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Lessons learnt from the COVID-19 pandemic towards universal healthcare in South Africa

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Healthcare systems need to change in the wake of the pandemic, according to Africa Health 2021 speakers.

COVID-19 a human crisis highlighting need for greater investment

With COVID-19, we are experiencing a global crisis that is simultaneously paving way for change, according to Professor Morgan Chetty, Chief Executive Officer of KwaZulu Natal Managed Care Coalition, commenting on the need for universal healthcare and health security during Africa Health 2021:

"COVID-19 exposed the fragile health systems in both high- and low-income countries. There is a need for health systems to not only strengthen the system but also embrace the notion of resilience.

Prior to the pandemic, we have witnessed health systems overstretched to adapt, casting a shadow on the ability to transform. COVID-19 is more than a health crisis, it is a human crisis with social, economic, and moral catastrophes.

It highlights the need for more investment in healthcare and the need for us to recognise that this is a global crisis. Nationalist policies in individual countries, especially superpowers are harmful in overcoming the pandemic. How can we have successful universal healthcare?"

Behavioural and lifestyle factors drive mortality

According to Dr. Maurice Goodman, Chief Medical Officer Discovery Limited in South Africa, healthcare should be delivered through multidisciplinary teams, with a variety of players at a variety of levels of expertise, working together in teams:

"We have globally witnessed, and Africa is included in that, notwithstanding the infectious disease burdens, that we carry that the greatest disease burden globally now with non-communicable diseases.

Behavioral and lifestyle modification wellness efforts, in preventing and treating the non-communicable disease burden is crucial. However, very interestingly, we discovered that even during the pandemic, after age, the second biggest driver of morbidity and mortality was behavioral and lifestyle factors.

Enablers who will empower us as a national and a global community to move forward is a very important component of public-private collaboration in South Africa.

It is known, we have parallel private and public healthcare systems and there have been some excellent examples in terms of our Electronic Vaccination Data System (EVDS), which was a system for delivering vaccinations nationally to both the privately insured and the noninsured population.

The departure from the archaic fee-for-service systems into more value-based healthcare delivery and funding systems and various regulatory changes will be required to empower these exciting new developments and systems.

We have two types of parallel healthcare systems in this country, and neither of them is perfect. Both have individual strengths, at the highest level, the way forward is to obtain the best of breed and merge the two healthcare systems.

Some examples of successes have been the national EVDS system which was implemented to manage the vaccination rollout nationally. There were growing pains, but overall, it worked and continues to work very well.

There were very close collaborations at a senior and ministerial level, alongside captains of industry. Healthcare is a broader economic sport, is not limited only to healthcare organisations, and witnessed senior government officials and the private sector coming together to address the various issues escalated by COVID.

It begins with a collaborative environment, driven from the most senior levels.

To bring out the best in both our healthcare systems, there is a world of detail underneath that, and we can burrow into any of it to move forward and improve. That is a starting point."

Universal healthcare as an interative process

The population of the world, and South Africa specifically, has laboured under a COVID lockdown for nearly two years, commented Dr. Tony Behrman, CEO, Medical Protection Society in South Africa:

"We have all changed, we rarely go out and when we do, we are frightened of people getting too close to us.

Some younger generations are not as heedful, and think they are immune; however, we know they are not. We need to look at the mental health pandemic which is dawning upon us and the non-communicable diseases pandemic.

Telehealth gives us the advantage of performing real-time consultations for patients. Nevertheless, this has a very marked disadvantage as well.

It is challenging to trace and monitor non-communicable diseases such as cancer, hypertension, diabetes, peripheral vascular disease, asthma, chronic obstructive airways disease hyperlipidemia. It is especially very difficult to make that diagnosis on a telehealth platform.

Additionally, there is a pandemic of deep-rooted depression in children.

Universal healthcare will start as an iterative process, and one of the problems we have recognised in these attempts so far is legislation, which is perceived as a ‘big bang’ theory. Thought process more than an iterative process, and predominantly starting at a low level, would be ideal.

We need to dispel the urban myths and the incorrect statements which have been made, such as if you entrepreneur medical aid, the rest of the country has no access to healthcare. This is an urban legend and a political statement, which has, unfortunately, been over-emphasised.

There is a vibrant state sector, which over the last three or four years has seriously pulled up its socks, as far as the number of individuals that it employs, both specialists, nursing staff, and general practitioners. Therefore, universal healthcare does not take place due to certain people being on medical aid, while others have nothing.

The health of the country is the responsibility of the government of the country, and the government has inherited a system that was tilted towards excellence for one sector of the population. The infrastructure in place could have been tweaked, and rebuilt over the last 27 years, to improve the position we currently find ourselves in.

We are now looking at a complete change in bringing in national health insurance, which brings in a potential of enormous costs, and unilateral control over funds. However, we have a thriving vibrant medical aid sector and a relatively well run but poor outcome, state sector.

The key is to merge those two as combined centers of excellence but to learn one from the other. Therefore, you must start with total and utter transparency and humbleness. It cannot be a political decision, which is ladled in our soil."

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