NATIONAL ASSEMBLY: 28th January 2009

Around the globe, health care has similar challenges, and whether it is Democrats under Obama or Socialists under Motlanthe, governments must opt for solutions that work. Essentially challenges relate to reducing health costs and corruption and increasing access and quality of care.

More specific issues of AIDS, TB, malaria and cholera must be addressed here, where our public sector is under pressure of collapse and in the private sector people are paying more often for less.

How to respond?

A healthy lifestyle is the cornerstone of preventive primary health care. As in the East lets organise daily workouts in pubic spaces; switch off TV and mobile phones and switch on sports, music, and art in schools and in our homes.
 

Immediately ban Transfats as proposed in my Bill and agreed to by the department and the private members legislative committee. They are artificially produced for commercial gain and contribute to heart disease, diabetes weight gain and cancer.

To ensure quality treatment, register conventional doctors, homeopaths, acupuncturists, chiropractors, naturopaths, ayurvedic and Chinese doctors through a single independent democratically elected Medical Council.
 

A Traditional Healer's Council should deal only with herbalists, surgeons and birth attendants, not 'aboprophete' and sangomas who work on a metaphysical dimension and cannot be monitored or controlled.

Ensure that at national and regional level, formal structures exist to provide for co operation and collaboration between all these health professionals. This should follow through into working groups and research teams that tackle issues like AIDS, TB, malaria and cholera regionally and locally.

Let us scrap the most damaging of our failed policies; the centralized model with unfunded mandates, bureaucratic conditional grants and the idea that one size fits all. It is confusing and lacks accountability and should be simplified and decentralized.

•     Let provincial and local governments control funds and choose priorities

•     Let discipline be meted out close to where doctors and nurses work

•     Build stronger health districts and improve co ordination between hospitals, clinics, mobiles in rural area and between these, schools and local police

•     Install integrated information systems for  tracking numbers of vulnerable children, people tested, diagnosed, on treatment, or applying for grants

•     Remove constraints that prevent districts and hospitals from negotiating partnerships with the private sector or working with NGOs and international donors. Currently most NGO funding is politically motivated, weakening the impact it has on major epidemics in South Africa.

To improve access and quality embrace Public Private Partnerships ((PPPs).
 

Contract the private sector to run mobile services in rural areas and to manage clinics or hospital wards.

Do away with licensing according to NEED. It is subjective and open to patronage and corruption. Rather draw health workers to underserved areas through incentives which achieve more than coercion.

Appoint independent health ombudsmen or standard compliance bodies that ensure minimum standards everywhere. Charters are no substitute for accountability.

HIV TB

The greatest burden on public hospitals is HIV and TB. Here the IFP suggests major changes.

Let us treat HIV like an ordinary disease without special secrecy provisions.  Testing should be the norm with an opt out provision for those who refuse it.

Change the focus of rights from privacy to non-discrimination. No persons should lose their jobs because they have HIV or receive a lesser chronic medical benefit. If they die of HIV they must receive full death benefit and full life payout.

The excessive focus on privacy adds to the culture of denial and gives people the sense that HIV is something to be ashamed of.

How do we reduce medical costs?

Free choice that engenders competition, minimum controls that ensure fairness and vigorous policing are the keys to effective ethical health funding at the lowest possible cost.

Require all who work to pay a percentage towards a medical scheme of their choice, with a low cost option offered by government. Enforce caps on medical scheme administration fees, which enable schemes to hide huge profits.

In hospitals, let government hospitals establish private wards and retain profits. Let government reduce costs by bulk buying of private services for registered patients, paid for per day or per capita or per procedure.

Where medicines are concerned, enforce transparency along the entire chain of medicine supplies so that similar discounts are offered for bulk purchases without prejudice or favour, but encourage discounting and competition.

Let any store sell medicines through a pharmacist and contract pharmacies to provide chronic medication to registered patients.

This framework would remove perverse incentives and contradictory regulations.  It would prevent the private sector misleading the public through marketing and the public sector doing so through populism. It would provide a far stronger health system to cope with HIV/AIDS, TB, STD's, cholera, vulnerable children and our mushrooming population of mentally disturbed persons. It would help us face current challenges.
 

Contact: Dr. R. Rabinowitz MP 

IFP Spokesperson on Health
082 579 3698