membranes, would be a more effective way to kill P. aeruginosa. Why does passively diffusing through the outer membrane and focusing on attacking the inner membrane make our QPC compound more effective? We don’t know yet. It’s like a magic trick.”
They showed that this same mechanism underlies the effectiveness of two commercial antiseptics: octenidine, more commonly used in Europe as a hospital antiseptic, and chlorhexidine, a common ingredient in mouthwashes.
Wuest and colleagues plan to continue research into how this newly identified mechanism may work against an array of pathogens and how that might translate into new biocides and more effective cleaning protocols in hospitals and other settings.
“Our work is paving the way for much-needed innovations in disinfectant research,” Wuest says.
A new thought piece led by the Harvard Pilgrim Health Care Institute with collaborators from Duke University and Kaiser Permanente Washington Health Research Institute highlights the challenges facing healthcare researchers and decision makers in the quest to improve population health in a constantly evolving healthcare landscape. The authors offer strategies to enhance the effectiveness of pragmatic clinical trials and increase their impact on real-world healthcare settings.
Pragmatic clinical trials, designed to inform health care decision-makers about the comparative benefits, burdens, and risks of health interventions, have seen a significant increase in interest over the past decade. Since 2012, the NIH Pragmatic Trials Collaboratory has supported 32 such trials, addressing critical issues like suicide prevention, opioid prescribing, and infection control.
Pragmatic clinical trials are designed to bridge the gap between research and care, and we believe this bridge can be built even more efficiently. – Richard Platt, MD, MSc
Pragmatic clinical trials compare treatments in everyday clinical settings, rather than under ideal conditions. However, the authors note that the adoption of trial findings by healthcare systems has been inconsistent.
“Our goal is to ensure that the findings from these trials are not only scientifically sound but also readily implementable in diverse healthcare settings,” says lead author Richard Platt, Harvard Medical School distinguished professor of population medicine at the Harvard Pilgrim Health Care Institute. “Pragmatic clinical trials are designed to bridge the gap between research and care, and we believe this bridge can be built even more efficiently.”
The authors identify key challenges and propose solutions to align trial goals with healthcare system needs, including:
Identifying relevant outcomes: Collaborate with healthcare leaders to determine the clinical or cost-saving outcomes that would motivate adoption.
Shortening trial duration: Designing trials to span 2-3 years to match the decision-making timelines of healthcare systems.
Conducting interim assessments: Utilizing interim analyses to provide timely information and potentially stop or modify trials early.
Considering costs: Understanding and planning for associated costs to ensuring interventions are sustainable post-trial.
“By accommodating the priorities of healthcare leaders and introducing adaptive trial designs, we can generate actionable evidence that truly improves patient care,” adds Dr Platt.
Healthcare professionals are increasingly giving advice to patients on how to improve their health, but there is often a lack of scientific evidence if this advice is actually beneficial. This is according to a study from the University of Gothenburg, which also guides towards more effective recommendations.
The researchers do not criticise the content of the advice – after all, it is good if people lose weight, stop smoking, eat a better diet or exercise more. But there is no evidence that patients actually do change their lifestyle after receiving this advice from healthcare professionals.
“There is often a lack of research showing that counselling patients is effective. It is likely that the advice rarely actually helps people,” says study lead author Minna Johansson, Associate Professor at Sahlgrenska Academy at the University of Gothenburg and General Practitioner at Herrestad’s Healthcare Center in Uddevalla.
Few pieces of advice are well-founded
The study, published in the Annals of Internal Medicine, was conducted by an international team of researchers. They have previously analysed medical recommendations from the National Institute for Health and Care Excellence (NICE) in the UK. This organisation is behind 379 recommendations of advice and interventions that healthcare professionals should give to patients, with the aim of changing their lifestyle.
In only 3% of cases there were scientific studies showing that the advice has positive effects in practice. A further 13% of this advice had some evidence, but with low certainty. The researchers also reviewed additional guidelines from other influential institutions around the world and found that these often overestimate the positive impact of the advice and rarely take disadvantages into account.
“Trying to improve public health by giving lifestyle advice to one person at a time is both expensive and ineffective. Resources would probably be better spent on community-based interventions that make it easier for all of us to live healthy lives,” says Minna Johansson, who also believes the advice could increase stigmatisation for people with, eg, obesity.
Showing the way forward
Today’s healthcare professionals would not be able to give all the advice recommended while maintaining other care. The researchers’ calculations show that in the UK, for example, five times as many nurses would need to be hired, compared to current levels, to cope with the task.
The study also presents a new guideline to help policy makers and guideline authors consider the pros and cons of the intervention in a structured way before deciding whether or not to recommend it.
Victor Montori, Professor of Medicine at the Mayo Clinic in the United States is a co-author of the study: “The guideline consists of a number of key questions, which show how to adequately evaluate the likelihood that the lifestyle intervention will lead to positive effects or not,” says Victor Montori.
The Department of Health has missed another deadline to provide nurses at public hospitals and clinics with uniforms by 1 September. Instead, a once-off allowance of R3 307 will be paid to nurses by 30 November to buy their own uniforms.
The Democratic Nursing Organisation of South Africa (DENOSA) says its 84 000 members “can hardly afford to get one set of uniforms” with that allowance.
Since 2005, nurses have received an annual allowance to buy their uniforms. In terms of a new agreement signed in March 2023, the department committed to providing uniforms directly to nurses, instead of the allowance of R2,600.
According to the bargaining council agreement, nurses were to receive seven sets of uniforms over two years. The uniform set includes a dress, or a skirt and a top (blouse or shirt), or a pair of trousers and a top (blouse or shirt). Accessories include a brown belt, brown shoes, a maroon jacket and a maroon jersey.
The agreement required the department to supply nurses with four sets of uniforms, one pair of shoes and one jersey in the first year, and three sets of uniforms, one belt, and one jacket in the second year.
However, as the 1 October 2023 deadline approached, the department said it was facing difficulties with the procurement process. In a last-minute bargaining council meeting in September 2023, the department informed nurses’ unions that it would not meet the 1 October 2023 deadline. Instead, it said, the supply of uniforms would be postponed until 1 September 2024 and a temporary allowance would again be paid meanwhile. Uniforms were to be procured through tenders in each province.
But in response to concerns expressed by DENOSA at a meeting in June 2024, the department acknowledged that it was battling with suppliers and would not meet the new deadline either.
Department spokesperson Foster Mohale said there were delays in procurement in some provinces and this was “receiving the urgent attention it deserves”.
He said the department had proposed a new plan and a new deadline of 1 September 2025.
Meanwhile, he said, nurses would be paid a once-off uniform allowance of R3307.60 by 30 November 2024. But DENOSA says this is “too little to buy uniforms”.
“With that amount, a nurse can hardly afford to get one set of uniforms. For a nurse to buy a proper uniform for the whole week, they need between R8500 and R14 000,” the union said in a statement.
Mohale said the uniforms will be supplied in line with the Preferential Procurement Policy Framework Act which stipulates that goods ordered by state institutions must contain a minimum of local content. The policy was first introduced in 2011 in a bid to protect South African industry and jobs.
But DENOSA said a centralised procurement system, similar to those used for police and army uniforms would be more effective than provincial procurement.
“The issue of quality is extremely concerning to us…This is going to open up the whole process to corruption which we have warned against, but it looks like the department has closed its ears on that matter,” DENOSA spokesperson Sibongiseni Delihlazo said.
With South Africa’s healthcare system facing a myriad challenges, experts at a health conference have put forward a range of practical solutions to address some of the country’s pressing issues. Ufrieda Ho rounds up some of the proposed solutions to improve patient care, including the use of public-private partnerships.
Closing the inequality gap and making trusted healthcare services accessible to the majority will require a whole systems overhaul. This was the underlying message of speakers at the recent Hospital Association of South Africa Conference who tackled the question of pragmatic steps to address the divides and failings of the country’s healthcare system. They put forward a range of solutions, models and case studies while highlighting the looming crises as more people fall through the cracks.
Around 15% of people in South Africa are members of private medical aid schemes, leaving 85% of people in the country largely reliant on a severely strained public healthcare system (though some do pay out-of-pocket to visit private sector doctors). As reported in Business Day, an argument was made at the conference for making medical scheme membership compulsory for everyone in formal employment, a move it is estimated could triple the number of people with medical scheme coverage and result in a 25% reduction in medical scheme premiums.
Delegates at the conference also heard that an integrated and coordinated whole systems approach is necessary. Speakers stressed that implementable interventions and innovations must kick in with urgency. Some argued that more political will is required, along with greater corporate commitment if effective public-private partnerships are to be established. Such partnerships was a key theme of the conference.
A kidney care example
Dr Chevon Clark, chief executive of National Renal Care, a private renal therapy provider, outlined the stark reality of an enlarging public health crisis as more people face kidney dysfunction.
“Globally, 850 million people have chronic kidney disease, acute kidney injury or are on renal replacement therapy. This signals a significant public health issue. This is twice the number of individuals estimated to have diabetes, and is 20 times higher than the number of individuals affected by HIV/AIDS.
“There has also been a 29.3% increase in reported chronic kidney disease over the last three decades. Not only is this increase deeply concerning, but so is the ability of our healthcare system to manage and treat individuals impacted by chronic kidney disease,” said Clark.
Last week marked Kidney Awareness week in South Africa. Against this backdrop, Clark said South Africa falls behind other middle income countries in having enough nephrologists and nephrology nurses for their populations. There is a combined 147 facilities for treatment and care in the public and private sectors – a shortfall, she said.
Clark said smarter public-private partnership initiatives are needed. She added these need to be focused on stronger stakeholder engagement, innovative funding mechanisms, advocacy and refining weak policy frameworks.
She presented a case study of National Renal Care (a private company) partnering with the Western Cape Department of Health and Wellness to set up a dialysis clinic at the Vredenburg Provincial Hospital. The hospital services a rural community. Before the unit was opened, patients had to travel long distances to access care in Cape Town. The inflow of patients from outside Cape Town also added to congestion at its facilities.
A benefit of the partnership, she said, is that they have been able to introduce newer technologies. Clark said they have a system that enables online and remote monitoring of patients. Patients’ records can be updated continuously and are maintained digitally. Clark said that patients have also been enrolled on a mobile app making patients “active partners in their healthcare and to drive compliance for better outcomes”.
Tele-health to track diabetes patients
Dr Atiya Mosam, a public health consultant and founder of Mayibuye Health, highlighted the importance of getting the basics right. She presented a case study of a public-private partnership in which a ‘tele-health doctor’ called diabetes patients from the Hanover Park Clinic daily for two weeks to monitor their glucose levels, adjust their medication when needed, and offer health advice.
Mosam said 74% of the patients contacted had to have their medication adjusted, indicating the need for this kind of immediate monitoring and treatment management. Mosam added that the intervention saw improvements in patients’ conditions and improvements in patients staying in targeted ranges for their glucose readings.
She added: “One man articulated that he had a new lease on life, attested to by his family. They said before the intervention, he was really very grumpy. Very interesting for us too was that many patients articulated that by having this contact with the ‘tele-health doctor’, they felt that the government cared for them.”
Cancer care
One area where efforts at a public-private partnership appears to have failed is cancer care in Gauteng. As widely reported, the Gauteng Department of Health set aside R784m early in 2023 for radiation oncology services, which would have included the outsourcing of some services to the private sector. That outsourcing hasn’t yet happened and the Cancer Alliance has since taken the department to court over the ongoing cancer treatment backlogs.
Health activist Mark Heywood, speaking at the conference on behalf of The Cancer Alliance, mentioned the ongoing litigation and said a hearing has been scheduled for 21 November.
Heywood drew parallels between HIV and cancer to illustrate how the fight for cancer treatment looks set to evolve, but also where wins could be achieved.
He said: “Cancer treatment and cancer medicines, like HIV medicines two decades ago, is inordinately expensive. It means that whilst cancer can be cured for the vast majority of people it is unaffordable and inaccessible. For the vast majority of people in our country, a cancer diagnosis is often a diagnosis that indicates a vastly shortened lifespan and the beginning of a journey to severe illness, very often indignity and death, and that is not how it should be.”
Heywood said government had an obligation to follow the constitutional framework to ensure access to cancer treatment as a basic health right. He also said private healthcare providers had to do better.
“There have been complaints of discrimination by medical schemes of only partial coverage of the costs and needs of care. This leaves people unable to complete treatment. There are allegations of overcharging by hospitals and specialists. There’s also a lack of collaboration between the private and the public sector, a lack of monitoring and a lack of a determination of healthcare outcomes when it comes to cancer,” he said.
But Heywood said the long – but ultimately successful – fight for access to treatment for HIV positive people in the country held important lessons that could be applied to cancer.
“What we learned with HIV was that with political will and with resource mobilisation, it is possible to dramatically alter the landscape of care and to tip the balance towards greater equality and social justice in healthcare,” he said.
“The question remains for the Hospital Association of South Africa and private health providers – what can you do to make cancer care more affordable, more accessible, and to build on public private partnerships to take them to scale to reach a greater number of people in a shorter period of time?,” Heywood said.
Mandatory health cover of formally employed is tried and tested and if put to use in South Africa could reduce the public health burden, increase public per capita spend on health, and free up resources that could help address the country’s most pressing health crises.
With widespread concern that the National Health Insurance Fund is unaffordable and will take too long to implement while most South Africans already struggle to access quality healthcare services, Netcare Chief Executive Office Dr Richard Friedland has raised the possibility of near-term solutions including an under-explored alternative.
Speaking at the Hospital Association of South Africa Conference in Sandton, he stated that private hospitals wish to work with government to find solutions to our country’s healthcare problems. He pointed to mandatory medical cover for the formally employed as a potential solution that has been well-researched over two decades and is a “workable solution that if implemented will be quick to roll out and in a very short time provide enhanced healthcare to all South Africans.”
Friedland pointed out that the African National Congress’ 1994 Health Plan recommended mandatory cover for the formally employed and the National Department of Health Social Health Insurance Working Group in 1997 recommended that mandatory cover for formal sector employees should be confined to those above the income tax threshold, due to affordability concerns.
What this all offers, explained Friedland, is a middle ground option. If the government mandates those South Africans who are formally employed together with their families to be covered by some form of health insurance or medical aid, “This will enable public health sector resources to be dedicated to the informally employed, unemployed and indigent.”
“With a formally employed population of 11.5 million, together with the estimated number of dependants, based on a 2.4 beneficiary ratio, this could result in up to 27.5 million of our population that could potentially over time become covered, leaving the remaining 35.5 (56% of the population) people dependent on public health resources,” Friedland said.
Government public health per capita spend, he said, could increase over time by 52% without any additional funding of the public sector budget.
“In simple terms, if one considered the entire population in South Africa, government’s responsibility would reduce from the current 85% of the population covered by public health to 56%,” he said.
The latest per capita public expenditure based on a consolidated health budget of R271 billion works out to R5054, when considering the population and excluding medical scheme users. With formal employment coverage, that per capita public expenditure on public health users would increase 52% to R7 659, research shows.
Friedland also told the audience that getting the scheme off the ground could be done in three phases.
Phase one would involve including the formally employed and their dependants who are above the tax threshold. This would grow the medical scheme coverage from 9,2 to 15,4 million. The completion of Phase 1 would also expand public per capita spend by 12,9% at present day levels.
Phase 2 would include those formally employed and dependents who are below the tax threshold. This would push medical scheme coverage to 27,5 million and expand public per capita spend to 52%.
Phase 3, Friedland explained, will allow for the expansion of the economy through recovery and an increase in employment.
This will have further benefits to South Africa’s health care system with research showing that for every one million formal jobs created, the public health system would benefit with a reduction of approximately 2.4 million people, it will no longer have to serve. Additionally, this will add a 7% increase from Phase 2 on per capita public health spend.
“The health system stands to benefit in more immediate and visceral ways. The reduced load on the public sector will result in a reduced burdens on doctors, nurses and other healthcare workers, will reduce overcrowding, shorten queues and free up funding to fix infrastructure, fund unfunded medical posts, and grow our medical skills training capacity – remember, we have a shortage of 27 000 nurses in South Africa, and this is expected to grow to 70 000 by 2030.
Not only is the idea not new, says Friedland, but similar approaches are adopted elsewhere. In Africa 61% of countries have contributory mandatory programmes for civil servants and 50% of them programmes for sector employees.
The private hospital sector, says Friedland, stands ready to explore this idea and others that result in lessening the load on the shoulders of all South Africans who need accessible quality healthcare today.
“We stand ready to collaborate on further system strengthening, to more private public partnerships, to addressing public sector elective surgery waiting lists, to joint efforts on human resource training collaboration,” he says.
