By 2030, South Africa’s health system should provide quality care to all, free at the point of service, or paid for by insurance, whether that is public or private, the introduction of the Presidential Health Summit report says.
The summit was held in October 2018 to find solutions to the country’s health system "crisis".
The report on that meeting, released by health minister Aaron Motsoaledi on Tuesday, said there was unanimous support for the principles of National Health Insurance (NHI) from every sector.
The report noted that the current health-care challenges in South Africa include negative staff attitudes, long waiting times, facilities that are not clean, drug stock-outs, poor infection control, and inadequate safety and security of patients and staff.
Here are the 11 key proposals from summit, as now captured in the report.
It is imperative that the moratorium in human resources be lifted to address the current 37,000 vacancies in the health sector, the report noted.
The summit also recommended that a HR roadmap be set up which would allow the system to attract and incentivise new staff – and retain current staff.
Corruption and abuse of HR systems should also be addressed immediately.
The report noted that the implementation of a policy on foreign-trained medical practitioners is imperative to allow them to be employed as health professionals.
To avoid drug shortages, the summit recommended that pharmaceutical budgets be ring-fenced to avoid money being redirected to non-medical expenditure.
In line with the ANC’s 2019 election manifesto, the summit recommended that a competitive state pharmaceutical company be established, drawing on best international practices.
The state should further invest in research and development to ensure that the company is innovative, competitive and highly skilled, the report said.
A database for all state-owned medical equipment and medical consumables should be set up with, the summit said.
It stressed that the database should not what equipment is working, and what is not.
To address corruption and economies of scale, the state should set up a centralised procurement system with standardised procurement systems and processes at a national and provincial level.
The summit recommended that provincial health budgets be increased from the current 27% of the total to 38% of all spending. And provinces on borders should get more money, it said, to make provision for the cross-border flow of people.
The summit proposed a coherent and aligned network of "structures" across the health system to spread responsibility downwards and so improve accountability. This must include a legislative framework that underpins these structures and their authority to act and hold everyone accountable, it said.
The report said South Africa currently operates with top-heavy management of health.
One change it recommends is formalising the roles of community health workers.
The success of a quality health system rests on information systems that can generate valid information at the right time, the summit said. So the state should establish a centralised database which takes into account the need for patient confidentiality.
South Africa’s health data is currently fragmented into 42 systems with no unified electronic health record. The report noted that current budget allocation is insufficient for the prioritisation of eHealth and health information systems.
The summit recommended that medical schemes tax rebates, which all private medical scheme members receive, be abolished, and that those funds be redirected to the NHI Fund.
Guidelines for internships in the public sector should be established and the working hours of all health-care professionals should be reviewed to ensure that workers are working according to the health care needs of the community – and within the reasonable capacity of the available staff.
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