Implementation of a National Health Insurance (NHI

by Aug 16, 2009All Articles

30 June 2009

Mr Speaker, Minister of Health, Dr Aaron Motsoaledi, Honourable Members of the House, Distinguished guest, Ladies and gentlemen

Let me start by congratulating all government departments, FIFA and the Local Organising Committee on hosting an extremely successful Confederation Cup. Let me also congratulate Bafana Bafana who has made us very proud. They have improved their game. They played well. We have shown the world that South Africa and indeed Africa is not only capable of hosting the World Cup, but can outshine many other countries in organising this great event.

Mr Speaker, now that the 2009 FIFA Confederations Cup is behind us we can pause and reflect on how the health system met its obligations in the provision of health and medical services for the tournament.

In general the provision of these services is considered successful and the detailed planning and preparation that took place has resulted in an incident free tournament.

However, there are also areas where we believe that we can improve. A thorough debrief will take place mid July 2009. Lessons learnt will be carried forward, as we begin to prepare for the 2010 FIFA World Cup.

With the World Cup involving 10 stadia, as opposed to the four used for the Confederation Cup, now is not the time to rest on our laurels. The Health Sector Preparations Workgroup will critically revisit its plans in minute detail to ensure that all aspects are suitably prepared for.

The World Health Organisation (WHO), working together with the Department of Health, sent a nine-member delegation of experts in communicable disease and mass gatherings to South Africa to evaluate the implementation of communicable disease control strategies during the 2009 FIFA Confederation’ Cup. This team commended us for the good work that was done. It also left us with minor recommendations.

The first identified case of swine flu in South Africa occurred during the visit of the WHO delegation. It provided the delegation the opportunity to observe firsthand how we, as a country, dealt with the incident. The reports received were positive. The delegation gave us the assurance that they would continue to support our efforts to ensure that we have a 2010 tournament that is free of any disease outbreak. To this end exchange and training programs will take place over the next 10 months.

I am confident as I stand here today that I will be able to tell the nation in April 2010 that the Department of Health, along with its partners, are fully prepared to ensure that we are more than adequately ready for the 2010 FIFA World cup.

Mr Speaker let me now turn to the priority issue of improving quality of care. Our patients and their families, and the communities we come from, are the most important voices that we will be listening to during this year as we move towards implementing more equitable and higher quality care through health systems strengthening.

We will also continue the recent successful efforts to work with our own staff and the many partners who are passionate about improving the quality of care in our country. We will formalise some of these relationships by appointing a number of our recognised experts to advise us on accepted best practice on an ongoing basis.

Since starting work last year, the Office of Standards Compliance had already initiated the process of reviewing and benchmarking performance against national standards in a number of hospitals and community health centres. This was followed by support to improve identified areas of weakness. In this financial year the national standards and assessment tools have been revised to ensure the most critical areas where quality or safety could be at risk are adequately covered, for both hospital and primary level care. These standards will be extensively publicised and used throughout the health system to guide our work and our managers.

We will continue to review progress in relation to our previous findings in every province, as well as rolling out the performance review and benchmarking exercise so that we cover a quarter of our facilities this year. In doing this, we will be seeking the most effective ways to ensure that such an exercise is credible and provides our department at all levels with an objective assessment of our problems and the underlying or contributory causes, thus enhancing accountability.

It is important at the same time to build our own capacity to make best use of the findings. These reports will give a detailed guide to managers both at facility level and those who provide support at provincial and national levels as to what needs to be done to reach the required standard. The aim is to enable all these facilities to receive recognition as having met the required standard.

To turn quality challenges around, we will use the methods shown internationally to be most effective. We will be pulling together a network of 100 targeted quality improvement projects around the country. These will be focused on measures to protect the safety of our patients including through the prevention of health-care acquired infections, long waiting times, plus basic cleanliness and maintenance of our facilities.

Through these projects, we will be able to improve poorly functioning system, weak management and poor supervision, and hopefully motivate and energise our staff working at delivery level as well as identify and effectively solve some of the impediments to their work. This focus at delivery level is what in the end will make the services as a whole work for the benefit of our patients.

One particular mechanism that is widely used in the private sector to improve quality is through proactively analysing and addressing the complaints and concerns of our users, both in terms of providing an explanation (and an apology) to them and taking strong measures to avoid their future recurrence. This will be the main aim of our national 24-hour toll free line, which will start operation during this financial year. It will work in close collaboration with all the provincial centres.

As the Honourable Minister has indicated, the implementation of the NHI represents a defining moment for the South African health system. It has been a long and winding road and many alternative considerations have been put on the table as to how best the country can achieve universal coverage.

In the 1994 ANC’s National Health Plan, it was clearly envisaged that the introduction of a mandatory prepayment-based, the national health insurance will go a long way towards the progressive realisation of ensuring that the South African population have coverage and access to adequate, good quality and affordable health care within the public and private sectors.

Ke nako – It is time to implement such a system, which is based on access to health services that are provided in a manner that effectively addresses the inequities of the past and also ensures that there is a unified national health system that accords our citizens sufficient financial risk protection from catastrophic health-related expenditures and improves the health outcomes of the population.

Mr Speaker, a key area in the strengthening of the health system and the implementation of the NHI is an integrated Health Information System (HIS).The World Health Assembly (WHA) has identified the need to strengthen the health information systems in member states. The WHA subsequently identified the Health Metrics Network to facilitate evaluations and to develop strategic plans based on the needs to achieve this important objective within member states.

Some of the areas that would need attention in order to strengthen the country HIS are addressing:
•    the current fragmented HIS sub-systems into an integrated country HIS
•    capacity building of the HIS staff
•    establishment of an integrated national data warehouse for all data sources and paying particular attention to enabling tracking of human resources, equipment, physical status of facilities and expenditure tracking
•    methods and estimation of provincial national health accounts, chronic disease surveillance, cause of death certification and survey methodologies.

The successful implementation of the National Health Insurance (NHI) will need a very strong ICT infrastructure. It is therefore paramount that an Integrated National Health Information System which will cater for all service providers, public and private, is developed as part of an e-Health Strategy.

South Africa has embarked on a process of acquiring an Electronic Health Record (EHR) for South Africa. The State Information Technology Agency (SITA) and the Department of Health will establish the requirements for implementing an Electronic Health Record for South Africa.

Mr Speaker, we have prioritised the improvement of service delivery in our hospitals. The Department of Health launched the Health Facilities Improvement Plan (HFIP) with 27 hospitals throughout the country. The Minister has already directed that each province add at least ten hospitals to this pool. The 27 hospitals were appraised against core standards that were across seven domains namely patient safety, patient clinical care, patient experience of care, patient access to care, management and leadership, infrastructure and environment/facilities management, and public health. Facilities were a mixture of district, regional, and tertiary hospitals across seven provinces. In working with the facilities we moved closer to creating good ownership and team building of all the internal stakeholders of the facilities facilitated over six months.

Our focus on hospital improvement plans will deal with patient experience of care in the health facilities the environment, management of waiting time, attitude of staff and facility management.

In addition we will address the backlog of equipment that needs to be provided for health workers to use. There are standards that are being developed to assist in the procurement and maintenance of these health technologies, so that levels of hospitals and health facilities have the appropriate technology. We are modernising equipment for cancer treatment. Along with this increased attention to technology, there shall be emphasis on the appropriate maintenance training. We shall also focus on equipment that is necessary for strengthening primary health care. We shall collaborate with other role players, including academic, research, donor and non-governmental organisations in this regard.

Emergency Medical Services are at the centre of enabling our people to reach places of care in times of emergencies. With the aim at reaching the targets of the Millennium Development Goals of reducing maternal and child deaths by 75% and 67% respectively, the response of the EMS teams is crucial. To this end we are embarking on the modernisation of emergency services. We will be concentrating on purchasing more response vehicles, building more base stations and strengthening training programmes. The hospitals will also be equipped to deal with the emergencies, particularly maternity emergencies.

Last but not least is the importance of cleanliness of our facilities. The environmental health supervision will be increased, with the engagement of communities and other partners in creating a conducive environment for the patients and the health workers. Hospitals indeed need to be places for healing and rehabilitation.

Mr Speaker, this budget shows that government is committed to health system strengthening.

I urge all members to approve the budget.

Thank you.
Re a leboga.

Issued by: Department of Health
30 June 2009

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