Tag: GroundUp

Categories : Healthcare Politics and RegulationsTags :

Call to Stop ‘Catastrophic’ Health Care Budget Cuts

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By Daniel Steyn for GroundUp

More than 1,200 doctors, nurses and other health workers in the Western Cape have signed an open letter to Finance Minister Enoch Godongwana, Premier Alan Winde and Finance MEC Mireille Wenger, calling for an end to “catastrophic” budget cuts in the provincial department.

The National Treasury cut health budgets at the start of the 2023/24 financial year and introduced further cuts halfway through the year, recommending a hiring freeze on new posts. Provincial departments were also told to absorb the cost of an unfunded public sector wage increase.

On Monday, Deputy Minister of the National Department of Health Sibongiseni Dhlomo told protesting unemployed doctors in Pietermaritzburg that the department will be taking the issue of budget cuts to Parliament this week and ask that healthcare be exempted.

In January, GroundUp also reported how two of the Western Cape’s biggest hospitals, Groote Schuur and Red Cross Children’s Hospital, are facing significant staff shortages.

According to the open letter sent by Western Cape health workers, the provincial health system has been “destabilised by indiscriminate freezing of virtually all clinical and non-clinical posts and a freeze on nursing overtime and agency budgets”.

“A reduction in posts mean that today, and tomorrow into the foreseeable future, there are fewer nurses, doctors, general assistants, clerks, physiotherapists, radiographers, porters, occupational therapists, dentists and specialists to deliver desperately needed healthcare to the population.”

The hiring freeze has also meant that critical medical posts remain vacant due to resignations or doctors completing their training.

The health workers wrote that the cuts will cause a reduction of surgical theatre lists, causing a postponement or cancellation of operations; patients in need of specialist medical care to wait longer due to fewer available hospital beds; oncology (cancer treatment) services to be delayed, meaning that cancers are diagnosed at later stages with less chance of successful treatment; and gains in neonatal, infant and paediatric care to be “reversed”, among many other issues.

Currently employed health workers will be required to work harder and longer to fill the gaps, which may lead to “sleep deprivation, burnout and fatigue-induced errors”, according to the letter.

Premier Alan Winde and MEC Wenger responded to the open letter in a joint statement on 7 February.

In the statement, Wenger and Winde agreed that the “nationally imposed” budget cuts are “devastating” and that they go beyond health services and “have hit education and social development services”.

“This is exactly what the Western Cape Government warned of and which it is now fighting to stop and reverse,” the statement read.

Over the next three years, the Western Cape Government faces cuts amounting to R6.7-billion. According to Winde and Wenger, these cuts are more than the total combined budgets of the provincial departments of community safety, economic development, and cultural affairs and sport.

In November, the provincial government declared an intergovernmental dispute (IGD) with the national government over the cuts. Mediation in this matter remains ongoing.

Asked to respond to the open letter, the National Treasury told GroundUp that the budget for 2024/25, which will be tabled on 21 February, will provide some guidance.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Healthcare Politics and RegulationsTags :

Unemployed Doctors March to Department of Health

On By ModernMedia

They demand permanent jobs and no budget cuts to healthcare

Doctors marched to the Department of Health offices in Pietermaritzburg on Monday to demand jobs. Photo: Joseph Bracken.

Over 80 unemployed doctors marched from UNISA campus on Longmarket Road to the KwaZulu-Natal Department of Health’s offices in Langalibele Street, Pietermaritzburg, on Monday.

They went to hand over their CVs and a memorandum demanding that the healthcare budget be increased to accommodate over 700 qualifying medical practitioners. The department was given 14 days to respond.

Eighty-four unemployed doctors also signed a register handed to the department.

The doctors were met by Deputy Health Minister Sibongiseni Dhlomo who said health minister Joe Phaahla had another engagement. Dhlomo said the department was working to address the issue of unemployed doctors, and that the minister would raise it this week in Parliament and ask that healthcare be exempt from budget cuts.

Dr Siya Shozi, part of a “small committee” of unemployed doctors with no political affiliation mandated to liaise with the department, said the march was coordinated through a WhatsApp group. Shozi was happy with the turnout but said it did not represent the large number of unemployed doctors in KZN and its rural areas.

Busiziwe Mancotywa, a grade one medical officer who has been unemployed since completing her training at the end of last year, said, “You apply for some positions where you meet the minimum requirements but for whatever reason you are never contacted”.

Mancotywa was joined by her brother, Nqaba, who is finishing his internship at Greys Hospital. He said if action is not taken now, he won’t find a job in the future.

Nomfundo Mbanjwa, also a grade one medical officer, complained about the cost of applying for jobs, including printing applications and transport to interviews. Mbanjwa says she had to sell her car to cover these costs.

Representatives from the South African Medical Association Trade Union (SAMATU) and the Public Servants Association of South Africa (PSA) joined the march and pledged support for the doctors.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : AddictionTags :

One of Cape Town’s Few Free Rehab Centres has Closed its Doors to Adults

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Photo by Alex Green on Pexels

By Matthew Hirsch for GroundUp

The Kensington Treatment Centre, one of few in-patient rehabilitation centres in Cape Town, has stopped accepting adults because of financial constraints.

The Western Cape Department of Social Development (DSD) confirmed that the Kensington Treatment Centre no longer takes adults “due to the need to accommodate more children in secure care without any additional funds”.

In the past financial year, the facility had treated 120 people.

The department says it is necessary to focus on youth at risk.

Its budget for substance abuse programmes has been cut by R600 000 for the 2023/24 financial year.

New applications will be directed to other substance treatment centres funded by the department, which currently has six in-patient facilities: Metro South, North, East, Cape Winelands, Overberg and West Coast. Enquiries and admissions can be made through self-referral or external referrals.

There are also six outpatient treatment centres run by the City of Cape Town.

Bianca Rabbaney, who works for U-Turn Homeless Ministries, has personal experience of how difficult it is to access rehab facilities in times of need. She lived on the streets for more than 20 years, because her family couldn’t cope with her. For most of that time she had a substance use problem.

“My life just spiralled down to almost completely nothing, and in that time I did search for help,” she says.

“There are so many of us who want to come out of drug addiction but we can’t do that when we’re out on the street. From my personal experience when I walked my journey, there were so many places I went to that rejected me.”

“They used to send us away because we didn’t have money to come into the facility or we didn’t have a place to stay. It made it difficult for someone like me to access that kind of assistance,” she says.

Rabbaney eventually got help at the Matrix Rehabilitation Programme Parkwood. She has been abstinent for eight years now.

“I never forgot the struggle that I had to go through to get to a shelter, get myself into a rehabilitation program and to get my life back together. We don’t have many of those facilities at the moment.

“I would like to send a message out there that there is hope after addiction. There is hope after being homeless. We just need more facilities.”

Budget cuts

The provincial DSD is concerned about possible further cuts to its budget.

“We will only know the impact on this programme next year after the final budget allocation,” said Monique Mortlock-Malgas, spokesperson to MEC Sharna Fernandez.

The department is also looking to regulate illegal rehabilitation centres.

“This process may assist with the demand for services to the extent that DSD can help more centres provide proper quality services to the public. Centres that are unable to comply will, however, need to be closed,” said Mortlock-Malgas.

Lise van den Dool, chief programme officer at U-Turn, says there are also state-funded beds in registered facilities but there is a long waiting period for these and this is a problem because people may lose motivation. “When a person is ready to walk that journey you’ve got a short window period,” she said.

Van den Dool said the biggest issue is what happens after the rehabilitation process. She said work programmes are fundamental to recovery – not just preparing people to be ready for work, but helping them keep their jobs.

According to data from the 2022 census, after loss of income, substance abuse is the main cause of homelessness in the country. Some studies, including one by U-Turn, suggest that there are at least 14 000 homeless people in Cape Town.

Republished from GroundUp under a Creative Commons licence.

Source: GroundUp

Categories : Healthcare Politics and RegulationsTags :

Health Department Agrees to Pay Nurses Uniform Allowance

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Photo by Hush Naidoo on Unsplash

By Marecia Damons for GroundUp

The Department of Health has averted a standoff with nurses in the public sector with a last-minute agreement to pay nurses a temporary allowance to buy uniforms.

Nurses threatened to work in their own clothes if the department failed to provide them either with uniforms or with an allowance by 1 October. This plan was put on hold pending negotiations between unions and the health department.

Since 2005, nurses received an annual allowance to buy their uniforms. But this ended on 31 March this year after a new agreement was signed by the Public Health and Social Development Sectoral Bargaining Council. Under the new agreement, nurses would be provided with uniforms.

As a result, nurses did not get the usual allowance in April this year. Instead, they were supposed to be provided with uniforms by 1 October 2023.

The agreement stated that in the first year, the department must provide nurses with four sets of uniforms, one pair of shoes, and one jersey. In the second year, it must provide three sets of uniforms, one belt, and one jacket.

But then, at a last-minute meeting of the bargaining council in September, the department told unions that it would be unable to meet the 1 October deadline. It proposed to put on hold the supply of uniforms until 2024.

Spokesperson for the Democratic Nursing Association of South Africa (DENOSA) Sibongiseni Delihlazo said labour unions said that if the department was unable to supply the uniform by 1 October, they must pay nurses an allowance as previously.

If the department failed to provide uniforms or pay an allowance, DENOSA said, its 84,000 members would embark on an indefinite protest action by wearing their own clothes at work from 1 October.

Following the last-minute bargaining council meeting in September, a new agreement was signed on 4 October.

The bargaining council resolved that a temporary uniform allowance of R3,153 be paid to all qualifying nurses by 30 November 2023. The health department also agreed to provide nurses with uniforms by 1 September 2024.

If the department fails to provide the uniforms by 1 September 2024, “the uniform allowance shall continue, considering the applicable inflation rate annually, as pronounced by the National Treasury in February”, the agreement read.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : General InterestTags :

Gift of the Givers is on the Ground in Gaza

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Imtiaz Sooliman calls for negotiations and compromise. “The only way to solve the problem is to do what is just.”

Haitham Najjar (left) of The Gift of the Givers Foundation helping to distribute water in Gaza. Photo supplied

By Matthew Hirsch for GroundUp

Dr Imtiaz Sooliman, founder of The Gift of the Givers Foundation, has appealed for negotiations, compromise and peace in the Middle East. The respected South African aid organisation has had a presence in Gaza for nine years.

Gift of the Givers doesn’t have an office in Gaza. Instead, the team of three people moves around distributing medical supplies, food and water. They are also involved in a women and child care centre, a health facility, and schools.

Sooliman says the organisation wants to send more people. “We are preparing to send medical teams but only if it’s not any risk to them.” He says a ceasefire or safe corridor is needed before the teams can enter Gaza. The organisation has 40 medical personnel ready to go in, Sooliman told GroundUp.

On Sunday Gift of the Givers reported that the team has been under severe physical and mental stress.

In 2014 Israel attacked Gaza for seven weeks. Sooliman said his team is reporting that this time it’s completely different. “They said it’s so difficult to move around. There’s so much anxiety and so much fear. The amount of bombs being dropped has never happened before.”

On Tuesday the UN High Commissioner for Human Rights said that 4200 people have been killed, and over one million people displaced, in just ten days, while large areas of the Gaza strip have been reduced to rubble.

The death toll includes a large number of women and children, as well as at least 11 Palestinian journalists, 28 medical staff and 14 UN workers. It also includes over 1300 Israelis, mostly civilians, killed by Hamas on 7 October.

Sooliman said that Gaza’s people face challenges with access to food and water. “Because there’s no electricity, the sewage plants don’t work. Because they can’t do burials, the decomposed bodies are going to cause infections. Because hospitals don’t have antibiotics, there’s a threat of infection there.

“They managed to do some mass funerals yesterday. As the bodies are coming in they are doing it straight away. There are thousands of bodies lying under the rubble that they can’t reach. They don’t have the equipment, they don’t have the personnel, but above all, it’s bloody dangerous to get there,” said Sooliman.

Sooliman said that he had a meeting with the Egyptian ambassador and South Africa’s Foreign Affairs Department on Monday in an attempt to get a humanitarian aid corridor open. “We are also looking at flying supplies on a cargo plane from South Africa and sending trucks to the border in Cairo.”

Asked how this situation compared to other humanitarian relief efforts the organisation had been involved in, Sooliman responded: “This is the worst situation in the world because there is no exit route. You can’t get out. The area is so small. It’s so easy to bomb it … Nobody can have a safety plan. Where are you going to hide? There’s no such thing as safety in Gaza.”

Gaza is only 350km2. It could fit into Cape Town nearly seven times, yet it has half Cape Town’s population.

Sooliman described Israel’s call to evacuate more than one million people from the north to the south of Gaza as “quite ludicrous”. “How can you move 1 million people in 24 hours when there’s no fuel and no cars? Where are you going to go to? Everything is bombed. How do you move an intensive care unit patient?”

He also called for restraint from both sides. “Civilians cannot be attacked in a war and that applies to both sides … At the end of the day, both sides must remember that there is no winner in war. Everybody loses out. The only way to solve this problem in the Middle East is to make peace, act rationally and make compromises.”

“This is not a thing about Jews against Muslims; it’s human against human. It’s not a religious thing, it’s a human thing … it’s about humanity. It’s in the interests of all parties to make compromises. The only way to solve the problem is to do what is just,” he stressed.

“When you act justly you will have peace, prosperity and peace in the entire region. Nobody loses out. Actually everybody gains more. They should go to the negotiating table, make compromises and give a just solution. If you do that then we never have to send any more supplies to the Middle East again,“ Sooliman added.

He said Gift of the Givers were accepting donations for their work in Gaza.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : HospitalsTags :

Department of Health in Last-minute Bid to Avoid Stand-off with Nurses over Uniforms

On By ModernMedia
Photo by Jeshoots Com on Unsplash

By Marecia Damons for GroundUp

The Department of Health is scrambling to avoid a stand-off with nurses who have threatened to work in their own clothes if a dispute over the provision of uniforms is not resolved.

Since 2005, nurses had received an annual allowance to buy their uniforms. But this ended on 31 March this year, after a new agreement was signed in the Public Health and Social Development Sectoral Bargaining Council in terms of which they would get uniforms instead.

As a result, nurses did not get the usual allowance in April – R2600 a year, according to Spokesperson for the Democratic Nursing Association of SA (DENOSA) Sibongiseni Delihlazo.

Instead, they were supposed to be provided with uniforms by 1 October 2023. The agreement stated that in the first year, government must provide nurses with four sets of uniforms, one pair of shoes, and one jersey. In the second year, government must provide three sets of uniforms, one belt, and one jacket.

The plan was that the procurement process would be centralised. But at another bargaining council meeting, in June 2023, the health department said it would be difficult to provide the uniforms on time.

Then on 12 July, Sandile Buthelezi, director-general for the DOH, issued a circular to all provincial health departments notifying them that the uniforms would be provided from January 2024 to January 2025.

The circular stated that the DOH would use a decentralised approach to providing uniforms by using provincial tenders.

“Provincial heads are responsible for participating and facilitating in tender processes through the bid specification in terms of colour, fabric composition and garment, development, review of the policy and monitoring and evaluation,” Buthelezi wrote.

Until January 2026, the circular said, nurses would be expected to wear the new uniform from Monday to Thursday and wear their old uniform from Friday to Sunday. From January 2026, when they would have both years’ issue, nurses would be expected to wear the new uniforms every day.

DENOSA responded to this a week later, and said the department’s circular went against the bargaining agreement.

Delihlazo said they proposed that if the department is unable to supply the uniform by 1 October, they must pay nurses an allowance as previously.

If the department failed to provide uniforms or pay an allowance, DENOSA said, its 84 000 members would embark on an indefinite protest action by wearing their own clothes to work from 1 October.

Delihlazo said the yearly allowance did not cover the cost of a full uniform. “Their uniforms are tearing and the colour is fading. So how can you expect nurses to wear uniforms if you don’t pay them a uniform allowance?”

He said the tender process meant the colour of the nurses’ uniforms and the quality of the fabrics might differ from one province to the next. The process also “opens a window of opportunity for corruption,” Delihlazo said. “Money may be given for uniforms but the tender process is porous.”.

Then, at a last-minute meeting of the bargaining council last Thursday, the department proposed to put on hold the supply of uniforms until 2024, according to a DENOSA statement. Meanwhile the health department would pay nurses an allowance of R3,153 by 30 November.

DENOSA said the agreement should be signed by the end of the week. If not, the union said, nurses would work in their own clothes.

The health department did not respond to GroundUp’s questions.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Emergency Medicine Healthcare Politics and RegulationsTags :

Alarm Raised over Amendments to Road Accident Fund Act

On By ModernMedia
Photo by Pixabay

By Tania Broughton for GroundUp

The Law Society of South Africa (LSSA) has urged members of the public and civic associations to formally object to proposed amendments to the Road Accident Fund Act which, if approved, will have “dire consequences” for all South African road users.

The draft amendment bill was gazetted earlier this month by the transport minister. It proposes major changes to how the fund operates and how it will pay claims.

According to the LSSA, it proposes significant changes to the existing law, including removing the rights of drivers, passengers and pedestrians to claim compensation for injuries they have suffered. Instead, it proposes that the fund will only provide significantly reduced “social benefits”.

And, says the LSSA, an innocent injured party would still be denied the common law claim against the guilty party for the balance of his or her loss.

Yet all road users contribute directly or indirectly to the fund through the fuel levy, estimated to be about R45-billion a year.

“The poor and disempowered, who make up the vast majority of claimants and who are compelled to use public transport, will bear the brunt of the consequences of these amendments. They will be forced into the public health system, as the prescribed tariffs will not cover the actual costs incurred at a private hospital. Under the present system, many receive treatment at dedicated private healthcare facilities,” the LSSA says in its statement.

Claimants will also not receive any lump sum payments and, if they are not able to produce a payslip, it was unlikely that they would receive compensation for loss of earnings.

The LSSA said those who can afford it will be compelled to take out private accident cover for medical and other expenses as well as accident benefits.

“This is likely to be very costly, as there will be no reimbursement of expenses covered from the fund. Medical aids will more than likely exclude cover or the cost thereof will have to materially increase to preserve the funds in the pool for all members.”

The LSSA said road accident victims will be uniquely discriminated against by the proposed legislation.

“Their rights to be compensated for harm suffered by the fault of another will be taken away. Persons who suffer harm from medical negligence or are injured in train or plane or boat accidents or in shopping centres, hotels, construction sites, holiday resorts, private homes or by electrocution or pollution and by a host of other causes, have unfettered rights to seek compensation from the person or entity who caused them harm.

“Innocent motor vehicle accident victims, alone, do not have this right, despite the fact that they pay premiums to the fund.”

At present, injuries sustained in a motor car accident anywhere in South Africa by any person are covered by the Fund.

The Bill now excludes injuries suffered in motor vehicle accidents in parking areas, sports fields, farm roads, driveways, private estates, game reserves or any other private road.

People who are not citizens or permanent residents are also not covered.

Persons crossing a highway are not covered. Persons injured in a hit and run are not covered. Pedestrians, drivers and cyclist who may test over the legal limit for alcohol and their dependents are not covered.

The Bill also proposes doing away with payments for pain and suffering, loss of amenities of life, disability, disfigurement or shock.

It also does away with lump sum payments for loss of earnings or support, replacing them with monthly payments, and giving the fund the right to continually reassess its liability to continue to pay.

While at present all medical and other expenses reasonably incurred that arise directly from the accident are covered, these will now be subject to a prescribed tariff. Any future medical expenses have to be pre-authorised.

The LSSA said the Bill also largely ousts the role of the courts in determining contested claims, establishing instead alternative dispute resolution procedures followed by referral to be a yet-to-be established Road Accident Fund Adjudicator.

Co-chair of the KZN Personal Injury Lawyers Association Anthony De Sousa said the biggest issues around the Bill was what was not known, such as what “social benefits” were and what the treatment tariffs would be.

“We don’t know what we are signing up for”.

“What also worries me is the people it excludes, such as pedestrians crossing highways. They don’t do that for fun. They do it because they have no choice and are trying to get to work or home.

“They are poor people and if they are knocked down, they really need help. To exclude them is just weird.”

He said while there may be a case not to cover motorists who don’t have licences, or who are over the legal alcohol limit, the Bill also proposed that their dependents are not covered, such as a child who is injured.

“The kids are not at fault, but suddenly they have no claim.”

He said the approach seemed to be: “Let’s try and save some money”.

“We pay a lot of money to the fund in terms of the levy. If you were to take that money and take up an insurance policy, you would probably get better cover and better value for money.

“I don’t think, no matter how they change it, it won’t work until they sort out the dysfunctionality, the administrative inefficiencies in the fund. You can change it to whatever system. They cannot properly administer it and run it.

“If they did their jobs properly, the fund would be saving itself a bucket load of money.”

De Sousa said the association was presently putting together its formal response to the proposals.

Collen Msibi, spokesperson for the Department of Transport said, “The bill is out for comments. The department will welcome all views and suggestions for its consideration.”

Comments and objections can be sent to Lindiwe Twala at twala@dot.gov.za or Trevor Mphahlele at mphahlelet@dot.gov.za

The deadline for comments is 8 October.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Injury & TraumaTags :

SA’s Injury Statistics are not Accurate, Experts Warn

On By ModernMedia
Photo by Maxim Hopman on Unsplash

By Sonia A. Rao for GroundUp

Reporting of gun crime in South Africa is wildly inaccurate, work by the South African Medical Research Council (SAMRC) suggests. This is because the official death notification form does not distinguish between gun deaths from accidents and gun deaths from homicide.

The SAMRC has called on the government to update the country’s official death notification form. In a September 2023 South African Medical Journal (SAMJ) editorial, researchers and scientists Pam Groenewald, Richard Matzopoulos, Estevão Afonso and Debbie Bradshaw, say the form does not comply with international standards. While the World Health Organisation recommends reporting manner of death on the medical certificate for cause of death, South Africa’s form does not allow this, they say.

As a result, South Africa does not have accurate information on injury statistics, says Groenewald, a specialist scientist at SAMRC.

“Given that South Africa has got a really high injury burden, this is really not acceptable,” she said.

The SAMRC has pointed out that accurate, timely mortality data for natural and non-natural deaths is especially important after the Covid pandemic.

In a press release, the SAMRC said natural deaths had spiked during Covid waves, while injuries had fallen during government-imposed lockdowns and alcohol sales bans. “Of particular concern is the significant impact of alcohol bans on injury-related deaths,” the council said.

The release also said the statistics are necessary to develop and monitor programs to reduce injuries and violence, and track Sustainable Development Goals of road traffic injury reduction, gender equality and reducing violence-related death rates.

South Africa’s official mortality statistics overestimate accidental injuries and underestimate homicides, transport and suicide deaths, according to a research report also published in the September 2023 SAMJ.

In official death notification form data from Stats SA for 2017, nearly 99% of firearm deaths were classified as accidental and only 1% as homicide. But the SAMRC’s National Cause-of-Death Validation Project (NCoDV) found more than 88% of firearm deaths were homicide, and its Injury Mortality Survey (IMS) found more than 93%.

Similar differences occurred for suicides. Only 0.3% of firearm deaths were recorded as suicide in the 2017 Stats SA data, but they were recorded as 7% in NCoDV and IMS data.

The research report says NCoDV and IMS provide more detailed and consistent data on causes of injury than the death notification form, but they are costly and time-consuming, and not feasible for routine surveillance.

“It costs a lot of money, when we could be getting this data in with every death certificate that gets completed,” Groenewald says.

She says the SAMRC has been asking for an updated death certificate form since 2012.

No annual mortality report since 2018

Also, Stats SA has not published an updated mortality report since the pandemic. The last official report was released in 2021 for the year 2018.

“We’ve got no cause-of-death data at all, not just injuries, nothing. We haven’t seen a death certificate from during the Covid period; we don’t know what doctors have reported,” she said. “It’s mind boggling.”

Felicia Sithole, deputy director of media relations for Stats SA, said in a statement that the Mortality and Causes of Death report had been delayed by a backlog of processing death notification forms as a result of the Covid lockdown, and because of Census 2022 work.

Sithole said Stats SA is committed to publishing the 2019 and 2020 Mortality and Causes of Death reports by the end of March 2024.

“Stats SA fully comprehends the importance of the Mortality and Causes of Death release, especially during the Covid-19 pandemic, and acknowledges that our data must conform to international standards,” she said.

The SAMRC report also calls for the dormant National Forensic Pathology Services Committee to be reactivated. This would help improve data quality, the report says. The committee, established in 2014, has been inactive since 2018/9.

Foster Mohale, a media officer for the Department of Health, said the Minister of Health is in the process of appointing a new National Forensic Pathology Services Committee.

The Department of Home Affairs had not responded to requests for comment at the time of publication.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Healthcare Politics and Regulations HIVTags :

Court Ruling Means that Pharmacists can Prescribe to People with HIV

On By ModernMedia
Photo by Miguel Á. Padriñán: https://www.pexels.com/photo/syringe-and-pills-on-blue-background-3936368/

The South African Pharmacy Council (SAPC) has been given judicial go-ahead to introduce its Pharmacy-Initiated Management of Antiretroviral Treatment (PIMART) initiative, which will allow specially trained pharmacists to manage and prescribe medicine to patients with HIV and tuberculosis.

Pretoria High Court Judge Elmarie van der Schyff has dismissed an application brought by a doctors’ organisation – the IPA Foundation – for the setting aside of the programme.

She said the pilot project had emphasised the value of the initiative, which was in line with the World Health Organisation’s vision to promote widely accessible primary health care.

“The untapped value of pharmacists in fighting HIV was also emphasised by the efficient role pharmacies played in meeting health care needs and providing health care services during the Covid-19 pandemic,” she said.

“The need to widen access to first line ART and TPT therapy on a community level is not a figment of SAPC’s imagination but a dire need that is also evinced in other countries.”

Read the judgment here

The IPA Foundation approached the court, under the Promotion of Administrative Justice Act (PAJA), seeking to review and set aside the SAPC’s decision to implement PIMART.

IPA claimed that the SAPC had failed to give interested parties an adequate opportunity to comment before the initiative was implemented. It further contended that PIMART unjustifiably encroached on the domain of medical practitioners and was in conflict with legislation.

IPA also accused SAPC of misleading the Director-General of Health, claiming there had been extensive consultation with stakeholders, which led to the approval and issuing of permits for the initiative.

The SAPC said the application should be dismissed. It said pharmacy-provided primary healthcare was a well known and functional concept in South Africa and PIMART was simply a “widening of this”.

Referring to the background and context, Judge van der Schyff said, in line with WHO recommendations that all people living with HIV must be provided with ART, the department of health had requested the SAPC to consider and implement interventions that would ensure that patients had increased access to medicines.

This led to the SAPC requesting the Director-General in August 2018 to consider issuing permits to pharmacists who had completed supplementary training, to manage patients and to dispense medication under PIMART.

In March 2021, the SAPC published a notice for public comment regarding the adoption of PIMART. The first permits were issued in August that year.

However, IPA submitted objections outside of the timeline for comments. It said this was because its members were struggling with another wave of the Covid-19 pandemic.

“Pharmacists and doctors operate in distinct and separate professional domains, the boundaries of which are closely guarded and some tension exists … IPA’s objection to PIMART seems to be rooted, partially at least, in this professional tension.

“This is evidenced by its fear that the decision to implement PIMART might ‘open the floodgates’ and ‘pave the way for pharmacists to ultimately treat and prescribe other schedule 4 drugs in respect of acute illnesses’,” the Judge said.

She noted, however, that the National Drugs Policy, in line with WHO guidelines, promoted “task shifting” to advance access to medicine and that at primary level, prescribing should be competency based, not occupation based.

Any alleged adverse effect that PIMART held for a medical practitioner had to be considered against the need to expand primary health care services aimed at preventing and treating HIV and providing first-line ART therapy.

Judge van der Schyff said the initiative gave members of the public a choice as to whether they wanted to approach a pharmacist, who had been issued with a permit, or a general practitioner.

In considering procedural fairness, the judge said there was nothing sinister in the timing of the notice calling for comment, that the project was not something hidden in secrecy and “I find it improbable, as alleged, that none of IPA’s members had timeous knowledge of the board notice”.

The decision to implement PIMART also fell within the ambit of the SAPC’s powers.

Evidence also showed that the PIMART training course was developed to ensure that pharmacists who successfully completed the training would be suitably qualified to safely and effectively assist in providing ART.

Judge van der Schyff dismissed the review application and ordered IPA to pay the costs.

Professor Francois Venter, former President of the Southern African HIV Clinicians Society and Director of Ezintsha, an HIV research organisation at Wits University, commented, “I hope this is the end of it. The pharmacies are an essential part of the health system, and pharmacists internationally play a big role in expanding HIV services.”

Republished from GroundUp under a Creative Commons 4.0 Licence.

Source: GroundUp

Categories : VaccinesTags :

Hepatitis B Vaccine at Birth can Save Thousands of Lives

On By ModernMedia

By Daniel Steyn for GroundUp

The hepatitis B virus is estimated to cause about 820 000 deaths a year globally. It is one of the leading causes of liver cancer. One in 20 people in South Africa is infected with hepatitis B, yet few people know about or have been tested for the virus.

During a media briefing on Friday, organised by the Gastroenterology and Hepatology Association of Sub-Saharan Africa (GHASSA), a panel of experts stressed the need for urgent interventions to eliminate hepatitis.

There are clear solutions, the experts said: increase awareness, increase access to testing, and prevent childhood transmission through birth-dose vaccination and screening and treating pregnant women.

“We are way overdue on bringing hepatitis out of the shadows and into the light,” said Professor Mark Sonderup, from the University of Cape Town’s (UCT) academic hospital at Groote Schuur.

In South Africa, an estimated 2.8 million people have chronic hepatitis B. Liver cancer caused by hepatitis B is on the increase in Africa and worldwide. Besides cancer, the virus can cause serious liver disease.

Hepatitis B is transmitted through bodily fluids, including semen and blood. Antiretroviral treatment for chronic hepatitis B is available but only 22% of cases are diagnosed.

An estimated 76 000 children in South Africa under the age of five have hepatitis B. Children infected with hepatitis B are more likely to develop a chronic infection.

Children infect each other: the virus multiplies in the body without presenting symptoms and a drop of blood shared through play between children can transfer the virus.

“They walk around like ticking timebombs, spreading infections,” said Dr Neliswa Gogela, liver disease specialist at Groote Schuur. Hepatitis B is 100 times more infectious than HIV, said Gogela.

Children born in South Africa receive a hepatitis B vaccine at six, ten, and 14 weeks old. If a vaccine dose was given at birth, it would cut out the first six weeks during which a child could become infected. Birth-dose vaccines are government policy but it has not yet been implemented. Other African countries like Namibia have introduced birth-dose vaccines.

The virus can also be transmitted from mother to child during and after birth. Pregnant women should be screened as part of prenatal and antenatal healthcare services, said Professor Wendy Spearman, head of Hepatology at UCT. Those eligible for treatment should receive antiretrovirals to prevent transmission of the virus to the child.

Hepatitis B is a silent killer, said Professor Mashiko Sechedi, head of gastroenterology at Groote Schuur. The virus stays in the body and only presents symptoms when the disease is at an advanced stage. It can cause multifocal liver cancer which renders the liver inoperable. “In South Africa, we’re seeing young patients presenting with advanced disease,” said Sechedi.

Professor Eduard Jonas, a surgeon at Groote Schuur, said that half of the patients in Sub-Saharan Africa who are diagnosed with liver cancer die within two and a half months of diagnosis. Late diagnosis and lack of treatment capacity make liver cancer particularly deadly in Southern Africa, he said.

Screening and testing for hepatitis are not easily accessible, said Professor Geoff Dusheiko, from Kings College in London. Whereas anyone wanting to do an HIV test can go to any government clinic and receive a point-of-care rapid test, they cannot do so for hepatitis B.

Rapid tests for hepatitis B are available but have not been rolled out by the government, so the only way to do a hepatitis test through public health facilities is to take blood, which is sent to a laboratory for testing.

While HIV, malaria and TB have attracted significant attention and funding, hepatitis has not. “We need people living with hepatitis B demanding access to treatment,” said Spearman.

Republished from GroundUp under a Creative Commons Licence.

Source: GroundUp