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SUB CATEGORIES General  |  HIV |  Medical Schemes | 

An already challenged system

12 September 2022 Myra Knoesen

COVID-19 has brought a lot of trauma to an already challenged healthcare system, particularly in Africa.

“One of the biggest lessons for us was that we must adapt and accelerate efforts to address our healthcare challenges and align across sectors to lead change in promoting access to quality care for the health citizen,” says Dr Katlego Mothudi, Managing Director of the Board of Healthcare Funders (BHF).

The redirection of resources

“The COVID-19 pandemic brought about several disruptions, not so much in terms of innovation, but more from a business unusual perspective. As a result of the newness of COVID-19 and the suddenness of its arrival, the entire healthcare sector was ill-prepared from an epidemic management perspective. Subsequently, this fuelled a lot of unfounded fears. The main concern for medical schemes was from a disease burden point of view, and the resultant claims experience, which was envisaged to be high. The second area of concern was because COVID-19 had additional implications, not just for the healthcare system, but for the economy as a whole. Medical schemes were thus concerned that this would negatively impact membership and scheme finances and eventual erosion of reserves, and potentially affect the ability of medical schemes to pay claims and to sustain the industry,” said Mothudi.

“However, we have since observed that a number of these concerns were not realised. In fact, we saw a significant reduction in the claims experience brought on by the low utilisation of services, as there were fewer visits to healthcare practitioners and even fewer admissions to hospitals, almost throughout the pandemic. Despite the high number of people with COVID-19 who were admitted to hospital in the first waves, the reduction in utilisation of other services counterbalanced those admissions,” he added.

From a healthcare funding perspective, Mothudi said COVID-19 has forced “us to think differently about how we resource and maintain access to much-needed healthcare services; and how we address issues of funding for treatment and prevention. It has forced us to relook healthcare strategies around rationing. With regards to innovation, the pandemic has enabled a shift away from total dependence on traditional brick and mortar facilities and face to face interactions towards increased use of virtual services such as telehealth.”

New and old gaps exposed

“To maintain access to healthcare services, various innovations were required for COVID-19, specifically for remote healthcare monitoring. While some of the technologies deployed were already available, and have been around for a while, the process of adopting them has not been standardised in the funding environment. One of the gaps, we realised, was around health technology assessment. While the industry has implemented health technology assessment to varying degrees, only a few entities have formalised processes for it, because of the gaps in the development of funding policies around new technologies. This meant that during COVID-19, the healthcare industry had to scramble to put together some of these policies in a short space of time, to ensure that access was not compromised,” said Mothudi.

“A second gap and area of concern was around progress made in health care reform. A number of initiatives in the form of bills, policies and recommendations from inquiries/commissions have been on the back burner for a while. There were no pathways that the industry could follow, for the swift reconfiguration of the healthcare system. Uncertainty regarding whether the provisioning of specific services healthcare would be from the public or the private sector; and the tensions between funders versus the supply side of healthcare need to be removed. As a collective, the entire healthcare industry had to identify how best to use the available resources from both the public and private sectors. This process had to be formalised during the pandemic, the state and private sector had to formalise contractual arrangements around admissions and use of private beds and vice-versa; and we had to look at how to commission new facilities at a faster rate, but still make sure that it is all is still done within the prevailing and newly promulgated laws and regulations. We had to learn how to work together,” he said.

Another gap, according to Mothudi, is around the adequacy of the country’s supply chain management. “The procurement of vaccines, PPEs and related material exposed the need for provision or establishment of local production of pharmaceutical items. This translated into the delay in the initiation of the vaccination process, as the country relied heavily on international manufacturers, or even donors, for that process.”

Emerging health risks

In terms of emerging risks, Mothudi said, “Firstly, the state of readiness to handle epidemics or pandemics needs prioritisation. South Africa was deeply exposed in this area and we need to address this. Secondly, we do not have a good focus on health surveillance or the necessary resources or systems to execute the required processes. COVID-19 has been an eye-opener that made us realise that resources that may have been regarded as on the fringe of healthcare provision, like epidemiologists, data scientists, etc, played a central role in the management of this pandemic and are, in fact, essential resources.”

“The third risk is around ensuring that the healthcare industry has adequate financial support for healthcare services to make it easier to support all the interventions necessary to deal with epidemics on this scale, or even greater, from infrastructural requirements to human resources. This also entails the safeguarding of the financial resources through elimination of opportunities for fraud and corruption,” he added.

Strengthening the system

“We need to recognise and utilise the pockets of excellence that already exist. This is not just a South African experience that people have found fault with progress made in science. A case in point in the Covid context is that we were able to develop vaccines at a much faster rate than we would have been able to 10 to 20 years ago, simply because there were already technologies in place, in the testing phase perhaps. This is because there was much more willingness to share data and experiences across countries and continents. There was also more agility in terms of the regulatory space to allow for faster approvals of new medicines,” he emphasised.

“We also have to be more deliberate about the introduction of healthcare technology and recognise its role in increasing access to healthcare. Buy-in of the consumer of healthcare services will be enhanced if individual circumstances are catered for, including costs to the user and availability of supporting infrastructure for these technologies,” continued Mothudi.

The current state of affairs

“We remain deeply concerned about the overall state of health in the region, as we still experience service delivery failures, and the disease burden is extremely high. The impact of reduced access to healthcare services during COVID-19 may expose us to downstream complications and deepen the burden of disease. We are deeply concerned that the healthcare challenges that we had pre-Covid may be worse now, in terms of burden of disease,” he said.

“Provisional data compiled by WHO from 84 countries indicates that an estimated 1.4 million fewer people received care for TB in 2020 than in 2019. WHO estimates that these COVID-19 related disruptions in access to TB care could cause an additional half a million TB deaths. In the first few months of the pandemic, there were reports of people who also stopped taking their HIV medication. We may, in the medium to long-term, begin to see the impact of this, but for now the challenge is that we don’t know how many people will end up with resistance to treatment as a result,” added Mothudi.

“There is also the challenge around human resources and what needs to be done to ensure that we have enough resources to service health needs. Healthcare practitioners who were trained through COVID-19 interventions to ensure the availability of resources will now not be available for ongoing required medical treatment or healthcare,” emphasised Mothudi.

“There are, however, some wins being achieved. We are making headway towards establishing plans to manufacture vaccines for COVID-19 in Africa. On 21 June 2021, President Cyril Ramaphosa announced that a new hub to manufacture vaccinations would be set up in Cape Town, Western Cape. We also have the Aspen Pharmaceuticals plant in Gqeberha, East London that will produce vaccines. A challenge that needs to be addressed going forward, however, is around patent laws, and adopting best practices from countries such as India to ensure that the pharmaceutical industry opens opportunities for more players in this space, particularly for local manufacturers,” he concluded.

Writer’s thoughts
The world needs solutions to address the current challenges worsened by the pandemic. And as mentioned above, we must adapt and accelerate efforts to address our healthcare challenges and align across sectors to lead change in promoting access to quality care for the health citizen. Do you agree? If you have any questions please comment below, interact with us on Twitter at @fanews_online or email me.

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