Linking the health of the nation to that of its healthcare sector

The health of a nation – economic and social – is so bound up with the physical health of its citizens that it stands to reason that ensuring an efficient and workable healthcare system should be at the core of its development plans. Given South Africa’s complex problems of growth, inequality, and infrastructure strain, no single group of stakeholders within the healthcare sector can hope to uplift the system on its own; it will require the cooperation of all public and private sector stakeholders to do so.

It was this principle that lay behind the inaugural Healthbeat Conference, hosted by Investec, which brought together speakers from the public and private sectors, as well as key non-government organisations, to engage in a series of talks and lively debates.

In his opening introduction, Investec Executive Director Richard Wainwright outlined Investec’s motivation for hosting the conference.

“Healthcare affects every single South African collectively. We know that we have financial constraints, but yet we know that if we work together, we can succeed,” he said. Furthermore, he argued that the event aligned with two key Investec values: the idea that we all live in society, not off it; and that open and honest debate is healthy. “This means we put things on the table even when we have differences and we allow every person in the room a chance to speak.”

All healthcare is local

The event kicked off with a stirring speech by Dr Aslam Dasoo of the Progressive Health Forum, an organisation founded on the principle of ensuring access to healthcare for all. Channelling geological concepts as well as socioeconomic analysis, Dr Dasoo argued that all healthcare was local: “It all comes down to the patient. It all comes down to the interaction between the health care provider and the health care seeker.” For this to work, however, a new politics was needed, one that allowed individuals and institutions to openly engage with the government on the best way forward.
 

NHI – is it an implementable solution?

Letlotlo Lenake, Equity Research Analyst at Investec, moderated the important topic of National Health Insurance (NHI).

Prof Alex van den Heever, Chair: Social Security Systems Administration and Management Studies at Wits University, argued that due to the poorly drafted regulations, the NHI Bill was unlikely to be implemented any time soon. He did not believe that a consensus was possible because what was proposed couldn't be implemented.

It was too complex for the government as it stands, he argued. “What we're really looking at is eliminating our provincial health system and our medical scheme system and creating a third system.”

He added that a centralised single-payer structure was not necessarily efficient and would be the wrong structure for South Africa.

Mabalane Mfundisi, SANAC-Co-convener of Community Constituency COVID-19, maintained that the NHI Bill should be signed into law right away and that the problems could be sorted out after that.

He said the proposed Bill should be trusted just as the IEC was trusted in 1994. He felt South Africa was one country and that quality healthcare should be open to all.

The CEO of the South African Private Practitioners Forum, Dr Simon Strachan, emphasised that the Forum did not support the funding mechanism proposed in the Bill. He argued that the Bill should not have any grey areas before it is signed into law, and felt that the NHI Bill was not required for any meaningful change in the healthcare sector. The private sector should be allowed to regulate itself.

Dr Khamane Matseke, CEO Clinix Health Group, was not happy with the proposed funding model. He felt that private hospitals should be left alone. Merging public and private hospitals would not help rural patients where there were no private hospitals. Dr Matseke further argued that consistency was required in government policy, and he questioned why the private sector should not be given tax incentives to build hospitals in rural areas.

Defining public goods

Investec’s Obakeng Pitse moderated the discussion on healthcare economics. Discovery Health’s Roseanne Harris unpacked the concept of health as a public good, namely a good that can be consumed by one person without affecting another’s right to consume it. She highlighted that for healthcare to succeed as a public good, it relied on the bedrock of healthcare professionals, including their skills, resources, and ways of delivering to the public.

The speakers also discussed the challenges of ageing populations within medical schemes and the need to bring more younger, typically healthier people into the system, as well as the role of technology and preventative measures in controlling costs.

The second discussion, moderated by Investec’s Reagile Moatshe, looked at the regulatory and legislative landscape.

Neil Kirby of Werksmans Attorneys highlighted the role of health in the economy and the need for laws and regulations to promote investment. “(We need to acknowledge that) health isn’t just a taker, but also a contributor to the economy,” he said.

Dr Mhlengi Ncube, Head of Policy and Research at the SA Medical Association, emphasised that healthcare workers were keen to deliver, but found their way hampered by issues such as limited positions and burnout. “Doctors find that they can’t get employment, even as there’s a shortage of doctors,” he noted.
 

Transformative models and technology

Itumeleng Merafe, Head of Investec Private Bank South Africa, moderated the topic of transformative models of healthcare delivery.

Dr Nthabiseng Legoete, an independent medical practitioner and social entrepreneur, highlighted the need for business, government and civil society to listen to the people who receive care: “If we can get these different entities in the same room, we can improve healthcare in this country.”

Dr Ramesh Bhoola, executive chairman of Joint Medical Holdings, emphasised the need for trust between the different parties. “If we have that attitude, the money will always flow, whether it grows in the private sector or public sector,” he said.

On the future of healthcare delivery, Adam Pyle, CEO of Life Healthcare SA, said: “I think we're going to see far more sophisticated models in terms of delivery, in terms of the reimbursement, in terms of the risk, and so.”

This led to the next topic, which dealt with the potential for technology to positively transform healthcare in South Africa, moderated by Tharina Bennie-van Dyk, Head of Corporate Leverage Finance at Investec.

The panel noted that perhaps the biggest opportunity lay in the field of telehealth, particularly in a country such as South Africa, where there aren’t always the economic, infrastructure and human resources available to deliver health services to all.

Said Jerome Thomas, MD at GE Healthcare: “Telehealth improves access because the medical specialist doesn’t necessarily need to travel to the patient.”

Alan Goldblatt, MD of SSEM Mthembu Medical Supplies said however that telehealth’s potential was perhaps not being taken up to the extent that it could be in rural areas: “It needs gumption – someone needs to spearhead it.”

Wits’ Prof Helen Rees highlighted the advances in artificial intelligence (AI). “It’s new and it’s moving fast. For example, AI is effective in testing the effectiveness of vaccines. It also works well in both low and high resource settings.”

Dr Riaz Motara, CEO of BrandMed added: “AI has been shown in many cases to be more accurate with diagnosis.”

Rees also highlighted the upside to investing in technology in the sector: “The biggest impact you get is in a low resource setting.”
 

In closing, Cumesh Moodliar, Chief Executive of Investec Bank Ltd, made the point that the purpose of the conference was to become a catalyst for discussion.

“Let's step up to the challenge and figure out how we can redefine a purposeful health care system. The mechanism and how we deliver it are absolutely what the debate is about. We [Investec] will continue with the engagement and hope that we can make a difference, make an impact, however small it may be, in a difficult set of circumstances,” he concluded.