Tag: 20/11/24

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Navigating the Road to Universal Health Coverage in South Africa

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By Dr Reno Morar, Director: Medical School, Faculty of Health Sciences, Nelson Mandela University

Dr Reno Morar

Johannesburg, 20 November: As Director of the newly established Medical School in the Faculty of Health Sciences at Nelson Mandela University, I am honoured to lead South Africa’s tenth and youngest medical school. Our medical students exude an infectious spirit of hope and enthusiasm as we progress toward graduating our first cohort of Mandela Doctors in 2026.

As we navigate our journey at the medical school and within the Faculty, our goal is to successfully graduate composite health professionals who are equipped to serve our communities.

This journey is inextricably linked to a larger national goal: achieving Universal Health Coverage (UHC) for South Africa.

With the signing of the National Health Insurance (NHI) Act into law, South Africa stands at a pivotal moment in its healthcare journey. Achieving UHC promises equitable access to quality healthcare for all South Africans, regardless of income or location. But transforming this vision of UHC into reality requires much more than policy reflected in the NHI, it calls for robust planning, thoughtful resource allocation, and, above all, collaboration across sectors.

Our nation’s medical schools and higher education and training institutions are essential to the UHC journey in their support of South African’s human resources for health strategy. This strategy provides a foundation for advancing universal health coverage by ensuring healthcare professionals are appropriately trained to meet the demands of a redefined healthcare system.

These institutions play an instrumental role in building a workforce ready to support the NHI system. Lessons from our response to the recent COVID-19 pandemic have already shown us the power of unity; as we move forward, this spirit of collaboration between the public and private sectors will be crucial in shaping a resilient and inclusive healthcare system that can achieve UHC.

The NHI Act sets out to provide universal access to quality healthcare services, bridging disparities and delivering equitable access to essential services for all South Africans. However, the path to UHC is about more than access, it requires quality, efficiency, and sustainability across a restructured healthcare landscape.

Photo by Hush Naidoo Jade Photography on Unsplash

The government’s role here is pivotal – responsible leadership, resource allocation, and effective oversight are critical to building public confidence. This transition poses complex governance and constitutional challenges.

Implementing the NHI Act requires establishing new accountability mechanisms, redefining roles, and reassessing funding streams. Addressing these structural challenges – especially in under-resourced and underserved regions – demands both strategic mindset and practical capacity to adapt quickly to evolving needs.

Many of South Africa’s rural and township communities face significant shortages in healthcare resources and access to quality services. For NHI to succeed in these settings, dedicated efforts in providing adequate healthcare infrastructure and equipment, staffing, and strong governance and leadership are essential.

Achieving the ambitious goals of NHI without a solid foundation in governance and accountability would be a costly misstep. The success of NHI demands careful, evidence-based planning with clear goals and accountability.

This approach will require decades of commitment, with the understanding that universal healthcare frameworks often take generations to mature fully. NHI will not be a quick fix, but with meticulous preparation, it has the potential to become a sustainable, far-reaching health system intervention.  

Government planning must also account for the rapidly changing landscape of healthcare needs and technology. South Africa’s healthcare system must prepare not only for current demands but also for future challenges, including digital healthcare infrastructure and data security.

Protecting patient information and ensuring uninterrupted services is paramount in a digital age where data breaches are a constant risk. Recent experiences with cybersecurity issues in the National Health Laboratory Services underscore the importance of proactive measures in this domain.

The pandemic has taught us the power of unity in times of crisis. During COVID-19, South Africa’s public and private healthcare sectors demonstrated resilience, adaptability, and a shared commitment to public health. This partnership was instrumental in resource-sharing, patient care, and vaccine distribution.

It serves as a powerful reminder that as the NHI system is implemented over the next 10 to15 years, the system will benefit from a collaborative model where the expertise and resources of the private and public sectors complement each other in the public interest and wider community access.  

Collaboration between the public and private sectors must focus on expanding healthcare infrastructure, enhancing service delivery in underserved areas, and integrating innovative technologies for more efficient patient care. By working together, public and private sectors can foster a healthcare environment that maximises strengths and mitigates gaps in service. 

To sustain the implementation of the NHI system, South Africa needs healthcare professionals equipped to handle both the scope and scale of this vision. Medical and health professions education must adapt and evolve to meet these challenges, training future healthcare providers not only in clinical skills but also in adaptability, empathy, and resilience.

At Nelson Mandela University’s Faculty of Health Sciences, we prioritise these qualities, embedding community-based learning and problem-solving into our curriculum to prepare graduates for a diverse and demanding healthcare landscape.

Students experience firsthand the disparities within South Africa’s healthcare system, and this allows our students to develop the necessary understanding of the realities their future patients face.

Our programme equips them to work in a wide array of settings – from rural clinics with limited resources to state-of-the-art urban facilities. This holistic training ensures our graduates are capable of addressing the multifaceted healthcare challenges with the empathy and innovation necessary to serve our communities across South Africa.

The journey toward UHC and the implementation of NHI system is both inspiring and challenging. It is a bold declaration of South Africa’s commitment to affordable universal access to quality health care services, healthcare equity – and must be approached with open eyes and a steady hand.

Our success will depend on a combination of strategic planning, effective governance, and a commitment to collaboration across sectors.

South Africa has a unique opportunity to build a healthcare system that is equitable and resilient. By prioritising these foundational steps, we can pave the way for a healthcare system that genuinely serves all South Africans, one that fulfils the promise of our constitution and reflects the spirit of our democracy. The future of our healthcare system is within our hands, but only if we approach it with responsibility, collaboration, and a deep commitment to the well-being of all our people.

It will be an intensely proud South African moment when we graduate our first 45 Mandela Doctors from our medical school in 2026! As South Africans, we also want to be proudly South African about the health system we build for and with our people. 

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A New Insight into the Mechanisms of Epidermal Renewal

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Picture by Macrovector on Freepik

The mechanisms underlying skin renewal are still poorly understood, but interleukin-38 (IL-38), a protein involved in regulating inflammatory responses, could provide insights. Researchers observed it for the first time in the form of condensates in keratinocytes, the cells of the epidermis. The presence of IL-38 in these aggregates is enhanced close to the skin’s surface exposed to atmospheric oxygen. This process could be linked to the initiation of programmed keratinocyte death, a natural process in the epidermis. This study, from University of Geneva (UNIGE) researchers, could bring new perspectives for the study of human epidermis and the illnesses that affect it.

Renewal of the epidermis relies on stem cells located in its lowest layer, which constantly produce new keratinocytes. These new cells are then pushed to the surface, differentiating along the way and accumulating protein condensates. Once they reach the top of the epidermis, they undergo a programmed death, cornification, to create a protective barrier of dead cells.

“The way in which the epidermis constantly renews itself is well documented. However, the mechanisms that drive this process are still not fully understood,” explains Gaby Palmer-Lourenço, associate professor at the Faculty of medicine of UNIGE and principal investigator. The study is published in the journal Cell Reports.

An unexpected role

Interleukin 38 is a small messenger protein that ensures communication between cells. It is known for its role in regulating inflammatory responses and its presence in keratinocytes, the cells of the epidermis, was previously associated with the preservation of the skin’s immune balance. “In keratinocytes in vivo, we found that IL-38 forms condensates, specialized protein aggregates with specific biochemical functions, a behavior that was not known for this protein,” recounts Gaby Palmer-Lourenço. Even more curious, the closer the keratinocytes were to the surface of the skin, the greater the amount of IL-38 within these condensates.

A reaction to oxidative stress

Blood vessels stop in the skin layer located below the epidermis. Therefore, the quantity of oxygen available for the keratinocytes is lower in the basal layers of the epidermis compared to the top layers that are directly exposed to the air that surrounds us. However, even though it is necessary to maintain cell functions, oxygen also causes oxidative stress by forming free radicals, reactive molecules that endanger the cell. “We were able to show that oxidative stress does indeed cause IL-38 condensation under laboratory conditions,” confirms Alejandro Díaz-Barreiro, postdoctoral fellow at the UNIGE Faculty of medicine, and first author of the study.

“Our results lead us to believe that, as we move closer to the epidermal surface, the increasing oxygen concentration promotes the formation of protein condensates, indicating to keratinocytes that they are in the right place to enter cell death,” furthers Gaby Palmer-Lourenço. This hypothesis provides new leads to decipher the mechanisms of epidermal renewal. It could also pave the way for a better understanding of the pathological mechanisms underlying certain skin diseases, such as psoriasis or atopic dermatitis. These questions will be further examined by the research group in future studies.

Contributing to an alternative to animal models

Alejandro Díaz-Barreiro is already working on the next step: “In the model we used previously, the effects of oxidative stress were artificially induced in a single layer of keratinocytes, a scenario that differs from the actual situation in the skin. We are therefore developing a new experimental system to apply oxygen gradients to in vitro reconstituted human epidermis. In this model, only the skin surface will be exposed to ambient air, while the other layers will be protected. This will allow us to study in detail the effect of oxidative stress on epidermal renewal.” By enabling a more precise analysis of human cells, this new system will provide an alternative to animal models often used for the study of skin biology and disease.

Source: Université de Genève

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From Vision to Reality: mRNA Technology Transfer Programme Building Sustainable Vaccine Manufacturing Ecosystems in LMICs

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The groundbreaking mRNA Technology Transfer Programme, launched in 2021, has achieved what was once unthinkable: from zero mRNA manufacturing capabilities in low- and middle-income countries (LMICs) in 2020, the initiative is positioned towards establishing 11 state-of-the-art good manufacturing practices (GMP) certified mRNA manufacturing facilities across 10 countries by 2030 and a further five facilities following later.

With all manufacturers in the Programme working on R&D across various diseases, this network is designed to meet the Global South’s R&D and mRNA vaccine needs. It stands ready to respond to any future pandemic to secure mRNA vaccine access across continents.

The transformative Programme, established by the World Health Organization (WHO) and the Medicines Patent Pool (MPP), works with the South African Consortium, Afrigen, Biovac, the South African Medical Research Council (SAMRC), and the Department of Science and Innovation and programme partners in Kenya, Brazil, Indonesia, India, Egypt, Nigeria, Ukraine, Bangladesh, Senegal, Tunisia, Serbia, Pakistan, Vietnam, and Argentina. 

The Programme, support by South Africa, France, Belgium, Canada, the European Union, Germany, Norway, and the ELMA Foundation, has propelled LMICs to the forefront of pandemic preparedness. It represents an unprecedented global effort to ensure equitable health solutions, enabling LMICs to respond rapidly and independently to global health crises. 

Charles Gore, Executive Director of the Medicines Patent Pool, stated, “From a standing start in 2020, the Programme’s growth has been nothing short of remarkable. After successfully developing a COVID-19 vaccine as proof of concept, the Programme is now expanding to address many other diseases relevant to LMICs. We are now poised to establish a sustainable mRNA vaccine production capacity that will benefit millions across the Global South, truly redefining what health equity can look like on a global scale.”

In a significant step forward, Sinergium Biotech is researching a human avian influenza (H5N1) mRNA vaccine candidate, and four R&D consortia have been formed in Southeast Asia, with more expected across other regions. The vaccines developed through this initiative will be shared across participating LMICs.

A map of the world with colored arrows and colored dots Description automatically generated

Unprecedented Capacity for Pandemic Preparedness and Resilience

With the manufacturing companies across four continents all based in LMICs, the Programme has fundamentally altered the mRNA vaccine production landscape. The initiative is projected to yield at least 60 million doses annually by 2030, with the potential to scale up to larger volumes that could supply up to two billion doses in the event of a declared pandemic. Leveraging future dose-reduction technologies, the Programme would have the capacity to cover all the mRNA vaccine requirements of the Global South.

As of December 2024, the mRNA Technology Transfer Programme has made significant progress, with nearly all site assessments completed. Half of the participating manufacturers have finalised their technology plans, with the remaining plans scheduled for completion by December 2025. Over a quarter of these manufacturers will have successfully received the technology platform transfer from Afrigen by the end of 2024, with the rest to be completed in 2025, marking an important milestone in the Programme. By December 2026, all manufacturing partners are expected to have demonstrated the technology at their respective sites, culminating in the full transfer of mRNA technology across all participants.

Prof. Petro Terblanche, CEO of Afrigen, highlighted, “The mRNA Programme has not only achieved our initial goals but exceeded them in every way. Afrigen’s work with our global partners has shown that LMICs can lead in R&D and manufacturing, transforming healthcare outcomes from diseases that affect the Global South. This Programme yet again demonstrates the power of partnerships and global collaborations.”

Dr Martin Friede, Coordinator at WHO, emphasised, “This mRNA Technology Transfer Programme exemplifies the power of collaboration in global health. We are delighted that WHO and the partners have signed an MOU with Prof Drew Weissman of the University of Pennsylvania to promote R&D of mRNA products for public health. We hope other institutions will also follow and share knowhow. We are committed to securing the necessary support to see these efforts through so that LMICs have the scientific and material resources to maintain this unprecedented level of pandemic preparedness.”

The Critical Role of Funding

Despite remarkable progress, additional funding is required to fully achieve the Programme’s ambition. An estimated US$200 million is needed to advance all manufacturers to GMP standards and continue to strengthen the R&D pipeline in support of at least 12 mRNA products currently in development. Encouragingly, Programme success has already attracted substantial catalytic co-investments. For example, for every dollar contributed by the Programme in the AFRO region, an estimated US$17 has been invested by regional stakeholders and other public health organisations.

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Psychotic-like Experiences in Teens Linked to Depression, Self-destructiveness

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Photo by Inzmam Khan: https://www.pexels.com/photo/man-in-black-shirt-and-gray-denim-pants-sitting-on-gray-padded-bench-1134204/

A study by researchers at the University of Helsinki and HUS Helsinki University Hospital found a significant association among adolescents between having psychotic-like experiences and depressive symptoms, as well as with self-destructive behaviours.

Psychotic-like experiences resemble symptoms of psychosis, but are milder, less frequent and much more common than psychotic disorders. While these symptoms do not constitute a disorder diagnosed as psychosis, they can still be disruptive, distressing or detrimental to functional capacity. Typical psychotic-like experiences include perceptual distortions and hallucinations, suspicious paranoid thinking, delusions and bizarre, unusual thoughts.

Psychotic-like experiences are abundant among adolescents referred to care, but are generally considered fairly neutral, with only some of the adolescents reporting them as frightening, worrisome or harmful. In the study, published in the journal Psychosis, the correlation between psychotic-like experiences and depressive symptoms turned out to be strong. This link was not explained by connections between individual psychotic-like experiences and depressive symptoms, but by factors that more broadly measure paranoia and unusual thoughts. In addition to depressive symptoms, paranoid thoughts and unusual thought content were also associated with self-destructive thinking.

Making questions about psychotic-like experiences part of care

The findings show that psychotic-like experiences should be systematically surveyed in all adolescents seeking psychiatric care. It should also be assessed how frightening, worrisome or harmful they are considered to be. Particularly in the case of responses emphasising bizarre thinking and exaggerated suspiciousness, attention should also be paid to assessing mood and self-destructive thinking, as these factors can remain hidden without further enquiry.

“Our findings provide a clear recommendation for treatment practices: psychotic-like experiences should be assessed as part of routine procedures, but it is also important to determine how they are perceived. These phenomena cannot be uncovered unless separately and systematically asked,” says the principal investigator, Docent Niklas Granö.

It should be clearly explained to adolescents and their families that these symptoms are common and often manageable. In addition, applications of cognitive psychotherapy, even brief interventions, can help adolescents understand their symptoms and alleviate the strain they cause.

Source: University of Helsinki

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Navigating Medical Aid Changes – Why Gap Cover is Essential in 2025 and Beyond

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By James White, Director of Sales and Marketing at Turnberry Management Risk Solutions

Photo by Alex Green on Unsplash

As South Africans prepare to review their medical aid plans ahead of the window for change leading up to December, many are grappling with the difficult decision of whether to downgrade their cover. Rising costs and ongoing economic pressures have led an increasing number of individuals and families to seek more affordable medical aid options. However, while downgrading may be an immediate cost-saving measure, it is crucial to understand how this decision impacts overall coverage and why adding gap cover should be a vital part of your strategy.

The consequences of downgrading medical aid plans

In 2025, medical aid contributions are expected to rise significantly, with many schemes projecting increases in the 10-15% range, far outstripping the Consumer Price Index (CPI) and most people’s salary increases. These hikes pose a major financial challenge, especially for the average family whose income growth may not keep pace with the rising costs of healthcare. As a result, many are choosing to downgrade from comprehensive plans to more affordable options, often focusing on hospital cover while choosing to manage day-to-day medical expenses out-of-pocket.

However, downgrading often comes with hidden costs. Lower-tier medical aid plans may only cover 100-200% of the scheme rate, while medical specialists and healthcare providers frequently charge significantly more than this. This leaves you vulnerable to substantial out-of-pocket expenses, particularly for specialist care or hospital procedures. As a result, gap cover, which is designed to cover the shortfall between what medical schemes pay and what healthcare providers charge, becomes increasingly essential when downgrading your medical aid.

The vital role of gap cover

When you downgrade your medical aid plan, you may face more co-payments, reduced benefits, and sub-limits on procedures that previously had unlimited coverage. Gap cover serves as a critical financial buffer, protecting you from these unexpected medical expense shortfalls. However, it is important to note that many medical aids are making changes to existing plans for 2025, with increased co-payments and reduced benefits, and potential sub-limits on procedures that previously had full coverage. This means you need to be more informed than ever, not only if you are thinking of downgrading, because changes may affect your existing plan as well.

By incorporating gap cover, you can safeguard against these potential shortfalls and ensure that you are not caught off-guard by additional expenses. This safety net can help you navigate the complex and evolving healthcare landscape in South Africa, ensuring that you remain adequately covered, even in challenging economic times, particularly as medical schemes change the way their cover operates.

Evaluating your medical aid and gap cover options

When reviewing your medical aid policy, it is essential to assess how well it meets your current and future needs, including factors such as affordability and coverage limits. Navigating the complexity of this often requires expert advice, which is why your broker is an invaluable resource. Brokers have an in-depth understanding of the medical aid landscape and can guide you in making the most informed decision for your unique needs, whether you are downgrading your plan or considering other options.

Your broker can help you understand the potential shortfalls that come with a downgrade and ensure you have the right gap cover to supplement your plan. They will also assist you in reviewing your policy schedule, interpreting medical aid terminology, and comparing plans to ensure that you are fully aware of the benefits and changes heading into 2025. The right broker will work with you to find a medical aid plan and gap cover that align with your life stage, financial situation, and healthcare needs.

Ultimately, working with your broker to ensure you have the right medical aid plan and gap cover will provide peace of mind and protect your financial wellbeing in an ever-changing healthcare environment. With the right guidance from a knowledgeable broker, you can make informed decisions that safeguard both your healthcare and your financial future.

About Turnberry Management Risk Solutions

Founded in 2001, Turnberry is a registered financial services provider (FSP no. 36571) that specialises in Accident and Health Insurance, Travel Insurance, and Funeral Cover.

With extensive experience across healthcare and insurance industries in South Africa, Turnberry offers unsurpassed service to Brokers and clients. Turnberry’s gap cover products are available to clients on all medical aid schemes, as they are independently provided and are therefore transferable in the event of a change in the client’s medical aid scheme.

Turnberry is well represented nationally, with its Head Office based in Bedfordview, Johannesburg with Business Development Managers in Cape Town and Durban. The Turnberry Team’s focus on outstanding client service comes from having extensive knowledge and experience in the financial services sector and is underwritten by Lombard Insurance Company Limited. Lombard Insurance Company Limited is an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.

Categories : Neurology Obstetrics & GynaecologyTags : Leave a comment

How Human Brain Functional Networks Emerge and Develop during the Birth Transition

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Shedding light on the growth trajectory of global functional neural networks before and after birth

Photo by Christian Bowen on Unsplash

Brain-imaging data collected from foetuses and infants has revealed a rapid surge in functional connectivity between brain regions on a global scale at birth, possibly reflecting neural processes that support the brain’s ability to adapt to the external world, according to a study published November 19th, in the open-access journal PLOS Biology led by Lanxin Ji and Moriah Thomason from the New York University School of Medicine, USA.

Understanding the sequence and timing of brain functional network development at the beginning of human life is critical. Yet many questions remain regarding how human brain functional networks emerge and develop during the birth transition. To fill this knowledge gap, Thomason and colleagues leveraged a large functional magnetic resonance imaging dataset to model developmental trajectories of brain functional networks spanning 25 to 55 weeks of post-conceptual gestational age. The final sample included 126 foetal scans and 58 infant scans from 140 subjects.

The researchers observed distinct growth patterns in different regions, showing that neural changes accompanying the birth transition are not uniform across the brain. Some areas exhibited minimal changes in resting-state functional connectivity (RSFC) – correlations between blood oxygen level-dependent signals between brain regions when no explicit task is being performed. But other areas showed dramatic changes in RSFC at birth. The subcortical network, sensorimotor network, and superior frontal network stand out as regions that undergo rapid reorganisation during this developmental stage.

Additional analysis highlighted the subcortical network as the only region that exhibited a significant increase in communication efficiency within neighbouring nodes. The subcortical network represents a central hub, relaying nearly all incoming and outgoing information to and from the cortex and mediating communication between cortical areas. On the other hand, there was a gradual increase in global efficiency in sensorimotor and parietal-frontal regions throughout the foetal to neonatal period, possibly reflecting the establishment or strengthening of connections as well as the elimination of redundant connections.

According to the authors, this work unveils fundamental aspects of early brain development and lays the foundation for future research on the influence of environmental factors on this process. In particular, further studies could reveal how factors such as sex, prematurity, and prenatal adversity interact with the timing and growth patterns of children’s brain network development.

The authors add, “This study for the first time documents the significant change of brain functional networks over the birth transition. We observe that growth patterns are regionally specific, with some areas of the functional connectome showing minimal changes, while others exhibit a dramatic increase at birth.”

Provided by PLOS