Since the subject of NHI was first broached, the minister of health, Aaron Motsoaledi has emphasised the need to create a strong primary healthcare infrastructure to support the final product.
He highlighted some of the success stories and future plans in his budget speech before parliament yesterday.
Operation Phakisa culminated in a detailed plan for turning all clinics and community health centres into facilities that will not only provide good clinical care but will improve the experience of patients who visit the facilities. Teams, dedicated to ensuring that all elements required for fully functional clinics are being established especially in the NHI pilot districts. Similar teams will be established in the rest of the 52 districts in the country.
During the pilot project, the teams were divided into eight streams:
“While this model is aimed at strengthening healthcare systems at our primary health facilities, this similar approach will eventually also be extending to our hospitals in the near future.”
“But I wish to reiterate that we are not labouring under any illusion that this is going to be a short and smooth road,” he said.
Because of the huge volumes of patients which South Africa is experiencing, one of the solutions will be to make sure that as many patients as possible do not have to visit health facilities.
“We are doing it by asking those patients who are stable, who do not really have to see a doctor or a nurse but who have to visit a health facility for their monthly supply, to register a collection point where they may collect their medicines, without having to queue or wait,” he explained.
Collection points may be a clinic or hospital dispensary, private GP, private pharmacy or even treatment adherence clubs.
“Such patients do not even have to queue for a file – they just march straight to the collection point and produce a card which they would have found in the pack they collected in the previous visit, or they produce an SMS which would have been sent to them by us. Presently we have 383 989 patients on this system and we are targeting 0,5m people,” Motsoaledi said.
Having 3m people just collecting ARVs, the logistics of supplying drugs have become problematic. Demands may always exceed supply, not because of shortage in one country but due to logistical problems.
“We have instituted a cellphone-based technology to deal with this. Presently this project is being conducted in 1,160 health facilities in the country,” he said.
“A nurse has to read a barcode on every package of medicines every week, using the cellphone that we would have supplied. She or he would then send this information to a central database where it is fed into a geomap.”
“The facility that has a stock-out will blink a red light in the geomap and we will phone the district pharmacist to warn them,” he said.
The department has identified areas of the population which are very vulnerable to tuberculosis (TB), namely correctional service facilities, mines and surrounding communities.
We also used this concept of vulnerable communities to determine which districts are more affected:
On World TB Day, March 24, deputy president, Cyril Ramaphosa, launched the most ambitious screening to date.
The screening is going on in the six districts in correctional service facilities, mines, schools, crèches and patients visiting local clients will be asked to undergo TB screening.
From the six districts, the programme will move to the big metros, especially the Ethekwini Metro and the Cape Metro which are the most affected in terms of TB caseloads. Then the worst affected provinces of the Eastern Cape, Gauteng, KwaZulu-Natal and the Western Cape will be targeted.
In conclusion, the minister proposed a budget of R36,46bn, which represents a 7,4% increase compared to the 2014/15 budget.
This is broken down into four components:
