Tag: South Africa

Categories : General InterestTags :

Shattering Ceilings: How Women are Revolutionising Healthcare in SA

On By ModernMedia
Nokuzola Mtshiya

In South Africa’s ever-evolving healthcare landscape, women are not just participants—they are pioneers, breaking barriers and driving transformative change. With women making up approximately 51.1% of South Africa’s population and over 50% of the African continent’s population of more than 1.4 billion people, their contributions are integral to the region’s progress. In the healthcare sector, women form the backbone of the workforce, representing a significant majority in roles ranging from frontline patient care to high-level decision-making.

writes Ms Nokuzola Mtshiya, Head: Stakeholder Relations and Business Development, Board of Healthcare Funders

The Board of Healthcare Funders (BHF) celebrates the incredible women who are leading the charge, advocating for equity, fostering innovation, and ensuring inclusivity at every level of the system. As trailblazers, they are not only providing essential frontline care but are also shaping strategies that will influence the future of healthcare in South Africa and beyond. This moment calls for even more women to step into leadership roles, to amplify their impact and continue to reshape the future of healthcare across the continent. Among the many remarkable women making a difference, we celebrate a few who are setting the standard for excellence and progress in the sector.

Professor Deborah Glencross: Revolutionising HIV diagnostic immunology

Professor Deborah Glencross’s journey from childhood, which was marked by frequent hospital visits, to becoming a leading expert in haematology and molecular medicine. is nothing short of extraordinary. Initially aspiring to be a paediatrician, her path changed due to health challenges. This shift led her to a groundbreaking career at the National Health Laboratory Service, where she has made a significant impact in the field of HIV care.

Prof Glencross’s development of the PanLeucogated (PLG) CD4 assay has been pivotal in improving the quality and affordability of CD4 testing, a crucial aspect of HIV care. Her innovation has saved South Africa approximately R12 billion, reflecting her ability to drive significant advancements despite resource limitations. This achievement underscores the potential for local insights and creativity to lead to profound healthcare improvements.

Throughout her career, Prof Glencross has been deeply involved in flow cytometry technology, which contributed to her pioneering work in HIV diagnostics. Her success is also attributed to the mentorship she received from influential figures such as Prof Barry Mendelow and Prof Ruben Sher. Their support helped shape her research focus and contributed to her international recognition.

Prof Glencross’s career highlights the importance of persistence and effective management of both professional and personal responsibilities. She advises young women in healthcare to seek support and let go of guilt, emphasising the need for better support systems such as on-site childcare and flexible work hours. Her vision for the future includes driving impactful solutions through local knowledge and creativity rather than relying solely on large grants. 

This driven and caring healthcare professional’s legacy is testimony to the significant impact that dedicated individuals can have on transforming healthcare and improving lives.

Dr Gloria Tshukudu: Innovator in plastic and reconstructive surgery

Dr Gloria Tshukudu’s career in healthcare is a powerful example of dedication and resilience. From a young age, influenced by her mother’s career as a nurse, Dr Tshukudu knew she wanted to be a doctor. Despite facing numerous challenges, including struggles with specialisation and balancing professional demands with personal responsibilities, she remained steadfast in her commitment to medicine.

Dr Tshukudu has achieved notable milestones in her career, including becoming the first South African woman to qualify as a plastic surgeon in 2013, pioneering research on chemical peels for ethnic skin and making significant advancements in plastic surgery. Her contributions have not only advanced her field but have also helped address issues related to gender dynamics and representation within healthcare.

Navigating the complex interplay between work, family responsibilities and societal expectations has been a significant part of Dr Tshukudu’s career. She has advocated for improved support systems, including better maternity leave and access to childcare, to enhance the working conditions for women in healthcare. Her leadership style emphasises empathy, support, and perseverance, reflecting her belief in fostering an inclusive and supportive environment.

Dr Tshukudu’s efforts have significantly increased the representation of women and marginalised groups in healthcare. Through mentoring and supporting younger professionals, she has contributed to the evolution of the healthcare sector, ensuring that future generations benefit from the advancements and opportunities she has championed.

Melanie Da Costa: A visionary in healthcare strategy and policy

Melanie Da Costa is a trailblazer in healthcare strategy and policy. She combines her expertise as a Chartered Financial Analyst (CFA) and a Master of Commerce (MCom) to make a profound impact on the healthcare sector. Her career began in the investment world, where she distinguished herself as a healthcare investment analyst and fund manager. Notably, she served as the Head of Equity Research for HSBC’s South African office, showcasing her deep understanding of financial dynamics and strategic insight.

In May 2006, Da Costa transitioned to Netcare, where she has been instrumental in the organisation’s strategic evolution. Her role in founding the Health Policy Unit has been crucial in shaping national health policy. Her responsibilities at Netcare include overseeing health policy, funder contracting and strategic initiatives, with a focus on international opportunities until 2018.

Da Costa’s influence extends beyond South Africa. She has played a key role in global healthcare policy discussions, leading Netcare’s participation in the South African Competition Commission Healthcare Market Inquiry and serving as the Board lead in the UK’s Competition Markets Authority Healthcare Inquiry. Her strategic acumen was further demonstrated during her tenure on the Board of BMI Healthcare in the United Kingdom, where she contributed until the group’s change of control in 2018.

Currently serving as the Managing Director of Netcare Akeso, Da Costa continues to drive strategic growth and innovation. Her leadership during the government-led pandemic response, including the vaccine rollout, was recognised with a Lifetime Achievement Award in 2022 from the Hospital Association of South Africa (HASA), honouring her contributions to health policy and unwavering commitment to improving healthcare systems. 

Dr Keo Tabane: Shaping the future of oncology care

Dr Keo Tabane’s journey into oncology bears witness to her unwavering commitment to service and excellence. Raised by an Anglican priest, her formative years instilled in her a profound sense of purpose, steering her toward a career where she could make a meaningful impact.

After completing her undergraduate training in 1999, Dr Tabane embarked on her medical career with an internship at Kalafong Hospital, followed by community service in Makopane. 

A defining moment in Dr Tabane’s career came early on during her internship when she faced prejudices as a young black woman. Instead of being deterred, she used this challenge as fuel for her drive, leading to her success and subsequent invitation to return as a specialist.

Her dedication and expertise earned her the prestigious Charlotte MacLeachy Award for medical excellence in 2019. By 2002, she returned to Johannesburg, becoming a specialist in internal medicine and later a pioneering force in medical oncology.

Dr Tabane attributes much of her success to the mentorship of Dr Daniel Vorobyov, whose guidance profoundly influenced her patient-centred approach. Balancing the demands of a high-stakes career with personal life has not been without its challenges. She views work-life integration as a dynamic dance rather than a static balance, blending her professional and personal spheres to enhance both.

Her advice to aspiring women in healthcare emphasises the importance of self-care and respecting personal boundaries. Dr Tabane envisions her legacy as one defined by a focus on patient-centred care, advocating for initiatives to tackle burnout and promote value-based care that keeps pace with medical innovation. Her vision for the future of healthcare is one where progress and patient welfare are intertwined, ensuring that every advancement serves to enhance the quality of care.

These women exemplify leadership and innovation in South Africa’s healthcare sector, making significant contributions that drive progress and equity. From advancing diagnostics and pioneering new treatments to shaping policy and driving strategic growth, their diverse achievements highlight the transformative power of women in healthcare. 

Their dedication and impact ensure that adequate healthcare reaches every corner of the nation, inspiring future generations to continue their legacy of excellence and service.

Categories : OphthalmologyTags :

Eye Health Services in the Public Sector are Critically Impaired – it is High Time the Health Department Responds

On By ModernMedia
Photo by Hush Naidoo Jade Photography on Unsplash

By Haseena Majid and Rene Sparks

Despite South Africa producing a substantial number of trained optometrists, the majority of them work in the private sector and in urban areas. This imbalance leaves rural communities underserved and exacerbates health inequities. Does it make sense for us to use public funds and institutions to train people predominantly for the private sector, ask Dr Haseena Majid and Rene Sparks.

Avoidable blindness and vision impairment are major global health concerns. The World Health Organization (WHO) estimates that at least 1 billion people worldwide have a vision impairment that could have been prevented or treated. In 2020, there were an estimated 11 million people living with some degree of vision loss in South Africa, of which 370 000 were classified as blind.

Avoidable blindness caused by uncorrected refractive error (vision problems that requires spectacles or contact lenses) and cataracts can be well managed in the presence of a capable work force that is both accessible and affordable to the public. As such, optometrists are crucial in combating avoidable vision loss. Their expertise in conducting comprehensive eye examinations, diagnosing and managing some eye diseases, prescribing corrective lenses, and providing preventive care is vital for reducing the burden of avoidable blindness.

But the current landscape of optometry services in South Africa reveals significant gaps in both governance and resource allocation.

The distribution of optometrists in South Africa is far from optimal. As of April 2023, there were approximately 4200 registered optometrists and 580 ophthalmologists in the country. While this is a considerable number of people trained to provide primary eye care services, the 6.7% serving the public sector – compared to 93.3% serving the private sector – is simply inadequate and has created stark disparities.

The available evidence points to an urban-rural divide in optometry services, with only around 262 optometrists employed in the public sector nationally, and disproportionately between and within provinces. It means that rural and poor communities, where a significant portion of the population resides, have very limited access to essential eye care services.

Further deepening the disparities in access to essential eye care is the government’s fragmented and inconsistent approach to eye health across provinces, resulting in some areas lacking any public eye care services, while others depend on external providers.

Training misalignment

All of these challenges come against the backdrop of substantial state investment in the training of optometrists. The government funds their training at several universities across the country. However, the majority of these graduates are absorbed into the private sector. In some instances, students trained on state bursaries struggle to get placed in the public sector.

This misalignment highlights a fundamental flaw in how public funds are utilised, with minimal benefit to the broader population that relies on public healthcare. It also contradicts the government’s mandate to provide progressive solutions to improve access to healthcare for all, as enshrined in the Constitution.

These ongoing governance gaps and the inefficient use of state resources also represent significant barriers to achieving health equity in South Africa as expressed in government’s plans for National Health Insurance (NHI). And while the implementation of NHI aims to bring our country closer towards universal health coverage, it is not yet clear whether, and to what extent, vision and eye care services will be included in the envisioned basket of services.

A lack of a clear plan could result in a missed opportunity to integrate optometrists into the primary healthcare system nationally.

What to do

Firstly, there needs to be an urgent reassessment of the costs to train optometrists against the benefits to the broader public. Are we training too many optometrists currently? Could the government initiate engagements with thought leaders and support partners to develop a community service and costing exercise to address the inequity and lack of access to eye health services, and simultaneously address the employment of optometrists within the public health space?

Secondly, the National Department of Health should establish a dedicated directorate for eye health services which should be integrated within provincial health structures. This unit should spearhead a comprehensive data collection system for vision and eye health which can be used to accurately assess needs, allocate resources, and plan effectively.

Calls for such a dedicated directorate have been made through scientific recommendation for more than a decade. But there has been no meaningful response and action from the health department and related decision-making entities.

Thirdly, the principles behind NHI offer a medium-term solution to address the disproportionate distribution of optometrists. Through the establishment of NHI-style public-private partnerships, private sector capacity can be leveraged to serve people who depend on the public sector. Such a public-private partnership will have to have transparency, accountability, and data integrity built into its structures. This will allow provinces and districts to monitor accurate data, and provide feedback that will help shape and improve services.

In summary, the health department stands at a critical juncture, where the systemic imbalances in optometrist distribution and vision care services have now become acute – with people in South Africa paying a very concrete and personal price in the form of avoidable vision loss. Delays in governance processes have historically hampered progress, but the need for swift and informed action is now paramount. The principles of public-private partnership that underlie NHI points to a solution, but the urgency of the crisis means we do not have the time to wait for the full NHI plans to be rolled out – by government’s own admission that will take many years. People losing their eyesight today simply can’t wait that long.

*Majid and Sparks are Global Atlantic fellows for Health Equity in South Africa and advocates on the National Eye Health Advocacy Project led by USAWA for learning and healing, a civil society organisation committed to reforms for health equity and social justice.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

Read the original article

Categories : Expert Opinion Medical IndustryTags :

From Bottlenecks to Breakthroughs: BHF Report Charts the Course for Southern Africa’s Healthcare Future

On By ModernMedia
Photo by Hush Naidoo on Unsplash

By adopting bold, transformative strategies, the healthcare industry can overcome critical challenges and foster innovative collaborations to create a more equitable and sustainable healthcare future for southern Africa, writes Dr Katlego Mothudi, Managing Director at the Board of Healthcare Funders (BHF).

Committed to promoting collaboration and creating actionable insights within southern Africa’s healthcare ecosystem, BHF’s recently published report highlights significant trends, obstacles and breakthrough solutions from key figures in the healthcare sector, and charts the course for a robust, inclusive healthcare future. 

By interviewing industry leaders – including funders, hospitals, clinicians, and the pharmaceutical sector – the report presents a strategic path forward that promises to revolutionise the region’s healthcare landscape. As southern Africa grapples with rising healthcare costs, a growing burden of non-communicable diseases (NCDs), and economic instability, this report charts the course for a robust, inclusive healthcare future.

The evolving landscape of southern African healthcare

Healthcare organisations in southern Africa are navigating a complex landscape filled with escalating challenges and promising opportunities. The rapid increase in the burden of non-communicable diseases (NCDs) and economic volatility is driving a critical shift toward more sustainable healthcare models while increasing healthcare costs and reducing affordability. 

Concurrently, there is a renewed commitment to achieving health equity, with concerted efforts to ensure healthcare is universally accessible. Universal Health Coverage (UHC) is in various stages of rollout across the region, reflecting varying national priorities and capabilities. In South Africa, the proposed National Health Insurance (NHI), despite its controversies, is being closely watched for its potential impact on other countries if implemented pragmatically.

In the private sector, the health insurance market shows notable growth. This is in contrast to stagnation relating to traditional medical schemes. These schemes face slow or no membership growth and rising utilisation rates, pushing a gradual shift towards value-based care with strategies to strengthen contracting arrangements, control expenditure and improve health outcomes. 

High levels of fraud, waste and abuse persist, particularly in southern Africa, where economic conditions have severely limited the growth of private health insurance or medical scheme coverage, highlighting the critical need for innovative healthcare financing solutions.

Additionally, the post-COVID acceleration of digital healthcare is gradually reshaping service delivery. Significant investments in artificial intelligence and predictive analytics are set to strengthen health risk management, boost patient care and enhance operational efficiency. 

This era of digital transformation is marked by collaborations with local and global tech innovators and a strategic internal focus on tech integration to overhaul legacy systems and traditional practices. This complex tapestry of trends indicates a critical juncture for the region’s healthcare, laden with challenges, yet rich with opportunities for pioneering change.

Bottlenecks and barriers

Southern Africa’s healthcare systems face significant barriers to sustainability, including inefficient and politicised regulatory environments, inadequate workforce training, economic instability and the growing corporatisation of healthcare, all of which hinder innovation, affordability and access while threatening both public trust and the quality of care.

Reactive responses to emerging challenges

In response to the bottlenecks and challenges facing the sector, healthcare organisations across southern Africa are collaborating with government and business coalitions, such as Business for South Africa, to address fiscal risks and policy uncertainties, and promote private sector participation, regulatory harmonisation and advanced technologies. 

They are prioritising integrated healthcare models focused on primary care and value-based approaches, investing in digital innovations such as telemedicine, electronic health records and AI to improve efficiency and outcomes. Efforts to optimise resource allocation and care quality through digitalisation and process reengineering are also underway. 

While these actions address immediate challenges, longer-term systemic solutions are necessary to achieve UHC and future-proof their markets.

Proactive systemic responses

To create a sustainable and equitable healthcare environment in southern Africa, long-term strategic solutions are essential, and aimed at broadening healthcare access, enhancing system efficiency and ensuring financial sustainability. 

To achieve UHC, access through a multi-payer system that guarantees quality, affordable healthcare for all is instrumental. Implementing UHC principles will promote preventative care, care coordination, and effective management of chronic diseases. Additionally, advancing public-private partnerships (PPPs) can significantly enhance access and care quality, with proactive private sector engagement helping to overcome existing barriers and drive progress.

To improve policy and regulation, it is crucial to enhance the oversight and effectiveness of regulatory institutions while fostering regional inclusivity across the Southern African Development Community (SADC) for better knowledge sharing. 

In South Africa, aligning the NHI with a multi-funder framework will integrate private funders and recognise employers’ roles in system sustainability. Updating benefits to reflect current health needs and economic conditions will make healthcare more affordable and less hospital-centric. Introducing Low-Cost Benefit Options (LCBOs) within medical schemes will broaden access, while strengthening competition and optimising private sector performance, will enhance care quality. Additionally, establishing a risk equalisation fund and mandating medical scheme membership is key to stabilising the insurance market and lowering costs.

To advance healthcare, investments in infrastructure and technology are essential, especially in underserved areas, to ensure equitable access. Strengthening healthcare training and updating practice guidelines will improve care quality and expand capabilities, while better workforce planning and collaboration between academia and healthcare providers will align training with industry needs. Additionally, leveraging digital health initiatives, such as telemedicine and electronic health records, will enhance service reach and efficiency.

Furthermore, incorporating Environmental, Social, and Governance (ESG) principles is crucial for promoting resilience and establishing southern African healthcare systems as leaders in sustainable practices. Adopting ESG standards will enhance the sustainability and governance of these healthcare systems.

These strategies are designed not only to address immediate healthcare challenges, but also to establish a robust foundation for a future where high quality healthcare is universally accessible in southern Africa. By implementing these solutions, the region can bridge the current gaps and pave the way for a resilient healthcare system.

Through collaborative efforts, strategic reforms, and innovative solutions, southern Africa’s healthcare sector is not only meeting current needs but also preparing for future demands that are defined by innovation, equity and sustainability. 

Categories : Expert Opinion Medical IndustryTags :

Transforming South Africa’s Healthcare Sector: The Essential Role of Leadership

On By ModernMedia
Dr Ali Hamdulay

By Dr Ali Hamdulay – CEO, Metropolitan Health Corporate

South Africa’s healthcare sector, a sophisticated and ever-changing industry, is central to the health and prosperity of our communities. Its effective operation, however, hinges on the strength and direction of its leadership.

Leadership, given the broad healthcare landscape, is far from a singular role; it’s a complex undertaking that requires comprehensive understanding of the wide medical ambit, the regulatory environment, compassion, and a forward-thinking mindset. Leaders are the primary builders of healthcare infrastructure, moulding it to encourage innovation, prioritise patient-focused care, and maintain the highest ethical standards.

Attracting and retaining skilled healthcare workers is a critical role that leadership in South Africa’s healthcare landscape must play. This includes attracting and retaining a diverse range of healthcare professionals such as doctors, nurses, and specialists. Leaders are responsible for creating a conducive work environment that not only draws in skilled workers but also motivates them to stay and thrive. Furthermore, leaders are advocates for healthcare workers, ensuring they have the necessary resources and support to carry out their roles effectively.

The rise of technology has ushered in substantial shifts in the healthcare sector. From telemedicine and AI diagnostics to electronic health records, technology has revolutionised how we provide care. Integrating these innovations into the healthcare system, though, is a challenging task that demands visionary leadership.

Leaders must understand these technologies, evaluate their potential advantages and risks, and oversee their implementation in a manner that enhances patient care without jeopardising privacy and security. Teams must also be equipped with the necessary skills to adapt to these changes and effectively implement new procedures.

A pivotal role of a healthcare leader is to champion health equity. Despite progress in healthcare, disparities in access and outcomes remain. Leaders play a crucial role in creating pathways to eradicate these disparities and to ensure that everyone, irrespective of their background, has access to quality healthcare. This involves understanding the social determinants of health, implementing policies that promote equity, and establishing an inclusive and respectful culture within the healthcare environment.

This cannot be done without support.

Leadership isn’t solely about leading; it’s also about inspiring others to lead. By exemplifying excellence and integrity, leaders can inspire their teams to aspire to the same standards. They can cultivate a culture of continuous learning and improvement, encouraging everyone to contribute their ideas and expertise.

A resilient healthcare system is anchored by robust leadership. It requires a mix of knowledge, skills and attitudes, a thorough understanding of the healthcare landscape, the ability to make critical decisions, the vision to embrace innovation, the empathy to advocate for health equity, and the charisma to inspire others.

We must elevate both individual and group thinking within our operating environments if we are to make meaningful progress in establishing a healthcare sector that prioritises access and quality. This approach contributes to a resilient healthcare workforce—one that can adapt to the dynamic landscape and is essential for the sector’s long-term viability and the overall health of South Africa’s population. By embracing this combination of collective and individual thinking, we propel the sector forward across businesses, the healthcare industry, and the nation as a whole.

Navigating the intricacies of the healthcare sector, particularly in the dawn of South Africa’s Government of National Unity, underscores the critical role of strong and reliable leadership. This fresh political landscape brings with it a wave of optimism. It has the potential to catalyse transformative change in our healthcare sector, from policy reforms and resource reallocation to the introduction of initiatives aimed at enhancing healthcare quality.

In our journey towards a more equitable and efficient healthcare system in South Africa, the focus on public-private partnerships must remain steadfast. These partnerships are instrumental in leveraging the strengths of both sectors to deliver better healthcare outcomes. They foster innovation, improve service delivery, and enhance accessibility, making them a crucial component of a robust healthcare system.

During this era of change, leadership is our compass guiding us towards quality access to healthcare for all. The role of leadership in ensuring progress and maintaining stability cannot be overstated. It is the driving force behind a healthcare sector that truly serves its people.

The future of South Africa’s healthcare sector is promising, but it requires the collective effort of all stakeholders. As a business, we recognise the critical role of nurturing our emerging leaders through mentoring and coaching. Our partnerships ensure continuity and preserve the essential skill and knowledge base of our healthcare workforce. These partnerships are key in establishing a healthcare system that is accessible to all and provides quality care.

As we commemorate Nelson Mandela Day, let us honour his unwavering commitment to justice, equality, and compassion. Our responsibility lies not only in the present but also in shaping a legacy for future generations. Let us build a healthcare system that echoes Mandela’s vision—a system that ensures access for all and equips our leaders to carry forth their roles with purpose and resilience.

Categories : Paediatrics VaccinesTags :

Childhood Vaccine Coverage in SA Declined in 2023, Finds WHO Report

On By ModernMedia
A marker used to measure immunisation coverage is to look at whether children received three doses of the vaccine against diphtheria, tetanus and pertussis. Photo by Mufid Majnun on Unsplash

By Elri Voigt

New data from the World Health Organization (WHO) and UNICEF show that globally childhood immunisation coverage stalled in 2023, while in South Africa it decreased. Elri Voigt unpacks the new data and asks local experts to put it in context.

A new report found that vaccination coverage rates around the world have not yet returned to levels seen in 2019, before the COVID-19 pandemic disrupted immunisation programmes.

There has been no meaningful change in immunisation coverage between 2022 and 2023, according to the WHO and UNICEF report published in July. It means progress in immunisation coverage has effectively stalled, leaving 2.7 million additional children who are either unvaccinated or under-vaccinated compared to pre-pandemic levels in 2019.

A marker used to measure immunisation coverage is to look at whether children received three doses of the vaccine against diphtheria, tetanus and pertussis – referred to as DTP3. Global coverage for DTP3 stalled at 84% in 2023, according to the report.

At the same time, the number of children worldwide who have not received any vaccinations has increased. We refer to these kids as zero-dose children. Ten countries account for 59% of all zero-dose children, with the global number in 2023 rising to 14.5 million compared to 13.9 million in 2022, according to the report.

Coverage slightly down in SA

Data from the report showed a slight decrease for a number of outcome measures in South Africa between 2022 and 2023. It was one of 14 countries in the African region that saw a decrease in coverage for DTP1 (the first dose of the vaccine for diphtheria, tetanus and pertussis), slipping from 87% in 2022 to 81% in 2023. Coverage for DTP3 also decreased, falling from 85% in 2022 to 79% in 2023.

South Africa was also one of 10 countries in the African region that saw a decrease in coverage for the first dose of the measles vaccine, and was singled out by the report as having the sharpest decline in coverage in the region between 2022 and 2023. Measles coverage dropped from 86% in 2022 to 80% in 2023.

Commenting on the accuracy of the new data, Professor Shabir Madhi, Dean at the Faculty of Health Sciences at the University of Witwatersrand (Wits), said it used administrative data, which can bias the estimates. He explained that the report bases vaccine coverage on the number of vaccines procured by government and deployed to facilities. For example, if a facility gets 100 doses of the measles vaccine and ends up discarding 50 doses, that doesn’t necessarily get reported.

The WHO acknowledges the potential for data inaccuracies. It stated that they calculate the estimated percentage of immunisation coverage by dividing the number of doses administered to a target population by the estimated number of people in that target population.

Madhi said a more accurate picture of childhood immunisation coverage in the country can be found in National Vaccine coverage surveys, like the Expanded Programme on Immunisation (EPI) National Coverage survey. Spotlight previously reported on results from the most recent EPI survey conducted in 2019.

Madhi said it appears the new report did not incorporate data from the EPI survey. However, even without this data, he said the WHO estimates are not too far off the local data. He remarked that he doesn’t feel “too strongly either way” about the accuracy of the WHO data since the bottom line is vaccine coverage in the country is lagging.

“Fluctuations in immunisation coverage are not uncommon,” Dr Haroon Saloojee, a professor of Child Health at Wits University told Spotlight. “One should not make too much of a fall or increase in coverage rates over one year, unless it is drastic.”

Data from the WHO report for vaccine coverage in South Africa between 2018 and 2022 had actually showed an overall upward trend, which was “promising”, according to Saloojee. However, he said the latest data from the report “holds no good news for South Africa” because the dip in coverage in 2023 was noteworthy.

How does SA compare?

“South Africa’s performance is moderate when compared globally, and poor compared to other high-middle income countries,” said Saloojee. “Considering that South Africa is a high-middle-income country, we should be performing much better in all our health indicators.”

He pointed out that countries in a similar bracket like Cuba and Uruguay have achieved high immunisation coverage through robust healthcare systems and effective public health policies.

Regarding zero-dose children, the report ranked South Africa 6th worst in the African region. In 2022, the country ranked 13th. With a total of 220 000 zero-dose children, the country accounted for 3% of all zero-dose children in the African region. Nigeria had the highest percentage at 32% of all zero-dosed children in the region, followed by Ethiopia with 14%.

‘Dysfunctionality of primary healthcare’

Apart from the international comparisons, Madhi pointed out that South Africa is not meeting its own targets of having at least 90% of children in each district fully vaccinated.

The EPI survey found that only seven of the 52 districts in the country were able to achieve the national target of 90% of children fully vaccinated under one year of age. Together, the data from the survey and the WHO clearly shows that childhood immunisation targets are not being met in the country.

For Madhi, the results from the EPI survey “speaks to dysfunctionality of primary health care in the country”. He said the immunisation of children, which is the bedrock of primary healthcare when it comes to children, acts as a “canary in the mine with regards to how well primary healthcare is working”.

He said South Africa is a leader in the field when it comes to evaluating and introducing vaccines to the public immunisation programme. But when it comes to implementation, for the vast majority of districts we “are falling completely flat on our face and coming short in terms of reaching our own targets”.

Implications for children

The health implications for children who are not unvaccinated or only partially vaccinated are significant.

“They are less protected against what can be life threatening diseases. And those life-threatening diseases include diseases such as measles, but also other life-threatening diseases such as pneumonia,” Madhi said.

“We’re selling ourselves short as a country in addition to actually compromising the health of children by not ensuring that we’re doing everything that’s possible to actually get children to be vaccinated,” Madhi added. “It also comes with other consequences, so it sort of lends South Africa to be more prone to outbreaks.”

Saloojee added that it is also likely that children who are not fully vaccinated are “not receiving many of the other health, education and social development services all children require and that is being provided by government, such as early childhood development services and child support grants”.

The reasons for immunisation coverage lagging are complex and the responsibility for fixing the problem lies with more than just one entity. Spotlight previously reported on some of the reasons children are remaining unvaccinated or under-immunised as identified by the EPI survey.

Madhi said there needs to be a fundamental relook at the country’s immunisation programme. Proper governance structures need to be put in place and the programme will need to be implemented all the way down to the sub-districts. There is also a need for real-time data and monitoring of that data so interventions can be done when children are missing their immunisations. He also suggested ring-fencing funds for vaccines, at either a national or provincial level, to ensure that money earmarked for vaccines are used for that purpose so as to ensure less stock-outs.

“The immunisation programme hasn’t changed much from what I can gather over the past 20 years, let alone the past 10 years. So we can’t expect a different outcome if the strategy that we’re using which has failed is the strategy that you continue pursuing,” Madhi said.

Saloojee said the National Department of Health can play a pivotal role in strengthening the immunisation programme by “providing leadership, resources, and policy support”. He said that to his knowledge the health department is currently preparing a national immunisation strategy to take us to 2030, but the draft is not up to scratch. The strategy, he says, will need to offer clear objectives, establish realistic indicators of, and targets for, measuring success, and attract a fully funded mandate.

Spotlight asked the National Department of Health for comment on the new WHO report and how it plans to respond to improve immunisation coverage. While the department acknowledged our questions, they did not provide comment by the time this article was first published.

Republished from Spotlight under a Creative Commons licence.

Read the original article

Categories : HIVTags :

New Research Shows Great Strides have been Made in Controlling HIV in South Africa

On By ModernMedia
Image: supplied.

Although South Africa has the largest number of people living with HIV worldwide, strides have been made in controlling the epidemic, especially in the reduction of HIV incidence, testing, and treatment.  Researchers from the South African Medical Research Council (SAMRC) and University of KwaZulu-Natal (UKZN) are inching closer to finding the answer to the natural control of HIV infection, leading to improved health outcomes and quality of life amongst South Africans.

 According to the latest survey by the Human Sciences Research Council, in 2022, there were approximately 7.8 million people afflicted with HIV in South Africa, the highest absolute number of people living with HIV globally. Yet despite having the largest genetic diversity in the world, African human genome sequences represent the lowest of all the human genomes that have been sequenced worldwide. There is a dire need to leverage genomics to back up and scale targeted intervention programs to put more people living with HIV on effective treatment.

Of particular interest in the global investigations into HIV is “elite controllers” (ECs), a rare group of HIV‐1‐positive individuals whose immune systems can seemingly suppress the infection from developing without taking antiretrovirals (ARVs). For every 200 people living with HIV, around one may be an elite controller (0.5%). In South Africa, with its high rate of HIV infection, the prevalence of ECs also appears to be higher. By “unmasking” the secrets of ECs through research, clues can be revealed, and new therapies potentially developed to benefit broader groups of people living with the disease.

In order to identify the polymorphism and mutations within individuals of African descent, and understand how they are associated with HIV disease progression, Dr Veron Ramsuran, Associate Professor at UKZN, and Prof Thumbi Ndung’u, Director for Basic & Translational Science at the Africa Health Research Institute, joined hands with SAMRC, MGI and local South African clinics in 2019 to take their 20+ years of work in EC research to the next level using whole genome sequencing (WGS).

“The HIV Host Genome project was started at the same time as we launched SAMRC’s African Genomics Centre in Cape Town with the support from MGI,” said project co-investigator Rizwana Mia, also co-founder of the SAMRC Genomics Centre and Senior Program Manager in Precision Medicine at SAMRC. “The partnership saw MGI putting down a high-throughput sequencing workflow and assisted us with the specialised scaled infrastructure design in our lab. This was at a time when there was no real infrastructure for large-scale next generation sequencing in Africa.”

“More importantly, by moving our laboratory workflow to scale, we are hoping to develop genomic research to address this quadruple burden of disease that South Africa faces,” explained Mia. “Our project looks at a unique cohort of patients that have the ability to control the HIV virus to ascertain how disease progresses and the host-directed mechanisms for innate immune control. In addition, we included family sets to help us better understand the relationship between pediatric non-progressors and their parents who are also HIV positive, to uncover and genetic differences that may contribute to host immune control of HIV.”

“We’ve identified new genes and polymorphism that are playing a role with HIV disease through new data generated from Whole Genome Sequencing,” said Dr Veron Ramsuran, principal investigator of the HIV Host Genome project. “Traditionally, there is a list of mutations or genes that are known to associate with HIV, yet they are largely based on studies on Caucasian populations. Our HIV research is adding to the general pool of knowledge pertaining to individuals of African descendent, which will thereby inform new treatment and new vaccine opportunities.”

“What’s important is also understanding how drugs interact with the individual,” added Ramsuran. “We’ve found in the past that certain polymorphism is associated with drug metabolism in genes. Building on this understanding of drugs in combination with the genetics of the individual, we can develop prediction tools to inform clinicians on drug type or dosage depending on the presence of the polymorphism to facilitate a more rapid metabolism of the drug.”

Encouragingly, investigations into Africa’s diseases will continue beyond this point. The HIV Host Genome project has laid the groundwork for the ambitious National 110K Human Genome Project. This large-scale population study will involve 110 000 participants from the South African population, aiming to understand more about of their genomic diversity, address various health challenges, and pave the way for personalized medicine in the country. Furthermore, the data collected will be incorporated into a national population database, enhancing research outcomes and deepening disease understanding for Africa.

Given South Africa’s diverse population, limited human genomics data and significant healthcare burden from diseases such as HIV, understanding pathogenesis and inherent mutations is important for implementing targeted treatments and public health programs. With its lower sequencing cost, high quality data, and efficient all-in-one workflows, MGI’s equipment play an instrumental role , will continue to drive progress in studying rare HIV phenotypes, which holds great promise in advancing the development of targeted interventions and cures– not only for HIV – but many other diseases.

“Looking at the genetic variation and its impact on HIV is a gamechanger, because it will shed light on some of the best immune responses that can be generated against the HIV virus,” stated Prof Thumbi Ndung’u, principal investigator of several of the project’s cohort studies. “And actually, this knowledge will be widely applicable and could have an impact on other diseases – infectious and non-infectious – as well as their drug interventions. It will make sure that Africans, just like everybody else, are at the centre of drug and vaccine development.”

Categories : Ethics and Law Medical IndustryTags :

High Court Ruling Strikes Down Key Part of NHI Act

On By ModernMedia
Photo by Tingey Injury Law Firm on Unsplash

A key part of the National Health Insurance Act is the requirement of private healthcare facilities to obtain a Certificate of Need (CON) in order to practise. Now it, this component has been struck down by a Pretoria High Court judge. Judge Anthony Millar struck down the Act’s key section, saying that it was “akin to an attempt to indenture the private medical service in the service of the state”.

The case had been brought by the Solidarity Trade Union, the Alliance of South African Practitioner Associations, the South African Private Practitioner Forum, the Hospitals Association of South Africa (HASA) and a number of healthcare providers and owners of healthcare establishments.

Sections 36 to 40 of the NHI Act would introduce a Certificate of Need (CON) scheme, essentially tying down doctors to a specified geographical location, which would be the only location where they could render their services.

It is declared that sections 36 to 40 of the National Health Insurance Act 61 of 2003 are invalid in their entirety and are consequently severed from the Act.

Judge Anthony Millar’s ruling

Any new healthcare facility would have to apply for a CON, which would be valid for 20 years. Existing facilities would have two years’ grace period to apply. This would applicable to hospitals, clinics, pharmacies and even to private rooms set up within the home of the practitioner. Operating without one would be a criminal offence – punishable with a fine, five years in prison or both.

It had been argued that because the regulations for CON had not been promulgated, the applicants’ argument was “hypothetical” and not “crystallized”. In Tuesday’s ruling, Judge Millar cited previous rulings and the constitutionality of the matter was still worth testing.

The CON scheme was extensive, Judge Millar noted, and would impact not only healthcare practitioners who worked in healthcare facilities and their employees, but also “juristic persons“, ie corporations or other organisations that can be legally liable.

Read the judgment here

‘A blunt instrument’

In terms of its constitutionality, the applicants’ argument was that, “at least six constitutional rights are infringed. They say it tramples on their rights including where they want to reside, send their children to school and the communities they belong to.”

Judge Millar noted, would mean that setting up a hospital was a hefty investment of R500 million or so, and there was no provision any support. Taken together with the 20-year CON validity, would serve to discourage private investment and became a “blunt instrument” with which the Director-General of Health could control private healthcare in the country.

Even though this provision was ostensibly to serve many, this could not come at the cost of individual freedoms, among them Section 22 of the Constitution which provided for the freedom to choose an occupation within the rule of law.

“The scheme is silent on the extant rights of both the owners of private health establishments, private healthcare service providers and private healthcare workers. Such extant right include their integration and professional reputations in the communities which they presently serve together with the significant financial investments and commitments made by them to be able to render the services that they do.”

Since health establishments are purpose-built and hard to convert for other use, this constitutes a de facto deprivation, he wrote.

“It does not behove government in pursuing transformation, to trample upon the rights of some ostensibly for the benefit of the many.”

‘Effective indenture’ of private healthcare

While the legal teams for President Cyril Ramaphosa, the minister of health, Dr Aaron Motsoaledi, and the director-general of health, Dr Sandile Buthelezi, argued that the public healthcare sector was overburdened, Judge Millar replied that this amounted to the effective indenture of the private healthcare system.

Among other problems, contesting CON issuance was without recourse and by turning down a certificate the DG could essentially deprive the affected parties of income, as doing so would see them prosecuted under Section 40.

The ruling was welcomed by healthcare professional associations.

As reported in the Daily Maverick, Solidarity chief executive Dr Dirk Hermann said, “This judgment is a major blow to the total NHI [National Health Insurance] idea, as the principle of central management is a core pillar of the NHI Act itself. A more extensive consequence of this ruling with regard to the certificate of need is that parts of the NHI Act are now probably also illegal in principle.

“The NHI in its current format cannot be implemented as the essence of the NHI is central planning – and this has now been found unconstitutional.” 

In a statement, HASA said that it regretted that the matter had to come to court. “We would have preferred achieving the objective of a stronger health system through a negotiated and collaborative effort to increase the number of medical students and nurses in medical training facilities to address the healthcare system’s needs,” the association stated.

Categories : General Interest Medical IndustryTags :

Essenwood Residential Home – A Case Study in Elevated Care Through Staffing Partnership

On By ModernMedia

Essenwood Residential Home, a haven for senior women since the 1850s in Durban, South Africa, provides exceptional care for its residents. However, managing the complexities of HR for a growing number of caregivers became a burden, taking away time and resources from core resident care duties. This is where Allmed, a specialist medical personnel solutions provider, stepped in to make a significant difference.

A long history of caring
Founded by the Durban Benevolent Society to provide care for elderly women, it initially resided on Victoria Street and in 1921, the home relocated to its current location on Essenwood Road, a larger and more suitable site. The Greenacre family played a pivotal role in this development, with Walter Greenacre donating the land and a bequest from his father, Sir Benjamin Greenacre, facilitating the construction.

Over the years, Essenwood has continuously evolved to meet the needs of its residents. It acquired autonomy in 1950 and established a dedicated assisted living wing in 1970. Most recently, in 2015, the home underwent extensive renovations to ensure it remained a safe and comfortable haven for its residents. Currently, Essenwood is home to 85 residents, with the capacity to care for 110.

The challenge of HR burdens stifling quality care
Essenwood, like many care facilities, struggled with the time-consuming tasks of HR management. Nursing Services Manager, Colleen Dempers, found herself spending a considerable amount of time on tasks like rostering, replacements for absent staff, and disciplinary issues. This detracted from the home’s primary focus – ensuring the well-being and individual care of residents.

“We found that we were spending so much time on HR issues that it became a huge distraction, Dempers explains. “It detracted us from additional time on HR issues that could be better spent on quality of care. This is what led us to Allmed for a solution.”

Allmed to the rescue with a partnership for success
Building on their established trust with Allmed, a partnership that began in 2016, Essenwood Residential Home made a strategic move to elevate resident care. Allmed was already providing relief support for registered nurses and enrolled nurses, offering a flexible solution for fluctuating staffing needs. The governing board made the tactical decision to entrust Allmed with their entire caregiving staff, ensuring continuity and quality.

“Our core function is resident care,” clarifies Chad Saus, Essenwood Residential Home’s General Manager. “We need to provide individual attention, activities, and a stimulating environment. By outsourcing HR, IR and payroll for 56 caregivers, along with the flexibility of additional resources when needed, Allmed frees us to focus on what truly matters – our residents.”

Streamlining operations for quality care with the Allmed advantage
The partnership with Allmed has yielded multiple benefits for Essenwood:

  • Reduced HR burden: Allmed took over recruitment, payroll, and disciplinary processes for caregivers, freeing up Essenwood’s staff to focus on resident care and quality of service.
  • Enhanced responsiveness: Allmed provided prompt and efficient support, addressing Essenwood’s concerns quickly and professionally. Whether it was staffing issues, training needs, or resident care challenges, Allmed offered round-the-clock support, solutions, and a “can-do” attitude.
  • Improved caregiver fit: Allmed understood Essenwood’s care philosophy and resident needs. The caregivers placed by Allmed at Essenwood integrated seamlessly into the environment, providing the high-quality care residents deserve.
  • Leadership that listens: Essenwood valued Allmed’s commitment to open communication. Any concerns raised by Essenwood were addressed promptly and collaboratively.

The impact: residents feel the difference
The positive ripple effects of the Essenwood-Allmed partnership are evident in the high standard of care received by residents. With a dedicated and well-matched caregiving staff, Essenwood can cater to individual needs and provide a more enriching environment for its residents.

A model partnership for senior care
The Essenwood Residential Home exemplifies the success achievable through a well-structured healthcare staffing partnership. By outsourcing HR and leveraging a qualified care staffing agency, Essenwood has demonstrably improved the quality of care for its residents. This model can serve as an inspiration for senior care facilities seeking to elevate their services and prioritise resident well-being.

Categories : Healthcare Politics and RegulationsTags :

A Holistic Approach will Build a Stronger Rural Healthcare System

On By ModernMedia
Photo by Hush Naidoo on Unsplash

As part of a series of podcasts titled “Advancing Healthcare” that examine the critical issues that must be addressed to achieve universal healthcare, Russell Rensburg of the Rural Health Advocacy Project calls for a focus and prioritisation of rural health. 

Across rural South Africa, the health profile of South Africans is changing. Thanks to the rollout of antiretroviral drugs, South Africa’s life expectancy has increased, and with that, the population is getting older. While this is good news, an ageing population does bring new challenges to the healthcare system.

Rensburg noted that as part of the success of the HIV response in the last 10 years, there has been an increase in life expectancy. But the challenge is that as disease profiles change, health care needs change too. “We need to respond to the differing health needs of young people and older populations,” he adds.

According to Rensburg, available data shows we must start taking differentiated approaches to delivering healthcare for different population segments. However, more data is required because no one knows the prevalence of certain diseases, like cancer. Also, lacking management data means little information on how facilities are run. Without the right data, he says, “We haven’t figured out a way of doing health promotion and health literacy.” 

The Rural Health Advocacy Project is a division of Wits University’s health consortium, and it aims to promote better health care for rural communities. However, providing meaningful rural health care requires understanding that each province within South Africa has its own challenges.

In Kwazulu-Natal, for instance, a recent study involving basic screening found high levels of diseases like diabetes and tuberculosis in people who had never accessed the healthcare system.

The Eastern Cape, says Rensburg, has too many hospitals that are expensive to run. “Some of those hospitals they don’t need,” he said. “There are, like, 91 district hospitals in the Eastern Cape; many of them are like old mission hospitals that, in my view, are sometimes too expensive to run.”

Limpopo, says Rensburg, has a malnutrition problem. “They have severe acute malnutrition rates that are quite high, which is ironic because it’s kind of a breadbasket province,” he said.

Another overreaching problem that healthcare professionals have to deal with in the rural districts of South Africa is that patients often bypass the community clinics and go to the hospitals when they need medical attention.

These clinics are bypassed because of negative experiences where patients endure day-long queues and medicines that aren’t in stock. “They go to the hospital, which costs probably five or six times more for the state to deliver that care,” explained Rensburg.

Rensburg believes more community health workers should be hired, and their training should be standardised to improve rural health care. “We need to professionalise them because it’s an opportunity to create employment in parts of the country with low economic activity,” he said.

According to Rensburg, other interventions that could improve rural health care could include cutting queuing times, improving antenatal care, and making maternity care easier to access. Pregnant mothers can wait up to 14 hours to access a bed.

Access to better management data would help in the better running of facilities. “I think the first baseline into improving healthcare is getting more people to understand their health status. And I think how we do that is being much more focused on gathering information. And then using that information for decision-making,” Rensburg said.

However, improving the well-being of South Africans living in the rural parts of the country goes beyond what the health sector can offer. “So maybe something like a Basic Income Grant could have a massive impact on people’s health, particularly in the rural areas where unemployment is 90%.” The basic income grant could help reduce malnutrition, Rensburg adds.

What could influence rural health soon is NHI. “I think the NHI is an opportunity to change how we deliver healthcare,” said Rensburg. “But when you look at the NHI proposals, it was about restructuring public-funded health care services. The whole thing talks about how we better manage hospitals by giving them their budgets.” Rensburg adds that restructuring publicly funded services, prioritising district health services, and improving the efficiency and efficacy of central, tertiary and regional hospitals by giving them greater autonomy should also be considered key to improving rural health.

This podcast, which is part of a series that aims at creating critical discussion around achieving universal health care, can be accessed at https://hasa.co.za/hasa-podcasts/ 

Categories : Healthcare Politics and RegulationsTags :

Nomantu Nkomo-Ralehoko’s Comeback as Gauteng MEC for Health Sparks Mixed Reactions

On By ModernMedia
Nomantu Nkomo-Ralehoko is sworn in by Judge Lebogang Modiba as the new MEC for Health. (Photo: Gauteng Provincial Government)

By Ufrieda Ho

ANC support in Gauteng dipped below 40% in the recent provincial elections and an ANC-led minority government is now at the helm. Among those in Premier Panyaza Lesufi’s new Cabinet is Nomantu Nkomo-Ralehoko who’s been reappointed as MEC for Health and Wellness.

Nomantu Nkomo-Ralehoko was first appointed Gauteng’s MEC for Health and Wellness in October 2022. A long-time ANC member, she previously served as MEC for Finance and e-Government and has been a member of the provincial legislature since 1999.

She returns to the critical role at a time when the province’s health department, based on extensive reporting by Spotlight and other publications,  remains mired in a chronic cycle of administrative and service delivery dysfunction.

At just under R65 billion for the current financial year, the department gets a massive slice of the Gauteng budget. While the National Department of Health leads on health policy, the day-to-day running of public healthcare services is managed by provincial departments of health.

The Gauteng health department has a high number of vacancies. On the administrative side this includes the critical position of a chief financial officer (CFO). The previous CFO, Lerato Madyo, was suspended in August 2022. Her case is still to be concluded. Research conducted last year by community healthcare monitoring group Ritshidze found that the majority of healthcare facility staff and public healthcare users that they surveyed felt that healthcare facilities were understaffed.

Madyo’s case is connected to ongoing investigations into corruption at Tembisa Hospital undertaken by the Special Investigating Unit. This was also the issue that whistle-blower Babita Deokaran was investigating before she was assassinated in August 2021. Deokaran was acting chief finance director before she was killed. Since her death it’s been confirmed that there was corrupt spending to the tune of R1bn at Tembisa Hospital.

When Nkomo-Ralehoko answered 10 questions from Spotlight shortly after her appointment in 2022, she said: “One of my immediate focus areas is to ensure that the department’s systems across delivery areas such as Finance, Human Resources, Monitoring and Evaluation, Risk Management, etc. are strengthened so that processes are not dependent on human vulnerability but there are clear checks and balances. An environment that has no consequence management breeds ill-discipline and a culture of ignoring processes and procedures as prescribed in our legislative framework.”

Gauteng also faces mounting surgery and oncology treatment backlogs. Its clunky supply chains and procurement systems have often left suppliers unpaid and facilities struggling without basic medical consumables as well as not being able to procure large pieces of equipment when it’s been needed. Some hospitals have had periods when patients have had to go without food.

There remains questions about governance capacity in the department. Notable examples from Nkomo-Ralehoko’s tenure so far include inaction over utilising a March 2023 Gauteng Treasury allocation of R784 million for outsourcing radiation oncology services. These ring-fenced funds were secured following sustained pressure and protests by activists and civil society. To date, this money has still not been spent.

https://platform.twitter.com/embed/Tweet.html?creatorScreenName=SpotlightNSP&dnt=false&embedId=twitter-widget-1&features=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%3D%3D&frame=false&hideCard=false&hideThread=false&id=1783790046073520568&lang=en&origin=https%3A%2F%2Fwww.spotlightnsp.co.za%2F2024%2F07%2F08%2Fnomantu-nkomo-ralehokos-comeback-as-gauteng-mec-for-health-sparks-mixed-reactions%2F&sessionId=0cf4a9233d69e0418da0c0880c4ca69b12ddb0e2&siteScreenName=SpotlightNSP&theme=dark&widgetsVersion=2615f7e52b7e0%3A1702314776716&width=550px

The department is also still to implement a June 2022 memorandum of agreement with the University of Witwatersrand. The agreement sets a framework for the department and the university to mutually address many of the health sector challenges in the province, while ensuring the academic training of the next generation of doctors takes place.

Another key challenge for Nkomo-Ralehoko will be how to navigate a changed Gauteng Provincial Legislature in this seventh administration. There is no outright majority and there is no unity government deal that includes the largest opposition party, the Democratic Alliance (DA). This will represent distinct hurdles for passing budgets or garnering enough votes for approvals in the house.

Despite these challenges, the reappointment of 58-year-old Nkomo-Ralehoko is being welcomed by some. They say that she brings stability to a portfolio that has been plagued by shaky, short-lived tenures in the top role. They say she has a flexible leadership style, and that she is open to working with many different stakeholders. But her critics charge that she cannot deliver the overhaul that the department needs and that she has not been tough enough on corruption.

‘More of the same’

Jack Bloom is the DA shadow minister for health in Gauteng. He says: “I don’t think the present MEC deserves to be reappointed, but that’s for the ruling party to determine. What we will get going forward is more of the same. The Gauteng Department of Health needs wholesale change but it’s not going to happen under the present situation.”

Bloom says Nkomo-Ralehoko’s comeback is “cadre deployment and political protection” and he adds: “I’m afraid that the corruption is across the board and the looting is going to continue.”

https://platform.twitter.com/embed/Tweet.html?creatorScreenName=SpotlightNSP&dnt=false&embedId=twitter-widget-2&features=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%3D%3D&frame=false&hideCard=false&hideThread=false&id=1808599071910691314&lang=en&origin=https%3A%2F%2Fwww.spotlightnsp.co.za%2F2024%2F07%2F08%2Fnomantu-nkomo-ralehokos-comeback-as-gauteng-mec-for-health-sparks-mixed-reactions%2F&sessionId=0cf4a9233d69e0418da0c0880c4ca69b12ddb0e2&siteScreenName=SpotlightNSP&theme=dark&widgetsVersion=2615f7e52b7e0%3A1702314776716&width=550px

He says the MEC slow-walked disciplinary action on many suspended senior staffers and has also failed to tighten up on the likes of pre-employment checks on would-be employees, resulting, he says, in weak candidates being appointed.

The EFF is the third largest party in the Gauteng legislature. Nkululeko Dunga was contacted to weigh in on Nkomo-Ralehoko’s reappointment but he declined to take our calls and didn’t respond to written questions.

‘Delays that cost lives’

Speaking briefly to news channel eNCA after she signed her oath of office on 3 July, Nkomo-Ralehoko mentioned oncology and radiation services as one of her priority areas. She referred specifically to the building of bunker-like facilities in order to house specialist cancer treatment equipment procured for Chris Hani Baragwanath Hospital and George Mukhari Hospital.

However, for Salome Meyer of the Cancer Alliance, the fact that equipment has been procured but is sitting in storage amounts to delays that cost lives. She says there are currently 3 000 patients in the province on waiting lists for cancer treatment.

“Our facilities are operational but they aren’t operating at full capacity because the  equipment is not in use or we don’t have  staff to operate the equipment,” Meyer says.

“What we’re seeing is resignation after resignation of radiation therapists because they aren’t on the correct pay grade. So even when we do get equipment there is not enough people to operate the equipment.

“The MEC has to start looking after her own people – the people who work in our clinics and hospitals,” she says.

‘Ensuring stability’

For the Democratic Nursing Organisation of South Africa (Denosa) in Gauteng though, Nkomo-Ralehoko has used her 20 months in the MEC role so far to start making the right turnarounds for the health department.

Bongani Mazibuko of the nursing association says: “We believe that this welcome appointment of the MEC will go a long way in ensuring that there’s stability in the department and it’s something that Denosa has long been calling for”.

Lack of stability has been a feature of Gauteng health over the last decade or so. When Nkomo-Ralehoko was appointed in 2022, she replaced Nomathemba Mokgethi, who had been in the job for less than two years. Prior to Mokgethi, Bandile Masuku was also in the position for less than two years. Gwen Ramokgopa filled in for a bit more than two years, and before her, Qedani Mahlangu was forced to resign after the Life Esidemeni tragedy.

Denosa in Gauteng also call for the finalisation of CEO appointments and for senior management posts to be filled. They also say fixing of infrastructure is critical “so that the department can be more functional”.

Mazibuko adds: “We need to ensure that appointment of nurses is prioritised as they are the backbone of the system. But we have faith that we can continue working together to ensure that the people of Gauteng get the health that they deserve.”

Right direction, but needs to act on corruption

Treatment Action Campaign Gauteng chairperson Monwabisi Mbasa also supports Nkomo-Ralehoko’s reappointment. He says compared to her predecessors, Nkomo-Ralehoko has so far been someone they feel they can work with.

“We have seen that in the past nearly two years the MEC has been trying to address some issues plaguing public healthcare at provincial, district and clinic level. She is hands-on and flexible, so we have confidence in her still,” Mbasa says.

But Mbasa says she must be held to account on not taking “drastic action against corruption”. He says 26 of Gauteng’s 37 public hospitals have in recent times run out of food but Nkomo-Ralehoko’s intervention included using suppliers and service providers who were not properly registered. He says it is a red flag and they will continue to hold the MEC to account.

Mbasa says to move forward now for health in the province will require alignment of the health department with the departments of infrastructure and development and of finance.

“Infrastructure of our health facilities is an emergency. We are also calling for the improvement of supply chain management and procurement of goods and services and we need to improve human resources.

“There are challenges and weakness in the Cabinet but it’s good that we are not working with completely new people in these portfolios. This is the time to accelerate and to ensure that we use the seventh administration to improve the delivery of public health,” Mbasa says.

After long and tense talks, negotiations with the DA to form part of the provincial executive deadlocked. This resulted in Premier Panyaza Lesufi naming a Cabinet with seven MEC positions for the ANC and one each to the PA, IFP and Rise Mzansi.

Republished from Spotlight under a Creative Commons licence.

Read the original article here