Tag: South Africa

Categories : Implants and ProsthesesTags :

Prosthetics Technology – Restoring a Life of Mobility, Without Limitations

On By ModernMedia

A new generation of prosthetic digits is transforming the lives of finger amputees.

Whilst small in size, the role of fingers in our overall body mobility is huge. Our fingers play a critical role in the accomplishment of everyday activities, allowing for tactile sensations and multiple fine movements from the grasping and manipulation of objects through to performing complex tasks.

Unfortunately, a significant number of finger amputations occurs each year. In fact, finger amputations account for well over 90% of all upper limb loss. The impact of this often extends far beyond the immediate area of amputation, having a much greater effect on the individual’s entire mobility.  According to the American Medical Association, losing the index and middle fingers mid-metacarpal creates a 40% impairment of the hand, 36% impairment of the upper extremity and 22% impairment of the whole body. The loss of four fingers is equivalent to a leg amputation or the loss of an eye in total impairment. [1]

The role of prosthetics in assisting these amputees to lead a far more mobile and functional life has come a long way. Traditionally, prosthetic fingers were only cosmetic and not functional. However, innovations in prosthetics technology have revolutionised this, enabling partial hand and/ or finger amputees to not only return to work but, as importantly, to a life without limitations. A recent report by the National Library of Medicine, stated that, “Over the past decade, significant advances have been made in 3D-printed prosthetics owing to their light weight, on-site fabrication, and easy customisation.” [2]

“Technology has struggled to provide relevant and fit-for-purpose solutions, leaving a void in the market,” says Ernst van Dyk (Managing Director, Össur South Africa). Össur, a global provider of non-invasive orthopaedics, recently announced its ownership of Naked Prosthetics – a provider of functional devices for partial hand and finger amputees. Making use of traditional machining, injection moulding and 3D printing, Naked Prosthetics develops and makes customised, robust and functional prostheses.

“We offer a fully customisable prosthetic finger design that allows the amputee full finger functionality,” continues van Dyk. These biomechanical prosthetic fingers are designed to replace partial or total loss of the fingers and functions exactly as a finger would. Further, the prosthetic, a non-motorised device, uses the remainder of an amputee’s finger to power the device.

Using sizing rings and photos specific to each amputee, the devices make use of a very high-end 3D printer to create the simple, elegant and fully functional device. Working with physicians, surgeons and prosthetists, each prosthetic finger is customised to the exact needs of each individual patient. Each affected finger receives a custom design to restore digit length, joint spacing and range of motion, accounting for a user’s unique amputation level and joint capability. Beyond the functional design, each has been tested for structural integrity and fatigue life.

Using mass-customisation and novel design, Naked Prosthetics’ fingers restore natural motion, dexterity and strength and are the result of strong collaboration between experienced engineers from aerospace, robotics, prosthetics and product development together with clinicians and patients. A strong focus on engineering design means that the devices are kinematically and structurally optimised to account for both the capabilities of the patient’s driving joints and the conditions under which the devices are used. Each device is designed with a safety factor above and beyond any forces the user will experience and can be used in virtually any environment.

Operated by the user through intuitive movement and driven by remaining intact joints, these prostheses require little acclimation and restore digit dexterity and hand strength without specialised training. Users report that with time these prostheses feel like a part of their bodies.

“Once a customer is fitted with their prosthetic finger, it is only a matter of weeks or months before they are fully functioning,” continues van Dyk. “Although the finger, or a portion of the finger is gone, the vibration of what is left sends a message to the brain allowing it to re-map and bring back function.” These functional, high-quality finger devices aim to restore the user’s ability to perform daily tasks, support job retention and encourage an active lifestyle.

Products such as these were not possible until only a few years ago. Says van Dyk, “Detailed CAD technology and 3-D printing makes it possible to mass-produce mechanical prostheses. It includes our custom body-driven devices (PIPDriver, MCPDriver, and ThumbDriver) that are designed for the unique shape of each patient’s hand and fingers after their amputation as well as the GripLock Finger (a passive, positionable device for those who suffered complete finger amputations or were born with congenital anomalies).” The GripLock Finger weighs in at an industry best of 25 grams and can hold up to 90 kilograms. These prostheses, made from aluminium, stainless steel, and medical-grade nylon (with a conductive tip that works on smart touch screens), are strong and rugged.

“The prevalence of finger and thumb amputations and the impact of this on the lives of these amputees deserves a high level of care,” says van Dyk. “Whilst development of prostheses has been impeded by technical and anatomical challenges, a new generation of practical, durable and body-driven prosthetic digits can enable care teams to address an unmet need and transform the lives of people who have undergone finger amputation.”

[1] April 2021 O&P Almanac by AOPA – Issuu

[1] Functional improvement by body-powered 3D-printed prosthesis in patients with finger amputation – PMC (nih.gov)

Categories : Healthcare Politics and RegulationsTags :

Motsoaledi’s Return could Work, but he Needs a DG who can Say “No Minister”

On By ModernMedia

By Marcus Low

In some respects, Dr Aaron Motsoaledi was the right person for the job when he was appointed as South Africa’s Minister of Health in 2009. But in 2024, the healthcare context in the country looks very different. Spotlight editor Marcus Low asks what we might expect from this new chapter with Motsoaledi in the top health job.

When Dr Aaron Motsoaledi first became South Africa’s Minister of Health in 2009, the number one task in front of him was clear. He had to rapidly expand the country’s HIV testing and treatment programme.

Over the next decade, he did exactly that. When he left the health portfolio in 2019, there were around 5.1 million people on HIV treatment in the country – roughly six times the 850 000 there were in 2009. Driven largely by this expansion in the HIV treatment programme, life expectancy in the country increased from 58.4 years when he started to 64.9 when he left.

But while Motsoaledi largely succeeded on HIV and tuberculosis, there was a sense that he was not a details man and struggled to see through important health system reforms. He never got on top of fundamental challenges like healthcare worker shortages and poor governance in provincial health departments. That is why we were cautiously optimistic when Motsoaledi was replaced by Dr Zweli Mkhize in 2019. We thought it likely that Mkhize would be better at turning rhetoric into actual reform. As it turned out, any hopes of that happening were derailed first by the COVID-19 pandemic, and then more definitively by the Digital Vibes scandal.

The return

In a recent editorial considering possible health ministers after South Africa’s 2024 national elections, we argued that President Cyril Ramaphosa might feel that he can get more out of Motsoaledi back in the health portfolio than at home affairs, where we think it is fair to say he struggled. Even so, hearing Ramaphosa read out Motsoaledi’s name on Sunday night came as a surprise. Our money was on Dr Joe Phaahla staying in the job – as it turns out, he was demoted to again serve as Deputy Minister of Health.

What to make of all of it?

From one perspective, Motsoaledi’s return is understandable. He is a close and loyal ally of Ramaphosa and therefore someone the President would want to keep in his Cabinet. He is a medical doctor who knows the health portfolio. He is a staunch supporter of National Health Insurance (NHI) and his impassioned leadership style is probably considered an asset by the President.

If one considers the Health Minister’s number one task to be the implementation of NHI, and if one sees the implementation of NHI to be an essentially political process, then you can see a case for Motsoaledi’s return.

But even if one accepts this line of argument, it does come with some kinks that are hard to straighten out. For one, the NHI Act is now law and the political battle has thus, to some extent, already been won, and it is time to move from the broad strokes of political rhetoric, that Motsoaledi excels at, to the detail of implementation, which hasn’t been his strong point. And, to the extent that the political battle surrounding NHI has been reopened due to the ANC losing its parliamentary majority, the type of leadership required now will involve building consensus beyond just the ANC, and arguably more challenging for Motsoaledi, making strategic concessions such as allowing a greater role for medical schemes than envisaged in the NHI Act.

But all that only really matters if one accepts the premise that implementing NHI should be the top priority for the Minister of Health.

There is an argument that implementing NHI will take many years and there are much more urgent healthcare issues that need to be dealt with right away. The harsh reality is that provincial health budgets have been shrinking, healthcare worker shortages remain acute, governance in provincial health departments is often a disgrace, and health sector corruption remains a far from solved problem.

During his previous stint as health minister, Motsoaledi faced many of these problems and, while he often said the right things, the bluster wasn’t ever really backed up with a sustained programme of reform. To be sure, there were important successes like the establishment of the Office of Health Standards Compliance and attempts to revitalise health facilities, but when it comes to the fundamentals of having a well-managed healthcare system with enough healthcare workers, the picture was bleak when he left the health ministry in 2019 and it remains so today. In short, there is a view, only reinforced by his struggles at home affairs, that Motsoaledi is not the right person to have in charge if you want to implement the complex, systemic reforms required to sustainably address South Africa’s urgent healthcare problems.

That may be a bit harsh. Ministers are after all politicians and their roles are meant to be political. While it certainly helps to have ministers who are serious about, and committed to the details of implementation, they should be working in conjunction with government departments and directors-general (DGs) in particular. It certainly hasn’t helped our Health Ministers that our National Department of Health has often been overstretched and arguably lacking in strong leadership.

One underlying problem here is that over the last two decades, South Africa’s DGs and heads of provincial government departments for that matter, have too often been yes-men or people appointed as a political favour. While that may in some ways make a minister or MEC’s life easier, it does not make for good governance when a DG or a head of department is a walk-over. Ministers need to lead on policy, but have DGs and deputy DGs who are trusted and empowered to get on with implementation.

One criticism of Motsoaledi’s previous stint in the job is that even though he had a good DG in Precious Matsoso and a few decent deputy DGs, rather than shield them from the political crises of the day, he drew them into those crises. One expert we spoke to this week suggests that Motsoaledi loved the limelight and wouldn’t let others lead while another charged him with not being hands-on enough – maybe the key insight is that those things might all have been true to some extent.

Either way, given Motsoaledi’s strengths and weaknesses and the very complex health challenges South Africa faces, it is now more important than ever that as Minister he leads on political and policy matters, but gives the actual administration the space to lead on implementation. For that to work, he will need a DG who is not just another politician or cadre, but one who is an excellent manager and implementer, and maybe above all, who has the guts to say “no minister” when he or she needs to.

*Low is editor of Spotlight.

Note: Spotlight is editorially independent and is not affiliated with, nor does it endorse any political parties. Spotlight is a member of the South African Press Council.

Republished from Spotlight under a Creative Commons licence.

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Categories : Healthcare Politics and RegulationsTags :

Gauteng Non-profit Organisations Reject Findings of Province’s Forensic Probe

On By ModernMedia

Six out of 13 drug rehabs previously funded by the Gauteng Social Development Department are now “under investigation”

Photo by Scott Graham on Unsplash

By Daniel Steyn and Masego Mafata

Non-profit organisations whose funding by the Gauteng Department of Social Development has been withdrawn say they are being unfairly punished for “frivolous” and “flimsy” findings made by forensic auditors.

Among the organisations concerned are women’s shelters, drug rehabilitation centres and organisations that provide meals and social work services to homeless people. Many say they have no choice but to scale down their services and even close their doors.

Only seven in-patient drug rehabilitation centres, out of 13 that received funding last year, will be receiving funds for the first two quarters of this financial year, the department confirmed to GroundUp on Wednesday. Six rehabs are under investigation, the department said. 

A manager at a children’s home told GroundUp earlier this week that they had to send a teenager struggling with substance use disorder back to their family because there were no state-funded in-patient drug rehabilitation centres available in the West Rand.

Forensic auditors were appointed by the department in 2023 to probe allegations of maladministration and fraud in the non-profit sector. The department’s budget for non-profit organisations is R1.9-billion for 2024/25, but Gauteng premier Panyaza Lesufi has promised it will be increased to R2.4-billion. Fourteen department officials have been suspended based on findings of forensic audits, the department has said.

The forensic audits were supported by outgoing MEC Mbali Hlophe. Hlophe has claimed several times that non-profit organisations in the province were “stealing from the poor” and that there has been extensive corruption in the sector.

A report provided by the department to the Gauteng Care Crisis Committee last week, on the orders of the Gauteng High Court, contains a list of 53 organisations that are under investigation, out of several hundred funded by the department.

Among the organisations on the list are Daracorp and Beauty Hub which received millions of rands in subsidies for training, while others have had their budgets cut.

But while organisations such as these have received large amounts of funding under questionable circumstances, the department has not provided evidence that this applies to all organisations on the list.

In May, almost two months into the new financial year, organisations flagged in the investigations started receiving letters informing them that they would not receive funding due to the findings made by the auditors. Some only received the letters in June.

When they requested clarity from the department, some received details in writing. But others were only given reasons for the suspension of their funding during a meeting with the department’s lawyers on Wednesday.

GroundUp spoke to representatives of five organisations who attended Wednesday’s meeting. They said the findings they were presented with on Wednesday were minor issues that should have been picked up by the department’s own monitoring and evaluation teams and would have been quickly resolved. They said they did not understand why a forensic audit was necessary.

The organisations have not received any funding from the department since the end of the financial year in March, and are battling to keep going.

“Flimsy and frivolous”

Derick Matthews, CEO of the Freedom Recovery Centre, which until March was funded for 52 beds for in-patient drug rehabilitation, told GroundUp that the allegations against the centre are “flimsy” and “frivolous”.

Matthews was told at Wednesday’s meeting that Freedom Recovery Centre had not submitted audited financial statements for 2022. GroundUp has seen evidence that he submitted the audited financial statements.

Matthews said the department had never before raised concerns about the organisation’s compliance with legislation. He said every quarter the department’s monitoring and evaluation officials would check the centre’s financial statements and that no concerns had ever been raised.

The auditors also found a “high turnover of security personnel” at Freedom Recovery Centre which was causing “instability in the organisation”. Matthews explained that this was because the security staff are employed from the centre’s skills development programme, through which a person who has been sober for a year works for three to six months at the centre.

“They are paid salaries from DSD funding. Our security is not working directly with the residents so they cannot impact the stability of the centre,” Matthews said.

The third finding against Freedom Recovery Centre was that staff members were being given “loans”. Matthews explained that sometimes when the department paid subsidies late, the centre would pay part of staff salaries from the tuck shop’s funds, which would later be deducted from their salaries.

Matthews says that they are in the process of discharging their last state-funded patients. “Both government-funded centres that we have been told to send people to during this crisis are full, they can’t help us. In the last week, I’ve received about 12 phone calls of people that needed urgent help and we can’t even help or intervene,” he said.

Representatives of other organisations GroundUp spoke to had similar concerns about the findings against them but did not want to be named for fear of victimisation.

They also raised concerns that their meeting on Wednesday was with only one department official and the department’s lawyers, while the organisations themselves did not have lawyers present.

They were told they have until Monday to provide evidence to dispute the allegations against them.

At the meeting on Saturday convened by Gauteng Premier Panyaza Lesufi, it was agreed that the organisations would receive an interim service-level agreement from the department by Monday, which would be finalised once the organisations were cleared. But not one organisation GroundUp spoke to has received an interim service-level agreement. Then on Wednesday they were told they will receive the agreements next week.

One organisation under investigation, Child Welfare Tshwane, was finally paid by the department last week after Gauteng High Court Judge Ingrid Opperman issued a directive that the organisation be paid to prevent harm to the beneficiaries.

GroundUp sent detailed questions to the Gauteng Department of Social Development, but we were told that the department will not be responding to media queries relating to the non-profit sector until further notice.

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Categories : Cancer Surgeries & ProceduresTags :

Cutting Edge Robotic Surgery: Beacons of Excellence at Two Cape Town Public Hospitals

On By ModernMedia
Dr Tim Forgan at the surgeon’s console of the da Vinci robotic system. (Photo: Biénne Huisman/Spotlight)

By Biénne Huisman

Within South Africa’s beleaguered public health sector – unsettled by budget cuts, understaffing, and divisive NHI legislation – cutting edge surgical robots that have been used to perform more than 600 surgeries at two Cape Town public hospitals are beacons of excellence that offer a glimmer of hope. Spotlight’s Biénne Huisman visited Dr Tim Forgan at Tygerberg Hospital to learn more.

Cutting edge robotic surgery might not immediately come to mind when one thinks of public hospitals, but in a first for public healthcare in South Africa, such systems are being used at two hospitals in the Western Cape.

The da Vinci Xi systems enable surgeons to control operations from a console – steering three arms with steel “hands” equipped with tiny surgical instruments; plus a fourth arm bearing a video camera (the laparoscope). The system translates a surgeon’s hand movements in real time, with enhanced precision, range and visuals, compared to manual surgery.

“It really is next level, it feels like you’re inside the patient,” says colorectal specialist Dr Tim Forgan, Tygerberg Hospital’s da Vinci robotics coordinator. “With this technology we can operate so much finer. You can see ten times better with this robot than with the naked eye; you can see tiny, tiny nerves you wouldn’t normally see. And you can manoeuvre surgical instruments so much better. Because of that, people have way better function after the procedure.”

He explains that the technology allows major surgery to be completed through small incisions – instead of larger cuts made by a doctor’s hand – leading to less bleeding and a faster recovery time.

Over 600 surgeries in two years

Lorraine Gys from Phillipstown in the Northern Cape can attest. On 22 February 2022, the 65-year-old pensioner became the first patient to undergo da Vinci robotic surgery in South Africa’s public sector. Forgan was behind the console, at Tygerberg Hospital.

Gys tells Spotlight: “The next day the sisters offered to wash me, I said to them ‘no, I’m not helpless.’ My recovery was very quick. I was up and about in no time, while the other patients had to be assisted. I was discharged on day four, and back at home I could even continue doing my own chores.”

Two years later, Gys is cancer free. The mother of three, who now lives in Eerste River, recalls how she made news headlines: “Before the operation, Dr Forgan explained everything to me. They asked my permission, saying that media will be there and the [provincial health] minister.”

Indeed, on the day Forgan operated on Gys, removing a cancerous rectal tumour, he was joined in theatre by several onlookers including former Western Cape MEC of Health and Wellness Nomafrench Mbombo.

“Yes it was a circus,” says Forgan, laughing. “A whole bunch of people watching me operate, quite bloody nerve-wracking. Fortunately I’m experienced at having lots of students around watching; plus performing surgery is just so immersive, everything else fades out.”

On that day, also in the operating room was colorectal surgeon Dr Roger Gerjy, keeping an eye. “He’s a very well-known robotic surgeon; a Swedish surgeon who works in Dubai,” says Forgan. “And if there was a problem, Roger would’ve taken over. He was also there to impart tips and tricks: move the instrument like this, shape it like a hockey stick; because with the robot it’s like having your whole arm inside [the body]. He’d give me advice on what to do with my extra floating arm – where to place it and how to manipulate it – because remember you’re controlling three arms at a time.”

Since 2022, the da Vinci robots installed at Cape Town’s two tertiary hospitals: Groote Schuur and Tygerberg, have enabled over 600 minimally invasive surgeries – including colorectal operations, prostatectomies, cystectomies (bladder removal surgery), and gynaecological procedures to treat endometriosis.

Groote Schuur Hospital has the other da Vinci Xi system run by Western Cape public healthcare

A spokesperson for the Western Cape Ministry of Health and Wellness, under former MEC Mbombo, Luke Albert explains: “We can see the immense impact it has for patients and the health system. For example, a traditional open cystectomy patient would require three days of ICU stay, as well as two weeks of hospital stay to recuperate. During this time, on average, 42% of patients require blood transfusions and almost 20% need total parenteral nutrition (when a patient is fed intravenously). A patient undergoing robotic surgery for a cystectomy requires no ICU stay and goes straight to a general ward for no more than six days on average, with no blood transfusions needed.”

Where the money came from

Asked how the department was able to afford R40 million per system for these machines in the context of severe budget cuts, Albert says: “The purchase was applicable to 2021/22 and not the current financial year; with all provincial health departments currently managing the effects of budget cuts.”

Asked the same question, Forgan explains the investment derived from surplus budget discovered within the throes of the COVID-19 pandemic: “There was a surplus because certain services just couldn’t be done. I mean, for us, we couldn’t do elective surgery. And how state funding works; if you don’t spend your [provincial] budget within the financial year, it goes back to central government.”

What it looks like

On a Friday afternoon at Tygerberg Hospital, Forgan is guiding Spotlight along corridors and up grey linoleum stairs, to the theatre where the da Vinci system is used. Dressed in black surgical scrubs bearing his name and a cap; on his feet Forgan is wearing bright pink crocs. In passing, he waves hello to fellow healthcare staff.

Inside the small blindingly white room, Forgan points out the three core components of the da Vinci system. There is a console with two control levers similar to refined joysticks – he demonstrates how to delicately hold them between forefingers and thumbs – a patient-side cart with four interactive metal arms (they are disposable; each arm can be used on twelve patients), and another trolley with a television screen. All connected by blue fibre optic cables.

As we speak, nurses arrive in the theatre, preparing it for upcoming gynaecology procedures scheduled for Monday. Forgan greets them, then continues to expand on his passion for colorectal surgery.

“With colorectal surgery, there’s a high rate of complications, but I really enjoy it, I really enjoy my job. When you have a successful outcome, saving a person from their cancer and prolonging their life through your intervention, that is the reward. Colorectal cancer is a very unpleasant disease, and operating like this can make one hell of a difference in a patient’s life.”

Colorectal cancer on the increase

Forgan adds that colorectal cancer is on the increase: “There aren’t many colorectal surgeons in South Africa, with a dire need for people to operate in this subspecialty. I mean, there are so few of us, we’re all on a WhatsApp group.”

Colorectal or colon cancer is the second most common cancer in South African men (following prostate cancer), and the third most common cancer in women (following breast and cervical cancer), according to the Cancer Association of South Africa.

Originally from Johannesburg, Forgan attended medical school at the University of the Witwatersrand. He qualified as a general surgeon at Stellenbosch University, sub-specialising in colorectal surgery at the University of Cape Town, before studying minimally invasive colorectal surgery at the Academic Medical Centre in Amsterdam.

He is also president of the South African Colorectal Society and runs a part-time private practise with his Tygerberg colleague, Dr Imraan Mia, at Cape Town’s Christiaan Barnard Hospital, where he has 32 all five-star Google reviews.

‘Early adopter’

Forgan considers himself an early adopter. But learning to use the da Vinci system did not happen overnight.

“We trained for ages,” he says. “On the surgical console there’s a simulator, so you spend hours and days and days doing procedures, over and over and over again. You have to get over 95% for each one of the procedures, before you can move on to the next skill.

“Then it’s how to use the machine, how to put it together, what to do if there’s an emergency; what if there’s a power failure and the machine stops working? How to safely remove it from the person. Then we went to the University of Lyon [in France] for two days of hands-on robotics training. And then a proctor – an international expert – comes to your theatre and does the procedures with you. So that was Dr Roger Gerjy, and that’s when we did Lorraine…”

First introduced by American biotechnology company Intuitive Surgical in 1999, the da Vinci Xi systems have sparked some liability lawsuits. An article from the Tampa Bay Times in February cites a lawsuit filed at the United States District Court in West Palm Beach, with a man claiming that a stray electrical arc from a surgical robot burned his wife’s small intestine during a colon cancer procedure, causing her death. The article quotes Intuitive Surgical’s 2023 financial report, which notes 8 606 da Vinci systems in use worldwide, having performed 2 286 000 procedures in 2023. The financial report mentions an undisclosed number of pending lawsuits, which the company disputes.

Nevertheless, Forgan remains an advocate.

Exiting via Tygerberg’s maze of corridors, he continues to reflect on his job. After our meeting, he is set to deliver a talk at the Cape Town International Convention Centre. His manner is earnest. Shrugging, he describes himself as a “glorified plumber”.

Republished from Spotlight under a Creative Commons licence.

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Categories : General Interest HospitalsTags :

Private Clinic Offers Affordable Healthcare for its Community

On By ModernMedia
Photo by Derek Finch

Only 16% of South Africans can afford private healthcare, and many low-income earners cannot afford healthcare and must rely on community clinics. These facilities are under intense pressure as they often cannot cope with the demand. For many workers, getting medical attention at these facilities means waiting for hours and being unable to work for a day and therefore losing wages. However, things could change if the pioneering efforts of a dedicated nurse with the financial backing of Standard Bank reach their full national potential.

“We assist this sector by working longer hours than do local government clinics that only open five days a week. Our services are available seven days a week at R300 per visit. Those able to pay for primary healthcare often must travel long distances to get to pharmacy-based primary healthcare clinics, mostly in the suburbs. The Rapha Clinic has been strategically placed between the city and the townships so that it can be easily reached by people commuting from their homes to the city,” says Ntombi Skosane, founder of Rapha Healthcare Services.

For Skosane, the clinic, which is located in the Montana area of Pretoria, realised her dream of being able to fill a vital gap in providing primary and basic healthcare to her community.

“As a nurse with 30 years in both the public and the private sector, I believed that I could open a clinic where I could establish a community service offering quality healthcare at affordable rates. The growing success of our operation shows that I was correct,” she adds.

Using her experience of clinics as a guide, Skosane has opted to have Rapha offer nine core services ranging from antenatal care and family planning to assisting with immunisations and wound care, as well as helping those with chronic illnesses and HIV testing and counselling.

“The Rapha Clinic met the stringent guidelines for being considered for a grant. These included an assessment of the viability of the business by the Standard Bank Enterprise Development Funding Committee, the commitment and required personal investment of the owner, and the sector in which the business operates. Although the business was operating successfully, it needed financial assistance to reach its full potential. In this case, the company needed additional stock and equipment to deliver a full service. After considering the application, Standard Bank purchased the required equipment for Rapha,” says Naledzani Mosomane, Head of Enterprise and Supplier Development at Standard Bank.

Skosane says that acquiring additional medical and surgical stock, emergency trollies, a vaccine fridge, wheelchairs, and air-conditioning through Standard Bank meant that the clinic would be able to attend to more patients more efficiently.

Rapha may be just a single clinic, but new outlets are being planned for Gauteng and the North West Province. Ten new clinics are being considered, as are health assessment centres in partnership with gyms and medical aids.

“We believe that Rapha Healthcare Services has a bright future. We look forward to playing a central role in growing the nation’s small business sector and developing relationships with a new generation of entrepreneurs,” says Mosomane.

Categories : Cancer Healthcare Politics and RegulationsTags :

Increasing SA’s Blood Cancer Survival Rate Starts with the State Healthcare System

On By ModernMedia
Credit: National Cancer Institute

While cancer survivors are increasing in countries like the United States, South Africa faces a different reality, with 4000 people dying from blood cancer every year. Dr Sharlene Parasnath, Head of the Department of Clinical Haematology and Stem Cell Transplant Unit at Inkosi Albert Luthuli Central Hospital and DKMS Africa board member, believes that this discrepancy is largely due to the quality of care provided to patients who rely on the state healthcare system. 

Counting the costs

She explains that South Africa’s state sector relies predominantly on conventional chemotherapy to treat patients as opposed to newer targeted immunotherapies. “These may be accessible to some patients in the private sector and standard care in developed countries but are out of reach for public healthcare due to their unaffordability. Countries that use more targeted therapies not only improve overall survival but also decrease the undesirable adverse effects of cancer treatments. These therapies may be given with chemotherapy or on their own and work by attacking specific genetic mutations in cancer cells. Examples include monoclonal antibodies (MABs) and Bispecific T cell engagers (BiTES), which mimic the immune system to destroy cancer cells. There are also tyrosine kinase inhibitors (TKIs) which block the signals that promote cancer cell growth.”

“The prohibitive costs of these treatments are why stem cell transplants are being encouraged in South Africa since they offer those with blood cancers a chance of a cure,” points out Dr Parasnath. “However, this approach comes with challenges. For instance, the state will not pay for a transplant from an unrelated donor, despite two thirds of patients in need of a transplant being unable to find a suitable donor from within their family.”

Fewer nurses, fewer transplants

“Human resource constraints, particularly the shortage of specialist nurses, is another factor hindering more stem cell transplants from being carried out,” she notes. “Currently, there is no formalised training for nurses in haematology in South Africa. So, what tends to happen is that the majority of blood cancer patients end up being cared for either by oncology-trained nurses or registered general nurses with limited practical education and training in the kind of care they require. Important aspects of nursing which can improve patient outcomes include dietary restrictions, visitor guidelines, decreasing bleeding risk, infection control and early detection of potential complications such as graft rejection, graft vs. host disease and veno-occlusive disease that can develop following a stem cell transplant.”

Referring to an article in the South African Medical Journal titled Haematopoietic Stem Cell Transplantation in South Africa: Current limitations and future perspectives, Dr Parasnath adds that lack of staff ultimately leads to implicit rationing of healthcare, thereby limiting access to this life-changing medical procedure.

Mental health is health

She stresses that human resource constraints in terms of mental health support is also detrimental to patients with blood cancers. “Unfortunately, this tends to be the case both in the public and private sectors, as one out of three people diagnosed with cancer ends up struggling with a mental health disorder such as anxiety or depression as well, yet  less than 10% of patients are referred to seek help. The South African Society of Psychiatrists has even warned that if left untreated or undiagnosed, this could impact the patient’s ability to function on a daily basis, including undergoing treatment.”

Dr Parasnath emphasises another glaring gap in mental health support. “NGOs offer on-site social workers for hospitalised children with blood cancer, but adults, especially those who are not members of medical aid schemes, often have no options available to them. Not only do they grapple with the emotional toll of their diagnosis and treatment side effects, but this is further complicated by anxieties around their finances and the wellbeing of their children.”

The Cancer Association of South Africa’s (CANSA) Fact Sheet on Cancer and Mental Health highlights that there remains a huge unmet need for mental health in cancer care, calling for more effective clinical integration of relevant services, which must be informed by patient choice and clinical need, and accessible throughout the patient’s whole cancer journey. It also stresses the need for measurement of patient quality of life as a marker of treatment effectiveness.

“The Department of Health must recognise clinical haematology as a discipline in its own right with its own unique needs. For too long, it has had to feed off of the limited oncology budget. But if we are to up the blood cancer survival rate, funding must be provided for necessities such as more modern treatments, unrelated stem cell transplantation and formalised training of nurses,” says Dr Parasnath.

She also urges South Africans to increase the pool of available stem cell donors either by registering themselves or supporting organisations like DKMS Africa which connects patients with potential matches by providing access to a global registry of over 12 million donors. Financial donations directly address two critical needs: funding the registration of new donors and assisting patients facing financial challenges as a result of the transplant process.”

“With focused efforts, South Africa can join the global trend of increasing blood cancer survival rates, offering a brighter future for patients and their families,” concludes Dr Parasnath.

To register visit https://www.dkms-africa.org/register-now or for more information, contact DKMS Africa on 0800 12 10 82.

Categories : Expert Opinion Healthcare Politics and RegulationsTags :

Debunking Myths: The Truth About Medical Schemes in South Africa 

On By ModernMedia

Despite the promise of Universal Health Coverage (UHC) for all, the recent signing of the NHI Bill has brought with it several misconceptions around medical schemes that undermine the very foundation of our healthcare system, writes Dr Katlego Mothudi, Managing Director at the Board of Healthcare Funders (BHF).

In a historic move aimed at transforming the South African healthcare landscape, President Cyril Ramaphosa signed the National Health Insurance (NHI) Bill into law. This landmark decision promises to move South Africa towards Universal Health Coverage (UHC) for all citizens, regardless of socio-economic status.

While the goal of UHC is commendable, the rhetoric leading up to the NHI Act’s announcement has created misconceptions about the role of medical schemes. 

With many believing that they should cancel their memberships immediately to enjoy free health services for the foreseeable future. However, Dr Katlego Mothudi clarifies that the implementation of NHI will take several years, dispelling this misconception.

The NHI Act introduces a single-payer system, central to the idea is that healthcare is a ‘public good’, suggesting all healthcare funding should exclude medical schemes, and should be government-funded. Dr Mothudi counters that healthcare is more accurately described as a social good. A public good, like military services, is one that the government must provide and from which no one can be excluded, regardless of payment. While healthcare is essential, it is not feasible to provide it as a public good.

The Board of Healthcare Funders (BHF), concerned about the numerous misconceptions propagated by government representatives since 2009, commissioned Professor Alex van den Heever, Chair of Social Security Systems Administration and Management Studies at Wits Health Consortium, to investigate these claims. Despite their hyperbolic nature and lack of systematic research, these statements have significant weight due to their endorsement by influential individuals. Prof van den Heever’s report identified frequently repeated assertions that he concluded were unsubstantiated and untrue.

Key Findings from the Report:

1. Medical Schemes are Unsustainable – False

In 2009, claims suggested that many medical schemes were headed for collapse due to unsustainable financing models, with 18 schemes reportedly nearing insolvency. Prof van den Heever’s report refutes this, showing stability in medical schemes from 2005 to 2022. The number of beneficiaries increased by over one million from 2009 to 2022, with consolidated reserves of R114 billion in 2022, far exceeding the required 25% reserve ratio. Broker costs have not been a systemic concern, and total non-health costs per average beneficiary per month for all medical schemes decreased by 34.7% in real terms from 2005 to 2020.

2. Health Services are a Public Good – False

   In 2011, Health Minister Aaron Motsoaledi claimed that private healthcare was a “brutal system” due to commercialisation. However, Prof. van den Heever clarified that healthcare is not a public good in the economic sense, as it does not meet the criteria of being jointly consumed without exclusion. Healthcare is a crucial service but providing it as a public good is not feasible.

3. Most Medical Scheme Beneficiaries are White – False

Last year, Prof Olive Shisana, an honorary professor at the University of Cape Town and special advisor to President Ramaphosa, stated that the private sector predominantly serves the privileged white population. However, Statistics South Africa’s 2021 research indicates that of the total population utilising private healthcare services, 50.2% are Black African, 32.3% are White, 9.8% are Coloured, and 7.6% are Indian/Asian.

Need for Balanced Perspectives

While the BHF supports healthcare reform, it raises concerns about the NHI Act’s constitutionality and calls for a factual review of claims about medical schemes. It is crucial to present both sides of the debate to understand the implications fully. Including government perspectives and addressing how the NHI will affect individual citizens would provide a more comprehensive view.

Medical schemes remain a valuable national asset that plays a crucial role in ensuring the long-term viability of South Africa’s healthcare ecosystem. BHF advocates for a balanced approach to healthcare reform that considers both public and private sectors’ strengths and weaknesses.

For a comprehensive look at findings from the report commissioned by BHF, see Prof van den Heever’s presentation at the 2024  Annual BHF Conference here. (Click to download PDF)

Categories : Implants and ProsthesesTags :

Össur South Africa Extends its Range of Non-invasive Prosthetics with Naked Prosthetics for Finger and Partial-hand Amputations

On By ModernMedia

Össur South Africa has announced the availability of Naked Prosthetics to the local market. This range of custom-made prostheses, precisely tailored to the user’s amputation and individual hand structure, positively impacts those with finger and partial-hand amputations by providing functional finger prostheses of high quality.

“Partial hand limb loss is the most prevalent of upper limb loss, with over 90% of upper limb amputations involving the fingers. Finger and partial-hand amputations also accounts for a significant number of amputations each year,” says Ernst van Dyk, Managing Director, Össur South Africa.

Whilst more common amongst working age men, finger and partial-hand amputations occurs regardless of gender or age. “The lack of mobility resulting from a finger and partial-hand amputation is not limited to the area of amputation only. Many amputees experience loss of mobility beyond the area of amputation,” stresses van Dyk. No fewer than 5% experience a resultant impairment of the entire body and as many as 75% of heavy manual labourers are unable to return to work.

“With Naked Prosthetics we are dedicated to positively impacting the lives of finger and partial-hand amputees. We aim to provide them with functional, high-quality solutions that seamlessly integrate into their lives and empower them to not only resume employment but, as importantly, to engage in the activities they love, thereby assisting them to live a life without limitations,” says van Dyk.

Naked Prosthetics’ innovative solutions, the result of strong research and development (R&D) efforts and manufacturing capabilities, has been recognised by Business Insider as one of the medical technologies that are changing people’s lives[1]. It currently offers four custom-designed devices that are fabricated to within millimetres of a patient’s unique anatomy to mimic the complex motion of a finger.

  • The PIPDriver is a body-controlled prosthesis designed for a finger amputation or limb difference on the proximal or distal phalanx. Its design is anatomically adapted to the proximal and distal interphalangeal joints for intuitive and natural movements. Benefits include improved functionality for everyday activities. It is easy to clean and care for, easy to put on and take off and has a cage-like structure that protects the residual finger. Its slim and smooth design allows the prosthesis to be worn on two or more adjacent fingers. It also includes a conductive tip option for touchscreen operation.
  • The MCPDriver is a body-driven prosthesis designed for a finger amputation or limb difference on the MCP joint (also known as the knuckle) of the index, middle, ring, and/or the little finger. It restores the original finger length, thereby helping to imitate natural gripping patterns and excels at restoring pinch, key, cylindrical and power grasps as well as grip stability. Its durable stainless-steel linkages and robust components allow the user to return to a highly demanding lifestyle. Benefits include a silicone pad that cushions the backplate for improved comfort, interchangeable silicone adjustment inserts that can be used to vary the volume and adjusting discs to obtain the best possible fit. Its natural abduction and adduction allow for intuitive use. As a result, the acclimatisation time after the initial fitting can be considerably reduced. It also includes the conductive tip option for touchscreen operation.
  • The ThumbDriver is a body-controlled prosthesis designed for an amputation or limb difference on the MCP joint of the thumb. It can restore two and three-point grips, enable secure gripping patterns with medium to large diameters and improve fine motor functions and skills. It features an adjustable preflex option that allows you to adapt the prosthesis according to the requirements of the task at hand. As a result, functional gripping patterns can be more easily attained.
  • The GripLock Finger is a passive and positionable prosthetic finger designed for a finger amputation or limb difference on the MCP joint of the index, middle, ring, and/or little finger. It is intended for use in conjunction with a custom-made socket adapted by a certified prosthetist. You can flex the finger to various degrees with your other hand or on a hard surface. Subsequently, you can release and fully extend the GripLock Finger by pressing the latch (lever arm) on the back or flexing the finger beyond the last locking position. It restores the original length, supports the use of both hands, prevents a misalignment of the metacarpal bone and provides a valuable tool to master everyday activities.  GripLock Fingers can be combined with our MCPDriver, PIPDriver, and/or ThumbDriver.

Says Kai, a trained plant and machine operator who suffered the loss of his forefinger, middle and ring finger after a work-related accident. “Thanks to the precise adaptation to my individual anatomical conditions, the prosthesis is an irreplaceable everyday companion for me. When I come home at night, I take off the prosthesis in seconds – just like you kick off your shoes after a long day at work. I think it’s important to convey to other people in similar situations that a work accident like mine doesn’t have to mean the end of the world. You can come to terms with many situations and end up living a normal life.”

Similarly, Cara (an active member of the Finger and Partial Hand Amputee Peer & Support Group), lost two and a half fingers on her left hand due to an unforeseen accident. Prior to her accident, Cara was an avid yogi and enjoyed practicing inversions (yoga poses where the heart is higher from the ground than the head) and handstands. “I spent a year doing physical therapy to regain strength in my left hand, but I still felt as though I was struggling to hold and grip my mat as I practiced yoga,” she recalls. Every time she tried to balance her weight, she would fall backwards due to the lack of grip and support. Within one week of receiving her Naked Prosthetics PIPDrivers, Cara was able to hold a side plank during yoga. “You may feel hopeless in the moment, but it does get better. And you will be surprised at what you could learn. I am a different person now and I grew from the experience.”

“We are committed to helping digit amputees discover innovative and life-changing solutions. It’s all about function and getting people back to living full lives, without limitations,” continues van Dyk. “We believe our range of technologically advanced and custom-made prostheses helps to achieve exactly this and we are excited to be able to offer it to local amputees.”

To find out more, please visit: https://www.ossur.com/en-za/prosthetics/np-devices

[1] Naked Prosthetics’ Technology Recognized – The O&P EDGE Magazine (opedge.com)

Categories : Healthcare Politics and RegulationsTags :

The Health Minister SA Needs: Astute Politician, Inspired Leader, Humble and Fair

On By ModernMedia

By Ufrieda Ho

By month end, South Africa will have a new Minister of Health. Ufrieda Ho asked some academics and activists what qualities that person should have to tackle the key health issues the country faces.

The precise health minister South Africa needs right now may not exist. But the portfolio still demands that the person appointed to this critical position be up to the job.

The appointment, when it happens, will come against a radically shifted political backdrop. Firstly, the elections results of the May 29 point to a coalition government for the first time in 30 years of democracy. The final configurations of a likely government of national unity is still anyone’s guess. And secondly, the National Health Insurance (NHI) bill is now an Act. President Cyril Ramaphosa signed off on the bill just a fortnight before the elections. It means by law, the work on the advancement of NHI must begin even as the contentions and contestations remain as thorny as ever.

Another reason why getting the right person matters is the money that comes with the portfolio. Annual government spending on health is in the region of R270 billion. Most of this spend is currently directed via provincial health departments, but flows under NHI will be nationalised and the NHI Act gives the minister extensive powers over NHI, and indirectly, the NHI fund.

At the same time, problems like entrenched health sector corruption and high levels of medico-legal claims against the state remain acute. Health budgets have been shrinking in real terms over the last decade. Financial shortfalls and shortages of healthcare workers in our health facilities are dire, while health needs enlarge.

Bridging ideological divides

Fatima Hassan, a human rights lawyer and founder of the Health Justice Initiative, says: “Policymaking in a coalition government is going to be so difficult – a Herculean task. And the place where you’re going to feel it most acutely is in health, because we have a dual health system and because NHI is sitting on the table.”

She says the role of minister will call for an astute politician. She says: “It must be someone who can work with different parties as well as constituencies in different sectors to try to bridge a number of these ideological divides.

“Health is a lightning rod for the differences between the different political parties; we saw this in how the parties campaigned for or against NHI,” she says.

Hassan says the worst case scenario will be someone in the position who is a “placeholder minister” who stalls on reforms, is a person more concerned with “calming the markets” and someone who will simply play the political long game waiting it out until the next elections.

“It must be someone who is able to work on creating a fairer system for access to proper healthcare services across the country, not just in specific provinces. They must invest in health infrastructure, invest in human resources for health, and invest in some of the more positive aspects of preparing for national health insurance,” she says. She adds that the person must prioritise fixing the “glaring issues in the NHI Act” to avert looming law suits.

In addition, Hassan says the minister must be someone who can stand up to the bullying of private sector power, including the likes of big pharma, and must be able to show leadership on domestic health issues while also being a strong Global South voice on international platforms to champion global health equity.

‘Health is more than a biomedical response’

Professor Scott Drimie is a researcher at the University of Stellenbosch and director of the Southern African Food Lab. Drimie works on food systems and food security and how these intersect with the social determinants of health.

For Drimie, South Africa’s health minister must be a person with an expansive leadership style; a person who is able to work across government departments and also be awake to the grassroots realities people face. Around 85% of people in South Africa rely on public healthcare.

“The minister must be able to grapple with the lived reality of most poor people and put in place a health system that supports the most vulnerable.

At the same time, that person should be someone who understands that health is more than a biomedical response – health is also issues like food security, sanitation, stable livelihoods and safety,” he says.

Another quality Drimie highlights is that the minister should be open to collaboration and experimentation. He says there has to be a “whole-of-government” approach and a “whole-of-society” approach. The Department of Health cannot achieve its key performance indicators on its own; it needs to collaborate with departments including social development, education and basic education.

“It must also be able to be bold with programmes and work with communities directly as well as with civil society, health advocates and health activists,” he says.

Reform of bureaucracies in the health department must also be something the minister tackles, Drimie says. He says it means appointing effective managers who are not micro-managed or politically influenced. Effective implementers of policies and programme, he says, can be a counterweight to politics.

“Politicians can come with very short-term, very narrow party politics,” says Drimie. But, he adds, enduring and relevant health programmes survive beyond political tenure and are more likely to achieve positive health outcomes.

Put people first and ‘show humility’

For activist Anele Yawa, who is secretary general of the Treatment Action Campaign, we need someone who puts people first. He says the minister must serve the interests of people and show humility for the office.

“The minister must not be someone who pushes his or her agenda. A minister is appointed; he or she did not submit a CV to us. So a minister must understand that there will be times when we as citizens and civil society will disagree with them. It’s because we will continue to speak truth to power, we will continue to hold them accountable; whatever the new coalitions will look like,” he says.

“Our ministers must not be arrogant and think it’s because we hate them. We will disagree and we will fight because it is an effort to make sure that things are done the right way and we can bring health services to the majority – it’s that person who is working class, black and is a woman,” says Yawa.

He says it means a strong minister must be one who maintains an open-door policy; who arrives at community meetings in person; take calls personally and engages.

Yawa says it’s also critical that the seventh administration is one that works cohesively. “We voted on the 29 May for a contractual agreement with government; not a fashion show. It means that we don’t just need a good health minister, we need a good administration that delivers on water and sanitation, on education and on social development, and so on.”

Motivate and inspire

Professor Lucy Gilson is head of health policy and systems division in the School of Public Health at the University of Cape Town. Her top qualities for a good minister also centre on people skills. She says the health minister in South Africa must be an inspiring leader.

“The person must be able to motivate health workers and managers to be the best public servants they can be.

“The person must also inspire the public to trust in the public health sector,” Gilson says.

The new health minister must have strategic management skills, she says. These will be necessary to navigate the complexity of power and interests in a coalition government and to figure out how the NHI will take shape.

In the end, she says the person in the post should have patience and persistence. She adds: “Bringing change to the health system is a collective and sustained effort over time. The minister must be able to strengthen capacity, assemble coalitions and networks of learning, experience and mutual accountability.”

Republished from Spotlight under a Creative Commons licence.

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Categories : Respiratory DiseasesTags :

Slow Progress after Decision to Make TB Prevention Pills More Widely Available

On By ModernMedia
Tuberculosis bacteria. Credit: CDC

By Tiyese Jeranji

Besides preventing illness and death, tuberculosis prevention therapy is estimated to be highly cost effective. Yet, uptake of the medication is not what it could be in South Africa. Tiyese Jeranji asks how much has changed since the Department of Health last year decided to make TB prevention therapy much more widely available.

Many people who have the TB bug in their lungs are not ill with TB disease. Having the bug in your body, does mean however that you are at risk of falling ill, should the TB bacteria get the overhand in its battle with your immune system.

Fortunately, we have medications that can kill TB bacteria before one falls ill. A recent World Health Organization (WHO) investment case, suggests such TB prevention therapy, commonly called TPT, reduces the risk of falling ill with TB in those exposed to the bug by 60% to 90% compared to people who do not get the treatment.

In South Africa, TPT has been available in the public sector for years, but until the publication of new government guidelines last year, only kids aged five or younger and people living with HIV could get the medication. Under the new guidelines, everyone who has had close contact with someone with TB should be offered a TB test and if they test negative be offered TPT – if they test positive they should be offered TB treatment. These changes dramatically expanded the number of people in South Africa who are eligible for TPT.

The antibiotics used for TPT has also changed in recent years. For many years, the only option was a medication called isoniazid taken for six or more months. We now also have two three-month options – isoniazid and rifapentine given once weekly and rifampicin and isoniazid given daily. These shorter duration treatment courses should help more people complete the treatment.

Down and up?

Dr Norbert Ndjeka, Chief Director of TB Control and Management at the National Department of Health, tells Spotlight that in recent years, South Africa has seen a steady decline in the number of people initiated on TPT.

The decline has been substantial. In people living with HIV, initiation on TPT dropped from 454 000 in 2018 to around 241 000 in 2023. In children aged five and younger who have had contact with someone with TB, it fell from 25 357 in 2018 to 15 775 in 2023.

TPT enrolments per province for 2023

ProvincePeople living with HIVContacts < 5 YearsContacts > 5 Years
Eastern Cape34 6232 5514 771
Free State14 5355621 027
Gauteng67 3331 3684 241
KwaZulu-Natal62 3623 1688 519
Limpopo15 871391452
Mpumalanga25 6186692 006
Northern Cape3 1788551 595
North West9 4335961 425
Western Cape8 5325 6151 278
South Africa241 48515 77525 314
*Typically, provinces with higher numbers of people diagnosed with TB or those with high numbers of people living with HIV will report higher TPT initiations.

There are two significant reasons for this decline, according to Ndjeka. Firstly, declining TB incidence, and secondly, declining HIV incidence.

“With fewer people diagnosed with TB disease, fewer contacts will need TPT, and with fewer people being diagnosed with HIV, fewer people will initiate TPT regardless of TB exposure,” he says.

WHO figures have shown a significant downward trend in the estimated TB cases per year in South Africa and according to Thembisa, the leading mathematical model of HIV in South Africa, the number of people newly starting HIV treatment has dropped from a peak of over 700 000 in 2011, to well under 300 000 in 2023.

But the recent downward trend in people taking TPT may be coming to an end. “We believe that the implementation of the new guidelines within the current strategic framework will lead to increases in TPT enrolment,” says Ndjeka.

In line with the new guidelines, there are also changes to what TPT data is being collected. “For example, we never used to report on TPT provision to contacts 5 years and older, but now we do and in 2023 at least 25 314 TB contacts 5 years and older were initiated on TPT,” he says.

20% increase expected in 2024

Based on the data reported for January and February of this year, Ndjeka expects that overall TPT initiations will increase by at least 20% in 2024 compared to 2023. Moreover, as documented in the National Strategic Plan for HIV, TB and STIs 2023-2028, there is a plan to have a steady annual increase in TPT enrolments leading up to 2028.

Ndjeka says based on the NSP TPT targets, South Africa is exceeding TPT targets for people living with HIV, but reaching less than 25% of targets for TB contacts. He points out that performance varies by province, but that all provinces have a long way to go in terms of reaching TB contacts.

‘Cost saving over time’

“The aim of offering TPT is to reduce the TB incidence,” Ndjeka says. “So, if everyone eligible is offered TPT there will obviously be increased costs initially but cost saving over time. This looks at cost of treating people with TB, lives saved/ deaths prevented as well as costs to patients.”

For South Africa, he says, it is estimated that we can reduce the number of people with TB by 138 000 by 2050 at an estimated cost of R23 226.90 per TB episode prevented.

Ndjeka says it costs the health department an estimated at R1 498.51 to treat one person with drug-susceptible TB for 6 months and R16 612.82 to treat one person with the standard drug-resistant TB treatment for 6 months. “These costs are for medications alone, which can also go beyond R70 000 depending on the patient and the type of resistant TB. Moreover, when factoring in clinical consultations, hospitalisations, and costs to patients the costs go up considerably,” he says.

The cost of providing TPT also depends on the regimen. One person on TPT can cost as little as R608.77 for a course of three months of isoniazid and rifapentine given once weekly, and up to R1 358.02 for 12 months of isoniazid. “TPT also has much lower associated costs for example there is no hospitalisation, fewer clinic visits and consultations,” Ndjeka says.

“By preventing TB, the cost of TB treatment is avoided along with the costs of treating some of the acute and chronic conditions that someone with TB may experience even after being cured of TB. These include chronic obstructive pulmonary disease, bronchiectasis and pneumonia,” says Alison Best, communication manager at Cape Town-based NGO TB HIV Care.

“For children under five in particular, who are at increased risk of disseminated TB like TB meningitis, the cost of not preventing TB could be death or severe lifelong disability,” she says, adding that preventing TB in a single individual also prevents the costs associated with any onwards transmission of TB from that individual to others.

Questions over implementation

Expanded TPT eligibility has been widely welcomed, but questions have been raised over how well the new guidelines are being implemented.

Best says government austerity measures have made implementing new initiatives in the healthcare setting challenging.

“There is not much political will to implement the guidelines (to expand eligibility for TPT) at provincial and district levels and this has translated into the slow release of circulars, delays in training health workers, poor knowledge of the policy and its low prioritisation,” she says.

Ingrid Schoeman, Director of Advocacy and Strategy at TB Proof (a local advocacy group), says often when a national policy is released, there are delays at provincial-level in releasing circulars to enable health worker training.

“This results in these services not being available at district-level. In the Western Cape, civil society organisations, the [provincial] Department of Health, City of Cape Town and implementing partners are now all working together to support health worker training, and implementing community-led awareness campaigns so that all close TB contacts know they are eligible for TPT,” she says.

Best adds that tracking the data to show how many people are starting and completing TPT tends to be difficult. She notes there are many gaps in capturing the information. This includes, at times, the limited recording of information in patient folders by clinicians and suboptimal inputting of data by data capturers.

Ndjeka says the national department of health has been conducting training on the new guidelines with provincial and district TB and HIV programme managers, district support partners and other trainers.

“They are then responsible for training health care workers. The antiretroviral therapy guideline training also includes TPT. Webinars on the knowledge hub (an online training platform) have also conducted,” he says.

However, Ndjeka conceded that there is a lack of awareness about the value of TPT. “Additionally,” he says, “there is reluctance from clinicians to provide TPT. This result in poor demand for TPT. Treatment adherence is another problem especially for people on the long regimen (12 months)”.

Plans to address these challenges, among other things, include marketing TPT as treatment for TB infection rather than prevention, targeted communication strategies, community mobilisation, and ongoing training and mentoring of healthcare workers, says Ndjeka.

Republished from Spotlight under a Creative Commons licence.

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