Days after the Council for Medical Schemes in South Africa announced it had ordered a forensic investigation into its registrar, Monwabisi Gantsho, for allegedly soliciting a R3m kickback, an earlier report has come to light raising further questions about his conduct.Dr Gantso heads the agency charged with overseeing the R110bn medical schemes industry. In November 2012, the council’s acting chairman Trevor Bailey instructed law firm Bell Dewar to investigate a series of allegations made by senior staff against the registrar. The law firm’s report, according to Business Day, concluded that the registrar:
• Ignored recommendations made by a council task team for the appointment of independent curators to three different medical schemes — Bonitas, Sizwe and Medshield — and had instead appointed curators "with whom he appear(ed) to have a relationship";
• Delayed an investigation into troubled medical scheme Medshield "without justification";
• Refused to approve the merger of Nampak Medical Scheme and Discovery Health Medical Scheme for "no justifiable reason";
• Appointed staff without following due process; and
• Put pressure on a junior staff member to reveal confidential minutes of meetings of the medicine pricing committee.
The article provides further report on the follow up actions according to Business Day.
Public-Private Mix
On 6 January 2014, South Africa’s Competition Commission began a market inquiry (an investigation)into the private health sector. The Commission was concerned about high prices in private health care and will use its wide powers to investigate the general state of competition in this sector to determine what can be done to achieve accessible, affordable, high quality and advanced private health care in South Africa. According to the Commission, there are indications that the private health care market is not working well for consumers. The market inquiry will examine the causes of why the market may not be working effectively, and will make recommendations as to how they might be made to work better in order to promote and protect consumer interests, while ensuring that markets
are fair and competitive. As such the Commission will specifically look into the increases in prices in private health care and determine the factors that are driving prices. This fact sheet outlines the terms of the Commission inquiry. It points to the opportunity to address inequality in the health system in South Africa. SECTION27, together with its partners, report that they will closely monitor the inquiry and ensure that the voice of ordinary users of private health services.
This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities. Data presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated. The findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages. Accrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program.
This paper seeks to determine how the corporate responsibilities of pharmaceutical companies in relation to access to medicines can be clarified and enforced. Two cases, one each from India and South Africa, are examined to determine how the domestic courts in both countries indirectly utilized the right to health to ensure that pharmaceutical companies did not impede access to affordable medicines through exercising their patent rights. There is a need to clarify and enforce the responsibilities pharmaceutical companies have to promote the right to health. The two cases from India and South Africa demonstrate the potentials of domestic courts as forums where these responsibilities can be effectively enforced. In the absence of a global enforcement mechanism for enforcing the right-to-health responsibilities of pharmaceutical companies, domestic courts can effectively fill this gap. In addition, this paper demonstrates that domestic courts can equally serve as forums for health diplomacy.
On the eve of the landmark inquiry into the private healthcare industry in South Africa, the Netcare group is challenging the Competition Commission's use of professional services firm KPMG as its technical service provider for the investigation. The commission originally suggested the market inquiry into the private healthcare industry after concerns were expressed that certain factors in the sector prevent, distort or restrict competition. Health Minister Aaron Motsoaledi has been particularly vocal in expressing his disquiet about the matter. The market inquiry provision in the Competition Act became effective last year and paved the way for the introduction of an inquiry into private healthcare. The provision will allow the commission to initiate an inquiry if it has reason to believe that any feature of a market distorts or restricts competition. Unlike the 2006 inquiry into banking costs, which required the banks’ voluntary co-operation, the commission now has wide-ranging powers to summon people to testify or to provide documents. It will be able to call for any information it may deem relevant and may initiate a complaint against a firm based on what it gathers during the inquiry. The final terms of reference for the competition authorities’ private healthcare inquiry were published at the end of last year. They included looking at possible cost drivers such as pharmaceutical manufacturers, medical equipment and the inter-relationship between the public and private healthcare systems.
The focus in Tanzania has mainly been on communicable diseases, in particular HIV/AIDS, TB and Malaria. Childhood illnesses, including diarrhoea and upper respiratory tract infections, have also received a great deal of attention. More recently, efforts have been directed towards neglected tropical diseases. However, the burden of communicable diseases is still high, so the increase in non-communicable diseases (NCD) creates a double burden to both individuals and the health system in general.The prevention of NCDs at the workplace is argued by the authors to require a multisectoral approach. The occupational health law (Occupational Health and Safety Act of 2003) in Tanzania stipulates that each employee undergo
a medical examination at enrolment. This could be expanded to include periodic examinations. Employers should push insurance companies to cover such examinations. Other options that could be useful are noted as the HIV committees already in place at workplaces. These structures could be used to also co-ordinate NCD prevention activities at workplaces.Another option could be to promote physical activity at the workplace through sports competitions, designated sports days or sports bonanzas. More advocacy is needed to raise the profile of the burden of NCDs and to bring them to the attention of policy-makers.
The United States Agency for International Development (USAID)/Tanzania
commissioned the SHOPS project and the IFC-World Bank Health in Africa
Initiative to conduct a private sector assessment of mainland Tanzania,
in response to a request from the Public-Private Partnership Technical
Working Group (PPP-TWG) in Tanzania. The assessment is intended
to assist the Ministry of Health and Social Welfare to develop a
prioritized agenda for more effectively engaging the private health sector
and building public-private partnerships focused on the country’s
key health challenges: HIV/AIDS, reproductive and child health, malaria,
and tuberculosis. It notes that although the private health sector in Tanzania is smaller than in some east African countries, it is sizable, diverse, and actively engaged throughout the health system
This report reviews the progress made in the health sector in Africa over the last 50 years, in terms of health outcomes, and particularly in the
utilization of, and access to, healthcare services. The current challenges faced by the health sector are assessed, and the discussion lays the groundwork for projections regarding the future of healthcare in Africa over the next 50 years. The authors outline that the private sector has been playing an increasingly important role in health financing in Africa, and that in some countries, such as Angola and Mali, all private expenditure is direct payments from households. Lack of continuity in policy, lack of resources, poor management of available resources, and poor policy implementation are identified as major impediments to improving the health systems. The private sector is playing a major role in the delivery of health services to citizens, yet dialogue and the sharing of information between the private and public sector is rare. They indicate that in addition to scaling up public spending, there needs to be a drive to ensure better value for money throughout the health system. They also suggest that The health sector will become a labor-intensive industry that can provide an estimated 2–3 million skilled jobs for young Africans and contribute to economic growth on the continent. As the pharmaceutical, medical technologies, and ICT segments develop, there will be more opportunities in research and development, manufacturing, sales and distribution. Within this industry, other opportunities will be driven by the hospital, health insurance, and medical education segments.
Occupational diseases are posing an ever increasing challenge to workers’ compensation systems. Out of the 2.34 million annual work-related deaths reported by the International Labour Organization (ILO) , the vast majority – approximately 2.02 million – are due to work-related diseases. As a consequence, occupational safety and health policy is shifting from an injury and accident centered approach to one that increasingly is occupational disease focused. To effectively address occupational diseases (ODs), many social security organizations responsible for insuring and compensating these risks are adopting a more proactive and preventive approach. Their leitmotif can best be described as ‘prevention is better than compensation’. Adopting such an approach also forms part of a broader understanding of the role that social security can play in promoting and shaping a national prevention culture.
This paper describes a reproductive health voucher programme that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the programme to include public sector facilities. Researchers conducted interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher programme in south-western Uganda. Barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the programme by involving public sector facilities were investigated. The findings show that access to sexual and reproductive health services in south-western Uganda is constrained by both facility and individual level factors that can be addressed by inclusion of the public facilities in the programme. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher programme with other services is likely to address some of the barriers. Accrediting public facilities has the potential to increase voucher programme coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening links between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilisation of resources to support the sustainability of the programmes. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher programme.