On 29 October, during its annual scientific meeting at the Sandton Convention Centre in Johannesburg, the South African Heart Association (SA Heart®) met with members of the National Department of Health (NDoH), Council for Medical Schemes (CMS), South African Medical Association, medical aid industry, pharmaceutical and medical device industry, as well as the Global Heart Hub – which supports patient advocacy for cardiovascular disease – with the intention to develop an advocacy forum to create a more empowered and engaged community of patients living with cardiovascular disease.
During the symposium, SA Heart® emphasised the cardiac profession’s difficulty in obtaining approval and full reimbursement for the evidence-based treatments, shown to improve patient outcomes. The rules and regulations surrounding the availability of treatments, variously determined by the NDoH, the CMS and funders, currently inhibit access to effective cardiovascular disease management. SA Heart®, an affiliate member of the European Society of Cardiology (ESC), adopts the ESC’s guidelines as its own, supplemented by consensus statements that take prevailing local circumstances into account. Instead of following the up-to-date recommendations of the ESC, both the NDoH and various private sector funders rather give preference to the CMS algorithms that are years out of date. These anachronisms determine standards of care, despite ongoing advances in evidence-based medicine.
Prescribed Minimum Benefits (PMB’s) are a set of defined benefits to ensure that all medical scheme members have continuous access to defined minimum health services, regardless of the benefit option they select. PMB’s are limited in their reach. Private sector funders often retreat behind rules and regulations within the state sector, as to the type and level of treatment that they approve. Each funder independently determines what will be funded and at what level. Based upon their unique Health Technology Assessments, each funder then decides what treatment is approved or declined. It is unfair to restrict treatment to what is available only in the state sector. Novel therapies could be more widely available if there were more constructive agreements between state and industry. The CMS is currently reviewing the PMB package and defining patient entitlement.
SA Heart® pointed out that physicians are at the interface between the patient and the funder. Frequently, the patient misunderstands their own relationship with their medical aid and may deem the practitioner responsible for limitations imposed on his/her treatment. The administrative burden on clinicians is often intolerable, requiring repeat motivations, chronic medication forms, PMB applications and telephone calls to funders.
During the symposium pertinent questions were raised around funder and regulator reimbursement decisions, as well as the obscure mechanisms governing the pricing of medicines and devices. SA Heart® also raised concerns about the future of both the public and private healthcare system. A balance between the two sectors is a delicate one, requiring careful policy decisions to ensure that both systems will contribute effectively to the overall health of our country. Debates often focus around issues of equity and quality of service. The idea of centralizing decisions and distribution in the pharmaceutical and medical device sectors can be seen as an effort to ensure equitable access to essential medicines and equipment. However, this approach could negatively impact the ability to cater for South Africa’s diverse and specific needs – with more bureaucracy and inefficiency.
The meeting was called to determine interest amongst the various parties in establishing a forum to find solutions to these problems, and to harmonise the regulations around access to both medications and devices. The panellists were unanimous in their agreement that the current rules, regulations and disparities between the public and private sectors need to be reworked and there was consensus that a forum should be created to continue these discussions and arrive at effective, durable solutions. SA Heart® committed to driving this process, and will regularly engage all stakeholders in future meetings, with the ultimate goal of improving patient access to innovative cardiovascular treatments.
Renowned clinician, researcher and educator Professor Harry Seftel has passed away at the age of 94. For many, he was well-known for his radio appearances concerning health and medicine. Hailed as a “national treasure” by President Cyril Ramaphoa, Prof Seftel contributed greatly to the study of non-communicable diseases in South African populations and was a strident critic of apartheid.
The Wits Faculty of Health Science posted on Twitter/X: “The Faculty mourns the passing of Professor Harry Seftel, distinguished professor of medicine at @WitsUniversity. Renowned for making complex medical issues accessible to all, Prof. Seftel was a passionate advocate for health promotion.”
Born on 28 December 1928, Harold Cecil Seftel became an intern at Baragwanath Hospital in 1953 shortly after receiving his medical degree, and by 1982 was Professor of Medicine and Chief Physician at Hillbrow Hospital.
An outstanding clinician, he contributed greatly to the categorisation of infectious and non-infectious diseases among Black South Africans. He held numerous positions and received an honourary law degree from Wits.
His research interests focussed on diseases with a high prevalence in various South African populations: oral iron overload, cryptogenic cardiomyopathy and arterial hypertension among Black Africans; coronary artery disease and diabetes mellitus among Asians and familial hypercholesterolaemia among Afrikaaners.
He encouraged research at many levels, authoring more than 200 publications in fields ranging from endocrinology to infective diseases. In doing so, he collaborated with many of the finest minds in their fields, locally and internationally.
Not content with confining his teaching to academia, he also educated the general public with presentations in the media, becoming a familiar face over the years. He became known for many catchphrases, with “trust no one, least of all yourself” being one of his most revealing.
Prof Seftel was also friends with Nelson Mandela, having met him at Wits University. While Nelson Mandela was in prison, he heard one of Prof Seftel’s broadcasts and reduced his salt intake to help with the health problems he suffered throughout his incarceration. Not surprisingly, Prof Seftel was a strident critic of apartheid and the gross inequalities it produced.
In his 1973 inaugural lecture at Wits, he said of the distribution of medical service South Africa: “The present situation is deplorable and shameful. The man from Mars who is due here shortly would find it quite incomprehensible. In particular he would find our system of priorities wholly illogical and immoral.”
The state of South Africa’s mental well-being is a cause for concern
Photo by Alex Green on Pexels
In Aon’s 2024 Global Medical Trend Rates Report, mental health is listed as a major contributor to morbidity, disability, injury and premature mortality; also increasing the risk of other health conditions. The state of South Africa’s mental wellbeing is cause for concern. The world has witnessed several major events that have also had widespread impacts on people’s mental health. Events such as the COVID-19 pandemic, natural disasters, economic uncertainties, social unrest and warfare have heightened stress levels and contributed to an increased focus on mental well-being.
South Africans are distressed and struggling with their mental health:
In Sapien Labs’ Mental State of the World 2022 report, South Africa was ranked as the country with the highest percentage (35.8%) of its population that are distressed and struggling with mental health.
Another prominent trend highlighted in the Sapien Labs report is the declining mental well-being of each successively younger generation. This is reflected in the Western Cape Government’s report on anxiety, depression and adolescent suicide which found that 9% of all teenage deaths are due to suicide.
According to the World Health Organisation (WHO) more than 700 000 people die by suicide every year, with South Africa rated as the country with the ninth highest suicide rate in the world at 23.5 per 100k, with suicide alarmingly being the fourth leading cause of death among 15 – 19-year-olds.
A WITS University study found that a quarter (25.7%) of South Africans are depressed with only a quarter of these affected individuals seeking assistance.
According to Jacqui Nel, business unit head of healthcare at Aon South Africa, depression is likely to be the world’s leading burden of disease by the year 2030, if not sooner. “It is easy to measure an individual’s weight, Body Mass Index (BMI), glucose and cholesterol levels, but it is much harder to measure what is going on in a person’s mind. The top challenge that human resource professionals are concerned with is keeping the workforce engaged and productive in the face of ongoing retrenchments, the spiralling cost of living, load shedding and the fact that 44% of South Africans have impaired credit records. All these factors are converging to create enormous contributory pressures when it comes to anxiety levels experienced by employees,” says Jacqui.
One of the leading trends in the mental well-being of employees is burnout, which places employees at risk of developing depression. It was classified as an occupational phenomenon in 2019 by the World Health Organisation (WHO) with its occurrence rate increasing on an annual basis, and it has only escalated since the onset of the pandemic and the radical changes to work models since then. “Employees that are burnt out feel exhausted, distance themselves from their colleagues and their job and show a reduction in professional efficacy,” Jacqui explains.
Finding a sustainable work-life balance model
These factors are clear indicators that there is something radically amiss in our work-life balance, and we need to do better as a society and employers in embracing a more sustainable work-life model that is cognisant of the forces that are at play in the workforce environment. “It starts by building resilience, agility and a sense of belonging at an individual and organisational level, and most of all, better support structures,” Jacqui explains.
Workforce Resilience
Workforce resilience describes a person’s fundamental sense of security at work, a strong sense of belonging with the employer and the adaptability and motivation they need to reach their full potential. “Workforce resilience matters because businesses that put their people first are more likely to thrive. By creating a workplace environment that provides security, motivation and belonging, employees and colleagues are better able to weather and process the fiercest of storms and pressures,” Jacqui explains.
Workforce Agility
Workforce agility describes a workforce that thrives on and embraces change rather than being threatened by it, a workforce that can develop future skills at speed and naturally pivots to stand out from the competition – all the while balancing investment and people risk with agility, creating value for the employer and the customer, alike.
“By investing in impactful Employee Assistance Programmes (EAP), employers empower their employees to better measure their progress and manage risk, enabling a diverse, inclusive and agile workforce. Workforce agility is the difference between merely surviving and thriving,” says Jacqui.
“It may even extend beyond an EAP, with organisations implementing programmes that are specific to the organisation’s challenges. Insights that are underscored by data and analytics, will be able to identify employee trends and concerns, enabling employers to wisely spend money where it is most required within the wellness of employees,” she adds.
Belonging
Belonging describes a connection to a community of peers and the support that each individual feels in relation to their working environment. “It is important because it enables a positive working life experience and underpins personal and professional growth, providing a voice and an opportunity to use it and be heard, regardless of role or rank. All the while, supporting wellbeing whilst driving diversity and innovation,” Jacqui explains.
“Fostering a sense of belonging in an employee starts by assessing how well the personality traits of a possible candidate align with the cultural fit of the organisation during the recruitment phase. It also extends to how well employees are supported during their time in the organisation, allowing them to naturally become agents of change and role models for the organisation’s culture by living the company ethos and way of operating to inspire adoption throughout,” Jacqui explains.
At the heart of this entire process, is the implementation of a well-rounded Employee Assistance Programmes (EAP) that is designed to support employees in dealing with personal and work-related stressors that may affect their well-being, mental health and productivity. This could include:
Confidential counselling sessions.
Assessments of an employee’s situation and referral to the correct counselling and support.
Crisis intervention for employees who are dealing with trauma such as bereavement, have been victims of violent crime or gender-based violence.
Offering work-life services that could range from finding childcare to legal assistance or financial planning.
Offering educational workshops and seminars on aspects such as personal finance through to health and wellbeing.
Wellness programmes that promote healthy habits and stress reduction and management techniques.
Consultation for managers and supervisors.
“There has been a significant increase in awareness and understanding of mental health issues as efforts by mental health advocates, employer groups and individuals have contributed to destigmatising mental health. This increased awareness has led to more open conversations about mental health in various sectors of society and it is here where Employee Assistance Programmes (EAP) play a crucial role in supporting employers and opening the doors for candid conversations and getting the needed help and support. The services of a trusted and skilled advisor are key in helping organisations develop and operate an EAP that is fit for your business and your people and their unique circumstances. “
“While there is a cost involved that is carried by the business, the results far outweigh the investment. It’s about providing employees and management with the means to weather the storms of an increasingly complex world of work, find a balance in their personal lives and come out on the other side with resilient and agile people who have a strong sense of belonging and purpose. This is about supporting employees to manage stress, improve productivity, and enhance their overall quality of life and wellbeing, which in turn improves workplace dynamics, contributing to a positive and productive work environment where skilled and valued employees want to be,” Jacqui concludes.
For decades, the standard way to prevent people who were exposed to tuberculosis (TB) from falling ill with the disease was to offer them a medicine called isoniazid, taken daily for six or more months. That changed in the last decade with the development of new preventive therapy regimens that are taken for four, three, or even just one month.
One complexity, however, is that both isoniazid and the new regimens are much better at preventing normal drug-sensitive TB than they are at preventing drug-resistant forms of TB. This is not surprising. As explained by Paediatric Infectious Disease doctor and Professor of Global Child Health at Imperial College London, Dr James Seddon, the two drugs that have mainly been used to prevent drug-susceptible TB are isoniazid and rifampicin (rifampicin’s sister drug rifapentine is also used). Now, by definition, he explains multidrug-resistant (MDR) TB is resistant to both these drugs so it’s unlikely to have any impact.
The situation is particularly tricky when it comes to children. In a 2020 statement the World Health Organization (WHO) says that it estimated that worldwide between 25 000 and 32 000 children develop MDR-TB each year, and mainly acquire it through transmission from close contact with an adult or adolescent who has MDR-TB. According to Seddon, while there is some emerging observational evidence on the use of drugs other than isoniazid and rifampicin to prevent MDR-TB, there has been no clinically tested regimen to give to children following MDR-TB exposure.
Now, much anticipated results from a phase three trial has shown that a single antibiotic pill, given daily for six months, is safe and effective to use in children who have been exposed to MDR-TB.
Results from TB CHAMP
The trial, called TB-CHAMP, looked at the efficacy and safety of using the antibiotic levofloxacin to prevent TB in children exposed to MDR-TB. Top-line findings from the study was presented last week at the Union World Lung Conference held in Paris, France.
“The paediatric population is probably the most neglected of all the populations affected by MDR-TB,” Dr Anneke Hesseling, Director of the Paediatric TB Research Programme at Stellenbosch University, told the conference. “Fewer than 20% who develop MDR-TB disease are actually diagnosed and treated, and so to find more cases and prevent more cases is really, really critical…So prevention is really key, and the TB-CHAMP trial is really a phase three efficacy trial looking at levofloxacin to prevent new cases of TB in children and also looking at the safety of levofloxacin.”
Hesseling, who is the Principal Investigator of the study, says that TB-CHAMP is the first trial to provide clinical data on what drug might be used to prevent TB in children who have been exposed to MDR-TB. It was conducted at five sites across South Africa, all with high MDR-TB burdens. The study was led by Stellenbosch University and the Desmund Tutu TB Centre. The findings have not yet been published in a peer-reviewed journal.
922 children were randomised to receive either levofloxacin or a placebo for six months. 453 children got levofloxacin and 469 got the placebo. The primary efficacy data featured data from 916 of those children, with 451 in the levofloxacin arm and 465 in the placebo arm.
Hesseling says that only children who were exposed to an adult in their household with confirmed MDR-TB were included in the study. At first children below the age of five were recruited, regardless of their TB infection status. Later children between the ages of five and 17 were included, but they had to either have a TB infection or be living with HIV. The majority of the children, 90%, were younger than five years. TB infection was confirmed with a blood test.
By 48 weeks, Hesseling says five children in the levofloxacin arm versus 12 in the placebo arm developed TB, which amounts to an incidence rate of 1.1% in the levofloxacin arm, and 2.6% in the placebo arm.
Implication of results
“While TB preventive therapy (TPT) has long been recommended and available for young child contacts of people with drug-susceptible TB, there has not been sufficient evidence to make strong recommendations for treatment that could prevent DR-TB. Therefore, the TB-CHAMP findings are critically important for a number of reasons,” says Professor Guy Marks, President and Interim Executive Director, International Union Against Tuberculosis and Lung Disease (The Union).
“The study provides the first high-quality evidence that DR-TB can be prevented in children by using six months of daily levofloxacin, and that this is a safe medication. Furthermore, this will encourage more community-based contact screening, which will also lead to early detection of children and contacts of all ages who already have disease, and initiate treatment,” he adds.
“The impact [of the TB-CHAMP results] is potentially tremendous as it would prevent DR TB among child contacts. DR TB is more complex to treat and cure and often children are marginalised, so this study puts the spotlight on an effective way to protect children. This is not just about the life and health of the child but the social, economic and mental health implications for the caregiver and the entire family,” says Dr Priashni Subrayen, Technical Director for TB at The Aurum Institute.
Seddon, who is also one of the Co-PIs for the study, tells Spotlight that it was important to establish the safety of levofloxacin since it belongs to a class of drugs called the fluoroquinolones, which were thought to have terrible side effects when used in children.
Results from TB-CHAMP show that this is not the case.
The side effects were mild, and the regimen was well tolerated, according to Hesseling, with only eight children having a grade one or higher adverse event in the levofloxacin arm compared to four in the placebo arm. Two deaths were reported, one in each study arm, but were unrelated to the study. Overall, six children in the levofloxacin arm discontinued treatment or left the study early.
Researchers from TB-CHAMP collaborated with researchers from the V-QUIN trial – a phase three study that looked at levofloxacin as TB prevention in adults in Vietnam – in order to combine their data which allowed them to show data for levofloxacin across different age groups. Seddon explains: “They’ve applied a novel analytic approach, which uses a Bayesian, or probabilistic, framework, where we take the results of TB-CHAMP and we say well, if we actually use some of the information from V-QUIN to inform the TB-CHAMP results, we can make that a slightly more confident estimate,” he says.
The combined results, according to Hesseling were able to also show that levofloxacin reduced the risk of TB by about 60% across the age spectrum but with a tighter confidence interval, indicating a more precise estimate of the effect.
Seddon tells Spotlight that the combined data showed that there were no serious adverse events, but the adult population experienced more grade one and grade two side effects than the children, but these went away either over time or when the drug was stopped. The side effects included inflammation in the joints and tendons, which is a known side effect of this class of drug.
Not a silver bullet
While the findings could be a game-changer and potentially inform MDR-TB prevention guidelines, particularly in children, the regimen is by no means a silver bullet. Seddon says that while the regimen was safe, when participants were asked whether they liked the medicine, more people said they didn’t like it in the levofloxacin group versus the placebo. Another downside is that the pill was an adult formulation and thus needed to be cut and/or crushed for the kids to swallow.
Seddon explains that the WHO, who have been provided with the data from both studies and expected to meet in early December, would need to consider a variety of factors before deciding what to recommend about the use of levofloxacin for prevention. That includes the fact that you need to treat a lot of children for six months who might not have TB despite being exposed in order to prevent a few cases.
“You have to weigh up the benefits versus the risks and the risks are low, but it is still giving a drug for six months to children and most of them don’t need it. But the consequences of getting MDR-TB are so bad that we really want to prevent that,” he says.
There is also the question around what effect using a broad antibiotic as preventive treatment will have on the microbiome of children and how this might drive resistance to the fluoroquinolones. Seddon says stool samples were collected from the study participants to determine how the drug affected a child’s microbiome and the potential for driving resistance. These data will also be provided to the WHO.
“I think that the evidence base is now very strong on the basis of these two trials. I think you can really say the issue of whether levofloxacin prevents MDR-TB, we’ve put that to bed,” he says. “Are there going to be other studies? Yes. I think that this is not over, levofloxacin is not the perfect drug for preventive therapy.”
Marks adds to this saying: “An important next step for TPT in DR-TB contacts will be studies that evaluate regimens that are shorter than six months – a long time to take medication every day, which can often be challenging. Effective and safe shorter regimens are now being used for child contacts of drug-susceptible TB and we hope the same progress can be made for contacts of DR-TB.”
As Marks has already stated, currently there are no strong recommendations for MDR-TB prevention by the WHO. In the 2020 TB prevention guidelines, it recommends that the preventative treatment for MDR-TB should be either a fluroquinolone or other second-line agent. It does however caution that these recommendations are based on low-quality evidence. Because of this, it recommends that the preventative treatment for MDR-TB should be individualised, and it be based on the drug resistance profile of the presumed contact. The drugs levofloxacin and moxifloxacin- both fluoroquinolones – may be used unless resistance is suspected. For levofloxacin a dosing schedule for both adults and children are proposed in the document.
Subrayen says that in South Africa the 2019 guidelines for the management of Rifampicin Resistant-TB (RR-TB) does indicate the use of levofloxacin as prevention treatment. The guidelines state that for prevention treatment a fluoroquinolone-based, multidrug regimen is preferred (either levofloxacin and high-dose isoniazid or levofloxacin, high-dose isoniazid and ethambutol). And if exposed to fluoroquinolone-resistant RR-TB, then high-dose isoniazid could be given. Delamanid could be considered as a potential option in very select cases. A training manual published this year by the Department of Health suggests that levofloxacin can be given on its own – but also stresses that the evidence base is weak, something that TB-CHAMP has presumably now changed.
Future of TPT
Seddon says that in a perfect world the ideal TB preventive regimen would be a so-called Pan regimen that could be given for a short period of time, to someone who has been exposed to TB and it works regardless of whether they had been exposed to drug-susceptible or drug-resistant TB.
“There are studies planned to use other drugs for prevention. There’s a study planned to use bedaquiline for a month or two and potentially using injectables that you just have to give once every couple of weeks. So, I think although this [levofloxacin] is a good option now, and it’s probably the best option we have now, this is not perfect,” Seddon says.
The study Seddon is referring to is the BREACH-TB study, a phase three trial that will look at whether a one-month treatment regimen of oral bedaquiline could prevent all forms of tuberculosis. It would be given to people exposed to both drug-resistant and drug-susceptible TB, and in people with HIV infection, including pregnant women and children.
Responding to questions from Spotlight earlier this year when this study was announced in the press, Sonya Krishnan, Assistant Professor of Medicine at Johns Hopkins University and Eric Nuermberger, Professor of Medicine at Johns Hopkins University, said that they anticipate recruiting between 1600 and 2 00 people to take part in the study – they expect around 400 to 500 of these will be people living with HIV. They also said that the control arm will receive the current standard of care in the country rather than placebo.
When asked whether any South African study sites will be included in the clinical trial, they said, “We very much plan to partner with study sites in South Africa. South Africa has a long-standing history of research excellence in TB.”
“A shorter regimen that fights both drug-resistant and drug-susceptible TB would be a game-changer for those living with TB and get us closer to our shared goal of ending the epidemic by 2030,” said Dr. Atul Gawande, USAID assistant administrator for Global Health, in a statement on the study. “This clinical trial will lay the foundation for a remarkable innovation in our fight against TB: a single-dose, long-acting injectable medicine.”
Indeed, if the science and development pans out as Gawande suggests it might, the future of TB preventive therapy might well be an entire course of therapy delivered through a single injection rather than a month or more of pills. As indicated in an article in the journal Clinical Infectious Diseases, work is already underway on the development of bedaquline, isoniazid, and rifapentine long-acting injections – though the research is for now still only in mice.
‘Communities need to be involved’
Hesseling raises the point that when treating or preventing TB, more than just the latest research advancement is needed to improve TB outcomes.
“For me treatment follows diagnosis, actually strengthening healthcare services, making communities more aware and creating demand for kids accessing diagnosis, preventive treatment and appropriate treatment, is actually where it starts,” she says. “So tools are amazing, but we actually need to have strong, effective healthcare services and knowledgeable, empowered communities.”
Seddon adds to this saying that results like those from TB-CHAMP are “a bit irrelevant if it is all kind of top down, paternalistic coming from the researchers, coming from the health system”.
“We really need to generate a community demand for this, where individuals living in communities where this is a problem are calling for this and getting angry about this and demanding it in a way that I think we’ve achieved very well with the HIV community,” he says. “It’s all well and good doing the science and then even better to get it [levofloxacin] into a guideline, but until there’s real demand for from the end user, I think it’s only going to have a certain amount of reach.”
Note: The terms DR-TB and MDR-TB are used somewhat interchangeably – Spotlight uses DR-TB to refer to drug-resistant forms of TB in general and MDR-TB to refer specifically to TB that is resistant to isoniazid and rifampicin.
A coherent, achievable path to universal health coverage now imperative
Glaring voids highlighted in submissions on the National Health Insurance (NHI) Bill threaten South Africa’s path to equitable healthcare access for all, cautions the Health Funders Association (HFA). The organisation has voiced its profound concern, emphasising the disconcerting sway of politics over the bedrock mission of prioritising the well-being of our nation within this critical healthcare deliberation.
“The practical barriers to successfully executing NHI as it is laid out in the Bill are hard to ignore, and yet the numerous concerns and suggestions raised in the consultation process have not been considered or implemented,” says Craig Comrie, chairperson of the National Health Funders Association (HFA).
“The clear shortcomings of the NHI Bill in terms of practical funding mechanisms and lack of collaboration with experienced health funders, among other aspects, have been overlooked for the most part, with only the Western Cape so far rejecting the Bill in its current form.”
The National Council of Provinces (NCOP) Committee on Health’s approval of the NHI Bill with insignificant edits does not address the numerous concerns raised in submissions made by the public and informed stakeholders, including the HFA, on behalf of its members.
The HFA is a professional body representing medical schemes and half of South Africa’s medical aid membership.
“There are constructive solutions to address the problems identified in the NHI Bill effectively, and it is not too late to fix the legislation. While the Bill is rushing towards the President’s pen to be enacted, the HFA respectfully appeals to the President to reconsider the wisdom of signing into law a Bill that has no workable funding mechanism while disregarding solutions proposed by private health funders, leading organisations, businesses and other key constituents,” Comrie says.
“We anticipate considerable resistance to the NHI Bill on Constitutional grounds, and as the HFA, we will continue to advocate for a more achievable approach to fulfilling universal health coverage aims.
“The timing of the recent flurry of activity in moving the Bill through the necessary hoops ahead of next year’s election invites the notion of a blunt instrument, an unrealistic election promise rather than a pragmatic solution for the highly complex health challenges South Africa faces,” he says.
Health Funders Association members, including leading lights in the industry such as Bankmed, CAMAF Medical Scheme, Discovery Health Medical Scheme, Fedhealth, Glencore Medical Scheme, Momentum Medical Scheme, Profmed and PPS Healthcare Administrators, to mention but a few, are ready to work with government to develop evidence-based solutions that will help secure access to quality healthcare for all South Africans.
“There is so much opportunity to make the NHI work. Private public partnerships and collaboration have achieved so much good for the benefit of South Africans in other sectors, and there is much our industry can contribute to help make quality healthcare more accessible and sustainable for all,” Comrie concludes.
Netcare Christiaan Barnard Memorial Hospital has earned a prestigious five-star rating from the City of Cape Town’s Water and Sanitation Directorate, joining the esteemed ranks of organisations dedicated to water sustainability. The accolade underscores NCBMH’s commitment to responsible water management and aligns with the hospital’s ongoing efforts to champion prudent and sustainable management of natural resources, supporting water-sensitive urban living.
Netcare Christiaan Barnard Memorial Hospital (NCBMH) has earned a prestigious five-star rating from the City of Cape Town’s Water and Sanitation Directorate, joining the esteemed ranks of organisations dedicated to water sustainability. The accolade underscores NCBMH’s commitment to responsible water management.
The City of Cape Town’s Water Star Rating Certification Awards acknowledged NCBMH’s dedication to best water use, supply, conservation and discharge practices. This recognition aligns with the hospital’s ongoing efforts to champion prudent and sustainable management of natural resources, supporting water-sensitive urban living.
“We are proud to be part of a community leading the charge in climate-smart healthcare transformation and are committed to playing a proactive role in averting a potential water crisis in Cape Town and across South Africa,” said André Nortje, Netcare’s environmental sustainability manager.
Nortje emphasised Netcare’s dedication to minimising environmental impact: “Our commitment extends beyond accolades. Efforts to conserve water, reduce waste and save electricity should be high on every South African’s agenda, and we are committed to doing our part to drive sustainability.”
NCBMH’s water conservation initiatives include a sophisticated greywater harvesting system, as well as a desalination plant capable of providing the entire facility’s water needs. These initiatives, as well as the installation of low-flow showerheads and aerator-equipped taps throughout the hospital, can achieve water savings of approximately 60 000 kilolitres for the facility per annum. The hospital’s desalination plant, installed in 2019, also has the filtration capacity to support all Netcare facilities in the City of Cape Town in a disaster situation.
Netcare achieved a 23% reduction in water consumption at Group level between 2014 and 2020. Nortje outlined the 2030 aim to further reduce the company’s impact on the natural potable water sources by implementing grey- and black-water recycling projects within selected facilities.
The company’s sustainability strategy, initiated in 2013, addresses electricity use, waste reduction, and water management. The Group aims to further reduce its impact on water sources by an additional 20% from the 2020 baseline. The strategy includes efficient equipment deployment, the evaluation of greywater and blackwater treatment for potable water and an operational efficiency drive.
“We believe every business should be a good corporate citizen contributing to our country’s future. At Netcare, we want to show South Africa and the world that sustainability is possible and that YOU can make a difference. The certification allows us to showcase our efforts to inspire businesses around us to join in the fight against wastage,” concluded Nortje.
With frequent and long stints at their computers, the average gamer is a sedentary night owl, often compromising on sleep – especially quality sleep – and being exposed to too much blue light. The topic has been explored in University of Cape Town (UCT) PhD candidate Chadley Kemp’s doctoral thesis, a meaty study of over 70 000 words.
Kemp’s research into habitual gaming activities is supervised by Associate Professor Dale Rae, a sleep researcher and senior lecturer at the Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS) in the Faculty of Health Sciences.
This work is founded on Kemp’s 2018 research underpinning a master’s in medical science at UCT’s former Department of Exercise Science and Sports Medicine in the Sports Science Institute of South Africa. This was upgraded to a PhD in 2020.
His research (he is an esports and video game enthusiast) explores adult esports players’ sleep, health status, light exposure patterns and physical activity.
“We know that sleep affects mental functioning in general, but we weren’t sure about the extent to which this applied to esports players,” said Kemp.
Framework for healthier gameplay
Kemp’s goal is to produce objective data that will guide the development of a framework aimed at promoting healthier gameplay standards and encouraging policy reform within the esports industry.
The tests they used to assess neurocognitive performance were intended to serve as proxies for certain aspects of esports performance because they tested specific mental skills important to gaming, he added.
“We gathered it would be a useful addition to compel gamers to adopt better sleep and lifestyle behaviour changes if it meant … that their health would improve, and they would benefit from better in-game performance – and get an edge over their competitors!”
Kemp’s focus is not on professional gamers, but what he calls “the missing middle” of the esports community: the amateur and semi-competitive gamers.
“This group doesn’t have the same infrastructure and support as their professional counterparts,” he explained. “But what makes them particularly interesting is the fact that they have to balance their gaming commitments with holding down a job, studies, or juggling family or household commitments.”
Global attraction
Esports are burgeoning across the globe – and not only among competitive gamers but audiences too. Writing in the South African Journal of Sports Medicine, Kemp and his co-authors noted that globally competitive gaming attracts 532 million fans alone, according to statistics released in 2022.
However, his study wasn’t motivated by an influx of gamers presenting themselves with sleep difficulties at Associate Professor Rae’s sleep consultancy, Sleep Science. Rather, it stemmed from a broader observation and concern within the local esports community about gamers and poor-quality and short-duration sleep, high levels of sedentarism, and excessive exposure to artificial or electronic night at night.
Based on these conversations and endorsed by anecdotal evidence from within the esports industry, Kemp said he and Rae were able to determine that sleep curtailment had seemingly become a “rite of passage” among gamers. Primarily, most gaming takes place at night because of gamers’ daytime commitments.
As there wasn’t much literature on the topic (much of it is focused on the implications of gaming in children and adolescents) and most studies were survey-based and didn’t target esports players or those regularly engaged with gaming, there was significant knowledge gap that needed filling. As a demographic, Kemp is particularly interested in adult esports players because of the greater health risks posed by age and unhealthy lifestyle factors, such as smoking and alcohol consumption.
Because he needed a tool to measure sleep and physical activity concurrently, he validated the Actiwatch, a special research device, to do this. The device also measures light exposure. For his sample group, Kemp recruited eligible esports players and measured variables of interest. These were clinical measures (anthropometry, blood pressure, blood markers) and self-report data (questionnaires on sleep, chronotype, daytime sleepiness and gaming addiction) and their cognitive performance.
“We also included non-gamers in our study, so we could compare our gamers against people who were not gamers. In total, we had 59 male participants (31 gamers; 28 non-gamers). (The females volunteering to participate did not meet the study’s inclusion criteria.) For a week, these individuals wore the Actiwatch to track their sleep, physical activity, and light exposure.”
Key findings
The key findings of his research make for interesting reading:
esports players have comparable sleep duration to non-gamers (control group) but tend to sleep later than others. They hit the middle of their sleep cycle around 04:08 compared to 03:01 for the control group.
A much larger percentage of esports players (45.2%) showed night-oriented habits (or evening chronotypes), ie they are more active and alert at night. This is in contrast to only 7.1% of the control group showing similar evening tendencies.
They nap more during the day, but their night sleep duration is similar to that of the control groups.
There was no significant difference in risks related to heart diseases or metabolic diseases between the two groups, which Kemp speculates might be related to their young age. But most of the health markers were tentatively raised, which could point to worse cardiometabolic health in future.
Esports players smoke more.
Esports players performed better in brain-based tasks, showing better attention and accuracy, and making fewer mistakes.
Esports players are less active than the control group. They sit more (11.2 vs 9.1 hours a day) and are less physically active, whether it’s moderate- or vigorous-intensity activity.
Esports players have specific active and inactive hours. They are less active in the early morning and certain evening hours but are more active around midnight.
Esports players are exposed to dimmer light for a more significant part of their day, and their exposure to bright light happens later at night.
This work is important for several reasons, said Kemp. A key takeaway from the research revolves around chronotypes.
“Esports players seem to have sleep patterns that align with being night owls and this may be influenced both by their natural tendencies and their gaming habits. It’s also possible that a genetic disposition and exposure to artificial light from screens collectively contributes to these sleep patterns.
“The combined effect is thought to create a cycle where their preference for evening activities leads to more gaming, which in turn reinforces the night owl tendencies. This impacts on their sleep quality and quantity.”
He added: “Perhaps more obviously, gaming is a massively popular phenomenon that transcends age, sex, and geography. It’s a dominant form of entertainment and its competitive arm, esports, is progressing towards acceptance as a genuine form of sporting competition.”
From the neurocognitive side, it’s clear that gaming can sharpen several cognitive abilities, such as attention and problem-solving.
“However, the catch is, if you’re not getting enough sleep, these enhanced skills could take a hit,” said Kemp. “Gamers might see slower reactions, flawed decision-making, and even a drop in their in-game stamina. So, while gaming certainly has its merits and can even boost certain mental skills, it doesn’t come without health considerations. “
Kemp’s research is aimed at ensuring that anyone engaged with gaming or esports does so in a healthy way.
“The purpose is to create a steppingstone towards health regulation in gaming and esports,” he said. “By creating awareness and providing evidence-based recommendations to prevent chronic health problems caused by unhealthy gaming behaviour, it supports individual decision making, governments, and policy makers. It’s valuable to anyone involved in or impacted by gaming.”
Kemp’s guidelines for gamers:
Get between seven and nine hours’ sleep a night and keep a regular sleep schedule (on weekends too).
Set fixed waking and sleep times to establish a more robust sleep–wake cycle.
For better sleep, ensure your bedroom is dark, quiet, and cool (16-18°C is optimal).
Limit the amount of light exposure in the hours before bedtime (including light from phones, laptops, TVs, etc).
Limit caffeine to the morning and afternoon. This means no energy drinks during those night-time gaming sessions).
Photo by Sora Shimazaki: https://www.pexels.com/photo/diverse-anonymous-colleagues-shaking-hands-at-table-with-coffee-and-folders-5673475/
As various players in South Africa’s health arena give input into the National Health Insurance, and the form it should take, they are agreed on one thing: its goal to achieve quality universal healthcare for all South Africans.
The recent COVID-19 vaccine rollout is a good foretaste of what is possible for South Africa’s healthcare system through the power of cross-sectoral collaboration – and a great case study for health systems strengthening in other countries too.
The rollout saw the public and private sectors, trade unions and community organisations pooling their resources and expertise to get the vaccines to South Africans as fast as possible, and the campaign showed that the country has the resources and expertise to provide a better, more equitable healthcare service.
The question is how we take these lessons and embed them in a healthcare system that serves all of a country’s citizens, and does so in a sustainable way, while adhering to best practice standards.
The clear answer is through the power of partnership – which has been demonstrated to work both here and in the rest of the developing world. Promoting public-private partnerships (PPPs), can accelerate access and distribution of innovative medications. By working together, government, originator companies, and funders can ensure that patients benefit from the latest advancements in healthcare.
Rwanda, for instance, has made significant progress in managing non-communicable diseases (NCDs) through community-based health insurance schemes. Brazil has successfully implemented a comprehensive primary healthcare approach. These countries have prioritised prevention, early detection, and treatment of NCDs, which can be adapted to the South African context.
Locally implemented initiatives under the global Making More Health (MMH) programme include training community health workers to provide primary care services, supporting local entrepreneurs in developing innovative healthcare solutions, and partnering with NGOs to improve access to healthcare in rural areas. These initiatives have helped address complex healthcare issues by empowering local communities and leveraging local resources.
MMH is a social initiative from Boehringer Ingelheim in collaboration with Ashoka, which combines business and social values to unleash innovation and achieve economic and social progress in healthcare. The objective of this long-term initiative is to source social innovation around the world, to explore unconventional partnerships and business models, and to encourage Boehringer Ingelheim employees.
We must also turn our attention to NCDs, which are a major health threat. The WHO estimates that globally, they are responsible for 74% of all deaths. Research into South Africa’s NCD states can play a crucial role in health systems strengthening by identifying the most prevalent diseases, understanding their risk factors, and informing evidence-based policies and interventions. This would help target resources more effectively and improve health outcomes.
This requires robust health data, hosted on a digital infrastructure, which would promote data-sharing among healthcare providers, and encourage the use of standardised data collection methods. This would help create a more accurate picture of the population’s health needs and enable better decision-making across the entire health ecosystem.
We also need to make sure we retain our world-class doctors, and address our critical nursing shortage – it’s estimated we need about 26 000 additional nurses to fill the gap. Without sufficient personnel to deliver healthcare, all the best intentions in the world will not deliver universal health coverage.
We must invest in improving the working conditions and incentives for healthcare professionals in the public sector, strengthen primary healthcare services, and promote collaboration between public and private providers. This would help to ensure that the expertise and experience of these professionals is effectively employed to benefit the broader population.
Moreover, increased collaboration with innovator companies in the private sector, many of whom are already involved in initiatives to strengthen the health system, would ensure patients receive the right treatment while expanding reach across the entire population. This would help tackle inefficiencies, streamline processes, and enable better resource allocation.
The fundamentals of health system strengthening in South Africa include adequate financing, a well-trained and motivated healthcare workforce, efficient supply chain management, and strong governance and leadership. Addressing these gaps – through partnership and collaboration – would help build a more resilient and responsive healthcare system and ensure that South African citizens have access to better healthcare.
For the year ended 30 September 2023, the Netcare Group’s profit after tax and exceptional items increased by 27.2% to R1 336 million (FY 2022: R1 050 million) and adjusted HEPS increased by 27.0% to 105.7 cents (FY 2022: 83.2 cents). A sustained improvement in activity, off a largely organic base, supported revenue growth of 9.5%. Coupled with tight cost control notwithstanding the high inflationary environment, this has resulted in excellent operating leverage, reflected in the 23.9% growth in operating profit.
Group chief executive officer, Dr Richard Friedland commented, “We are encouraged by the ongoing normalisation and resilient demand for private healthcare services, allowing the Group to continue on the solid trajectory reported during the first half of this past financial year.”
Total paid patient days (PPDs), inclusive of acute and mental health, increased by 6.7% with improved occupancies of 64.4% for FY 2023 (FY 2022: 60.1%).
Dr Friedland continued, “It is also very pleasing that we have made excellent progress in implementing our key strategic projects. The CareOn digitisation project is nearing completion and has been successfully rolled out at 38 acute hospitals to date, covering 90% of beds. The project is delivering tangible benefits for patients across the Netcare ecosystem, and the gross financial benefits of R104 million in FY 2023 have exceeded expectations.”
Similarly, Netcare’s environmental sustainability strategy continued to deliver financial savings and plays a pivotal role in reducing exposure to the impacts of the instability of the national electricity grid. In line with the 2030 sustainability strategy, the Group concluded an agreement for a renewable energy (RE) supply arrangement with NOA Group Trading, a renewable energy trader. This agreement will increase the proportion of Netcare’s total energy consumption derived from RE sources to c26% and represents an important step towards Netcare’s goal of achieving 100% reliance on RE sources by 2030. Netcare is currently exploring further grid-wheeling opportunities that will potentially increase RE-derived energy to c.40%.
In order to address the growing demand for mental healthcare services in South Africa, Netcare successfully commissioned Netcare Akeso Gqeberha (72 beds) in May 2023. Sales of NetcarePlus products to the retail and corporate segments continue to gain traction, contributing to the Netcare ecosystem through increased access to private healthcare beyond traditional medical schemes and the increased use of its services. Netcare Diagnostics progressed with the rollout of validated and quality assured point of care devices across Netcare’s intensive and high care units, theatres and emergency departments as well as Medicross medical and dental centres.
Dr Friedland said, “We remain committed to our Consistency of Care strategy, broadening the measurement of clinical outcomes and patient experience to ensure we deliver on our core purpose of providing the best and safest care to our patients.”
Cash generated from operations was strong, increasing to R4 135 million (FY 2022: R3 950 million), and the cash conversion ratio amounted to 100.5% (FY 2022: 113.0%). In line with the capital allocation strategy of returning excess cash to shareholders, the Group executed a share buyback programme that, collectively, entailed the repurchase of 33.7 million shares at a cost of R444 million.
Similarly, in line with the dividend policy, which aims to provide shareholders with a sustainable dividend of 50% – 70% of earnings, the Board declared a final dividend of 35.0 cents per share. This, together with an interim dividend of 30.0 cents per share represents 61.5 % of adjusted HEPS and an increase of 30.0% over FY 2022.
Netcare is encouraged by the ongoing improvement in the Group’s financial performance as demand continues to normalise from the impact of the COVID-19 pandemic. The higher activity levels, coupled with ongoing efficiencies, resulted in strong operating leverage and an improvement in Group EBITDA margins of 120 basis points to 17.4%, from 16.2% in FY 2022.
Total capex, including strategic projects, amounted to R1.5 billion for the year, of which R136 million related to expansionary projects, including the completion of construction of the new Netcare Akeso Gqeberha facility and R82 million invested in the hospital digitisation project.
The Group incurred operational costs relating to strategic projects of R258 million (FY 2022: R249 million).
Netcare experienced an average of Stage 3.6 loadshedding across its facilities during the year, resulting in a sharp increase in generator diesel costs to R124 million from R37 million in FY 2022.
At 30 September 2023, the Group‘s cash resources and available undrawn committed facilities amounted to R3.7 billion.
DIVISIONAL REVIEW
Hospital and emergency services
The segment delivered a steady performance for FY 2023, driven by continued recovery in demand and further normalisation of the post COVID-19 operating environment.
Revenue for the segment increased by 9.6% to R23 050 million (FY 2022: R21 024 million) and total patient days increased by 6.7% to 2 447 494 days in FY 2023 (FY 2022: 2 293 344 days). The steady increase in activity contributed to higher occupancy levels with total occupancy of 64.4% (FY 2022: 60.1%).
Notwithstanding the changes in various networks that were effective from January 2023, a milder flu season and extended vacations by specialists, acute hospital patient days increased by a solid 6.1% against FY 2022, equating to 95.1% of FY 2019 with ICU and high care PPDs being 10.1% higher than pre-pandemic levels.
In line with the trend reported in H1 2023, year-to-date growth in medical PPDs of 8.5% continued to outpace surgical PPD growth of 3.9%. Medical PPDs have recovered to 99.0% of 2019 levels, while surgical PPDs continue to be impacted by sector trends, inter alia, declining maternity cases, as well as an outmigration of lower margin day cases, and have recovered to 91.7% of pre-pandemic levels. Total surgical cases comprised 51.5% of patient days (FY 2022: 52.6%; pre-pandemic levels: 53.4%) and medical cases 48.5% (FY 2022: 47.4%; pre-pandemic levels: 46.6%). Surgical cases continue to contribute more than 70% of revenue.
Demand for mental healthcare remains strong with mental health patient days increasing by 12.7% compared to FY 2022. The newly opened Netcare Akeso Gqeberha facility contributed 2.3% of this growth. Activity has surpassed pre-pandemic levels by 5.4% (same store) and 11.6% inclusive of the 36-bed Netcare Akeso Richards Bay facility (commissioned in May 2022) and the 72-bed Netcare Akeso Gqeberha facility (commissioned in May 2023).
The strong increase in mental healthcare activity has resulted in occupancies improving to 72.7% (73.5% excluding Netcare Akeso Gqeberha) in FY 2023 from 68.1% in FY 2022 (FY 2019: 71.6%).
In 2023, Netcare Christiaan Barnard Memorial Hospital received Level 1 trauma accreditation from the Trauma Society of South Africa, which is aligned to the American Trauma Society accreditation principles. There are only four hospitals in South Africa that have achieved this status, all of which are in the Netcare Group.
Netcare’s geographic footprint, electronic medical records (EMR) offering, and highly accredited facilities, allow the Group to continue attracting specialists and a net 124 doctors were granted admission rights at acute and mental healthcare facilities during FY 2023.
Primary care
Total GP and dental visits decreased by 3.1% in FY 2023 compared to FY 2022. The decline in visits is predominantly attributable to the higher base in FY 2022, which was boosted by increased COVID-19 GP visits during the Omicron-driven fourth wave. Revenue increased by 4.6% to R663 million. EBITDA margins were adversely impacted by diesel fuel costs.
Strategic update
Netcare has made excellent progress in the implementation of its key strategic projects and is now well placed to benefit from the rapidly changing dynamics driving demand in the healthcare sector.
Digitisation: Significant progress has been made in the implementation of the CareOn hospital EMR offering, which is a major focus of the digitisation strategy. This new way of care has been successfully implemented at 38 of the 45 Netcare hospitals to date, comprising 8 645 beds (90% of registered beds). In addition, over 28 000 healthcare professionals, comprising nurses, doctors, allied health professionals and pharmacists are actively using the system. Rollout to the final seven hospitals (943 beds) will be completed by April 2024. Dr Friedland said, “We remain confident that this investment will create a sustainable competitive advantage for the Group and will prove pivotal in laying the foundations in achieving our strategy of person centred health and care that is digitally enabled and data driven.” Digitisation has now been completed across all ancillary businesses in the Netcare ecosystem spanning across Netcare Akeso, Netcare Medicross, Netcare 911, National Renal Care and Netcare Cancer Care radiotherapy.
Netcare App: Netcare successfully launched its App in July 2023, which represents the next phase of the strategy to enable digital engagement with patients and clients. There has been a robust take-up of this App, which allows online pre-admissions, doctor appointments, the ability for Netcare 911 to geolocate someone in an emergency, access to a Summary of Care, and the ability to purchase NetcarePlus policies, with further services to be added in future.
Promoting access to healthcare: NetcarePlus has a portfolio of innovative healthcare products and funding solutions that promote access to affordable, quality healthcare in South Africa. In FY 2023, Netcare launched additional pre-paid procedures, completed enhancements to NetcarePlus GapCare and NetcarePlus Accident Cover, and also launched a new primary care offering.
Netcare Diagnostics: Netcare Diagnostics, which supports a Black female owned pathology service provider, Dr Esihle Nomlomo Inc., is gaining traction and made a positive contribution to EBITDA. The first stage rollout of 122 blood gas analysers at Netcare’s intensive care and high care units has been completed, with a further 70 point of care devices commissioned at ten emergency departments. Additionally, the service has been rolled out at ten Medicross facilities to date and will be extended to further sites in FY 2024.
Environmental sustainability: The first phase of the Group’s environmental sustainability strategy commenced in 2013. Since then, energy intensity per bed has reduced by 39%, exceeding the initial 10-year target. Similarly, the Group has exceeded its 2023 financial targets, achieving cumulative operational savings and benefits of more than R1.5 billion to date, yielding an IRR of 40%. In FY 2021, Netcare embarked on the second phase of its strategy, with a primary target of reducing Scope 2 emissions to zero by 2030 and Scope 1 and 3 emissions by a combined 84%. The Group’s 2030 strategy aims to achieve 100% utilisation from renewable sources, with zero waste to landfill and an additional 20% reduction of impact on water sources.
Outlook and guidance
Although the macro environment remains impacted by national power grid load shedding, global supply chain limitations, constrained consumers, and high levels of unemployment, Netcare has a number of measures in place to mitigate these challenges and remains focused on optimising the progress made in FY 2023. Furthermore, the environmental sustainability projects will continue to mitigate the significant escalation in costs associated with increased reliance on diesel powered generators resulting from the instability of the national electricity grid.
Although there has been limited growth in medical scheme membership, the pool of covered lives remains resilient and underscores the sustainable demand for quality private healthcare, which is exacerbated by the growing disease burden and ageing insured population.
For FY 2024, the Group expects revenue growth of between 7.5% and 9.5%. Total patient days are expected to grow by between 2.5% and 3.5% off a largely normalised base. The increased activity will drive further EBITDA margin expansion, improved earnings and a higher ROIC.
Netcare will continue to maintain an optimal capital structure, and the strength of the statement of financial position and the ongoing improvement in operational performance in the underlying businesses will continue to support dividend payments in line with the Group’s dividend policy. Netcare will also continue to return excess cash to shareholders by way of share buybacks or special dividends.
Dr Friedland concluded, “We are confident that our strategy remains relevant, and we are firmly committed to realising growth opportunities, improving returns and the successful execution and completion of our key strategic projects. Notwithstanding the fluid economic environment, we expect ongoing improvements in the operational and financial performance of the business in FY 2024 and beyond.”
Only concerted multi-disciplinary collaboration and research will stem the tide of diabetes and diabetes-linked cardiovascular disease (CVD), the latter currently the leading cause of death locally and worldwide, claiming 17.9 million lives annually1.
This was the consensus among some of the world’s leading cardiologists and researchers gathered at the SA Heart Association’s annual congress aptly themed: ‘The Cardiac Collaboration,’ which took place at the Sandton Convention Centre in Johannesburg from 26-29 October this year.
Globally, CVD takes more lives than TB, HIV and malaria combined, while 215 South Africans are killed by CVD every day – with 80% of CVD and strokes being preventable.1,2 The prevalence of diabetes has also increased in South Africa, from 4.5% in 2010 to 12.7% in 2019. Of the 4.58 million people aged 20-79 years who were estimated to have diabetes in 2019, 52.4% were undiagnosed.3
With diabetes being a key driver of CVD – especially in Africa (with limited access to novel drugs and the prevalence of sugar-rich, poverty-driven lifestyles), the mutual consensus at this year’s congress was that collaboration is key.
Dr Zaheer Bayat, Chairperson of the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA), told delegates that endocrinologists and cardiologists would have to work together to improve outcomes for diabetic patients, 30% of whom suffered cardiovascular events. He warned that a 134% increase of people living with diabetes was predicted over the next two decades, translating into a dramatic surge in chronic kidney disease, cardiovascular disease, blindness, and amputations.
Dr Bayat said he intends appealing for mass diabetes screening to find the 52% of people whom researchers estimate are undiagnosed. Ideally, this should be followed by access to cheaply acquired, effective new glucose-lowering drugs.
“The reality is that this country cannot afford all the new treatments for everyone – not private funders, not government. So, drugs are not really a solution – the best solution is to change lifestyle and prevent disease in the first place,” said Dr Bayat.
“We’re here to fight for our patients, not our pockets. Can we afford to have 52% of our patients not knowing they’re diabetic? People who should be contributing to our economy are living with diabetes and eventually dying,” he asserted.
Dr Bayat also said that globally, First World countries such as the USA and Sweden are reducing myocardial infarctions, strokes, and amputations, because they’re doing all the right things together. This included adopting a healthy lifestyle, effective management of sugar, blood pressure and cholesterol and smoking cessation.
“However, here in South Africa with private healthcare representing 15% of healthcare delivery but consuming 50% of the spend and the public sector representing 85% of the population and consuming the other half – we’re not doing nearly as well. With only 200 cardiologists in the country (one per 190 000 population), and even less nephrologists, we need to join together and change the trajectory of diabetes. We must work together to reduce morbidity and mortality,” said Dr Bayat.
According to the SA Heart Association, this graphically illustrates the importance of a multi-disciplinary approach, the very reason why the conference was called ‘The Cardiac Collaboration.’
The SA Heart Association has already begun forging formal ties with other academic societies and next year, it hopes to join and host joint sessions with collaborative meetings to connect a multidisciplinary team in order to achieve a well-rounded balance of care.
