KPMG Global Healthcare Conference April 2015

Good evening to Dr Mark Britnell, Chairman and Partner, Global Health Practice, KPMG - Dr Anuschka Coovadia, Head of Health for Africa, KPMG Lord Nigel Crisp, Co-Chair of the UK All Party Parliamentary Group on Global Health Sir David Nicholson, former Chief Executive of the UK National Health Service Business Leaders, Regional and International leaders on health,

Ladies and gentlemen, it gives me a great pleasure to address you this evening.

Sometimes the business of running the biggest opposition party in South Africa and a provincial government presents you with all kinds of challenges. Some are urgent while others aren’t but they all require your attention nonetheless. This is why the Premier, Helen Zille, asked me to address you on her behalf this evening due to a last minute engagement.

Welcome to the Western Cape and to Cape Town for those who have travelled far and wide to attend this conference. It is our wish that you may find it incredibly useful and take back with you a wealth of experience that is shared during the conference.

I have noted with great interest that the main sub- themes for this conference are:

• Universal healthcare;
• Low cost innovation, and
• Affordable life sciences.

I believe it would be appropriate for me to briefly paint a local context within the province before I express my thoughts about the relevance of themes you have identified.

In South Africa, the provision of healthcare is often compounded with the complex relationship it has with socio-economic circumstances.

This is why, simply providing a service in South Africa will never be enough. When dealing with any service delivery subject, one needs to consider the context in which many South Africans operate.

One of the biggest challenges with the provision of services in South Africa, is the stark reality of the racially skewed access.

It is no secret that due to our history of Apartheid, the majority of our clients are solely dependent on the public healthcare system because they have no other options.

This means that the provision of health as a service is an emotionally charged one.

It must be understood that challenge is viewed through the prism of an entire group of South Africans- the previously disadvantaged.

As many of you may know, SA is confronted with a quadruple burden of disease: These include:

• Non-communicable diseases including  Mental illness;
• Communicable diseases such as HIV/TB;
• Maternal/child health, and
• Injuries.

HIV/AIDS remains a major challenge though the Western Cape has the lowest incidence and prevalence. 

Infections are prevalent in the age 25-34 age group, more so among young women. We currently have approximately 160 000 Aids patients on ART and we are proud of the MTCT rate being being reduced to less than 2%. We will continue to strive to get this to ZERO%.

The twin epidemic of TB associated with HIV is an escalating challenge. Of particular concern is the increase in drug resistant TB especially multi – and extreme drug resistance. As you know these patients are more complex and expensive to treat, when ill have to be admitted for longer periods and have a poorer prognosis.

We draw some comfort by having the highest smear positve TB cure rates  in the country ( close to 81%) but have a long way to go and much to be done.

The silent and escalating epidemic of Non Communicable diseases (NCDS) including mental illnesses remains a challenging beast for us. Chronic diseases such as cardiovascular diseases, cancers, respiratory, diseases and diabetes account for 58% of deaths in South Africa. Of greater concern is that the risk factors for NCDS are at unacceptable levels and continue to show increasing trends.

In the Western Cape 32.7% women are obese, which is 8% higher than national average. 47% of men and 27% of women smoke which is the highest prevalence in the country.

The high prevalence of these risk factors of obesity and overweight, smoking and substance abuse and physical inactivity even amongst school children is of grave concern and does not bode well for the future trajectory of the NCD epidemic.  Research also shows very high levels of undetected disease, diagnosed patients not on treatment, and those on treatment not well controlled. This poses major challenges for the health service in this province.

Mental disorders are aggravated by the scourge of substance abuse in the province. Our acute health facilities are struggling with the intake of acute psychotic patients.

The Department has had to prioritise the building of infrastructure to accommodate these patients within general hospitals. Research here also shows very high levels of undetected and untreated illness.

The high levels of inter-personal violence and road traffic accidents fuels the injury burden that lands on our doorstep.

This is clearly aggravated by the abuse of alcohol, which has been identified as a game changer by the WCG and the province is busy designing interventions in this regard. 60% of deaths from Road traffic accidents and 50% from interpersonal violence were found to be associated with high levels of alcohol. Instead of channeling our resources and skills towards other matters, we spend close to R17 billion dealing with the effects of alcohol and drugs in communities.

We regretfully find ourselves as one of three fatest nations in the world, amongst the worst binge drinkers in the world, having amongst the worst rates of homicide in the world, nothwithstanding amongst highest burden of HIV and TB. The disease burden is further complicated by the fact that multimorbidity has become the norm. This has raised the complexity and cost of making the diagnosis and providing treatment as well as its consequent implications for more advanced technology and higher levels of skills and competencies.

Juxtaposed alongside the complex burden of disease that I have described, is the slow growth of the SA economy which is about 2% currently and its consequent implications for health funding. The health budget in the province is projected to decrease in real terms over the medium term.

While this tension between escalating burden of disease and limited resources is a global one, given the magnitude, complexity and scale of the challenge in our country and province, it is particulary acute and places an enormous strain on the health services.

The Department has grappled with this challenge and put out its vision and broad strategic thrusts in Healthcare 2030 which was published last year and available on the Departmental website.

The vision narrative includes multiple perspectives of an envisaged service for 2030 including that patients, staff, communities and partners. The patient perspective includes access to a good service in clean facilities, within aceptable waiting times, treated with dignity and respect, listened to by staff, good clinical treatment and receiving their medication.  

Essentially the three core challenges are to increase the wellness of the population, improve the quality of care and improve efficiencies i.e make the health rand go further.

I include within quality universal and equitable access to health care, being more patient - and person – centred and improvement in clinical and population health outcomes.

The only sustainable route to address this challenge of escalting burden of disease and limited resources is to develop a healthier population.

Thus the wellness strategy within Healthcare 2030 and the broader WCG will be driven by the Department in conjunction with our partners that includes, amongst others, other departments, other spheres of government, communties, private sector and HEIs. Some of the exciting proposals in this regard include the WOW programme, the focus on the first 1000 days of life and strategies to address the alcohol and substance abuse. 

We are also pursuing an integrated model of service delivery in the Drakenstein area as a pilot to concentrate our resources in an area to get maximum value and optimal outcomes.

I must commend the colleagues involved who are showing very high levels of energy and enthusiasm. I see the wellness strategy, which is primarily geared towards addressing the upstream risk factors,  when scaled up in the province as the key driver to bend the curve of NCDs. Many of the projects that we do have been funded through the generosity of private companies who have agreed to work with us through the public-private-partnerships and initiatives. This means we are able to deliver more than what the allocated budget will allow us to do. These partnerships have been invaluable. We have managed to:

• Initiate an agreement with Clicks and Dischem across the province to rollout family planning an immunization to clients at a nominal fee. The clients pay an admin fee while we pick up the tab for the medication. This means that we are able to increase our reach rapidly and provide the service to our clients in a convenient way.
• We have managed to enter into agreement with various partners so we may rollout the Wellness Mobiles. The Wellness Mobile are the transversal project of the Department of Education and Health which began to travel across the Western Cape screening Grade R and 1 learners for vision, speech, hearing or skin problems. We currently have five vehicles, however we intend to increase this number so we may reach more children who would otherwise not have this kind of access. So initiatives like the Wellness Mobiles are very close to my heart.It is through these screenings that we are able to assist children at a very young age and potentially prevent crippling illnesses before they flourish. 
•  We have managed to make the paediatric wing of the Victoria Hospital, which will go a long way to assist thousands of children, a reality. This was provided to us by the Ackerman Foundation and Children’s Hospital Trust.
• The upgrades that have been done at the Red Cross Children’s Hospital through the wonderful work of the Children’s Hospital Trust.
•  And the brand new Mossel Bay Clinic which is being built currently will be done through our partnership with Petro SA.

I also intend strengthening the community based healthworker platform as I believe that these workers will play a key role in the wellness strategy.

As I mentioned the WCHG supports the right to universal healthcare. The National Department is still to release its White paper on the NHI which will provide more detail.

The treasury is still to release the detailed costing of the proposals. However, in the short to medium term both the Healthcare 2030 and the NHI Green paper have focussed their attention on strengthening the health system – both the line function service delivery as well as the support services, improving the quality of care, strengthening the District Health Service, improving the information systems etc.

There are NHI pilots in the country, including the Eden district in the Western Cape, where health service improvements are being experimented with to learn lessons that can be rolled.

Finding creative solutions and encouraging innovation within the health service is also an important strategy. We cannot do more of the same and expect different results. Innovation could involve doing basic processes differently to improve efficiencies. In the area of ICT, the mobile technology especially cell phones can enabale the Department to leapfrog some of the challenges that have confronted us.

The regulatory and compliance driven enviornment within government departments stiffles the opportunity to be creative.

While we cannot wish the bureaucracy away, we can certainly encourage and create the space to grow innovation within the Department. The private sector and experiences of other countries can significantly assist in this regard.

Nothwithstanding the advances in technology, health service delivery is a labor intensive industry. The peope factor is central to delievring an optimal service.

We have realised that the vision of Healthcare 2030 to provide “access to person centred, quality care” would simply not be possible if we did not take our staff with us.

They need to be proud of being public servants and standing tall as members of the Western Cape Health Department.

They need to feel engaged, recognised and acknowledged. The staff at the coal face know the problems and know the solutions. We as the leadership and management of the Department need to be visibily supportive, provide the strategic direction and resources within what is available.

The Department has aggressively started to address the health infrastructure over recent years.

This is not only important to improve the patient experience but makes an enormous difference to the working enviornment and morale of staff. The opening of the Khayelithsha and Mitchells Plain Hospitals over the last 3 years, which are state of the art hospitals including green friendly, have changed the landscape of health provision in the metro.

The three rural regional hospitals – George, Worcester, Paarl have also been revitalised. There are many other infrastructure projects including PHC clinics, EMS stations and fOrensic pathology Labs that have been revitalised. 

I feel particularly priveleged to be given this opportunity to lead the best performing health department in the country. We are a large service  - we see approximately 14,7 million PHC patient contacts per year and in addition conduct 4,5 million home visits. In our hospitals we have admitted approximately 500 000 patients annually to acute hospitals and attend to around 1,9 million outpatient visits. We have about 31000 staff.

I pay tribute to the dedicated and committed staff in every corner of the Department that make a difference in the lives of the most disadvantaged and vulnerrable sections of the population that depend on our services 24/7, 365 days a year. Building onto those gains means improving the lives of South Africans, one patient at a time, in every corner of this province. This is the goal that keeps me up at night and motivates me to get up in the morning.

The resilience of this country and its people was once the thing that kept us going through the toughest and darkest times, it will be the thing that keeps us going in the future. South Africa is without a doubt a better place today than it was before 1994.

My aim is to build on those gains and taking the health department, the health service and system to a new high.

I can only do this in partnership with communities, NPOs, HEIs, organised labor and of course yourselves in the private sector.

I wish you a very engaging deliberation during this conference and I look forward to the outcome.

Thank you

Media Enquiries:  Colleen Smart Media Liaison Officer Western Cape Ministry of Health Tel: 021 483 5862 Email: Colleen.Smart@westerncape.gov.za