Opinion, South Africa

Melanie Da Costa: On Integrating South African Healthcare

Melanie Da Costa talks about creating greater engagement between the private and public sectors to improve healthcare delivery.

Melanie Da Costa - EHN

In the lead up to the Hospital Association South Africa (HASA) 2017 Conference taking place in Cape Town from the 25-27 September, Director of Strategy and Health Policy at Netcare and Chairperson of HASA, Melanie Da Costa, talks about creating greater engagement between the private and public sectors to improve healthcare delivery.

Tell us about your background in healthcare.

I started my career as a healthcare analyst for a stockbroking firm over 20 years ago. I then progressed to running global funds where I invested specifically in healthcare across different countries. I’ve been with Netcare for about 11 years as the Director of Strategy and Health Policy and I sit on the Board of BMI Healthcare, the largest private hospital group in the UK. I’ve also chaired HASA for several years now, and this has all culminated to give me a good understanding of South Africa’s healthcare system.

Tell us about this year’s conference theme: ‘The Healthcare Puzzle – integrating healthcare’?

A few years ago we set out to create more impactful engagement with stakeholders, and as a result we introduced a macro theme of how to advance healthcare. Each year we try to innovate around that and generate deeper discussions around the subject of advancing healthcare.

HASA supports very open debate, and we are very comfortable engaging on contentious topics and having speakers representing different stakeholders with divergent perspectives. This year’s theme about integrating healthcare is an evolution on the broader framework of advancing healthcare and improving access to care in South Africa.

How do you define integration in healthcare?

That’s an important question because integration means different things in different settings. In a very developed market it might mean eliminating fragmentation of care with multidisciplinary healthcare teams etc. In South Africa, integration of care is about how we use our national health resources to better serve our broader population. And what this means is: how public and private sectors speak to each other; how government contracts private providers; and how they use private medical schemes as a cornerstone of National Health Insurance (NHI). So integration of care in the context of the HASA Conference is essentially about how we bring private and public healthcare together.

The growing prevalence of chronic diseases is placing a heavy burden on our health system, which is worsened by the inequalities between the private and public sector. How can integrated care improve this situation?

The growing prevalence of chronic diseases is the single biggest driver of healthcare spend globally, including South Africa. As a result the chronic disease burden is putting added pressure on our already strained public health system. A large percentage of the South African population have issues gaining access to the health system because of some very basic, structural weaknesses that we still need to address. We have a shortage of access points and human resources, and we also often have shortages of medicines, not to mention extreme rationing of life-saving treatments like dialysis or radiation therapy. An example of which is the oncology crisis in KZN province currently public sector patients don’t have access to radiation treatment.

On the other end of the equation, the private sector is ready and willing to help, and can be contracted by the public sector to deliver that much needed cancer therapy. So instead of waiting for an NHI, why not start contracting with immediate effect? We know that the private sector has a great number of resources, especially in specialised areas, so there’s absolutely nothing to prevent a contracting agreement being put in place to ensure optimal patient care across public and private facilities.

What’s your opinion on the move to a digital healthcare system, particularly electronic patient management systems to, for example, coordinate care? 

There are various elements to the digitisation of care, and in South Africa I think that we are in grave need of some very basic electronic tools to give us a greater sense of the population’s needs. But it becomes even more granular than that; at a public hospital how does the hospital manager know that a nurse has arrived for work? Do they have clock-in and clock-out systems? How do they know the availability of beds in ICU vs. the general ward? How do they know the availability of stock? Do they have all of these systems? These systems are lacking and the digitisation of these systems would improve efficiencies in the health system, both private and public. An electronic health record (EHR) system is a beautiful solution and of course it would be fantastic to have, but as a country we first need to address some more of our basic needs.

Are South African doctors, particularly in the private sector, open to an integrated healthcare system or is there some resistance?

It’s quite hard to get a sense of what doctors are feeling for one reason: doctors are so busy. Because there’s such a shortage of doctors in this country we’ve got huge waiting lists, so they don’t have time to take part in political discussions. The sense that I have is that doctors’ first priority is getting the opportunity to see their patients. They are less concerned about who is reimbursing them, whether it is a medical scheme, an NGO, government or NHI, just as long as it’s a fair reimbursement and they are able to get their work done.

So I would say that doctors are completely open to an integration of private and public healthcare. It is however fair to say that doctors needs the appropriate tools (medical equipment and medicine etc.) to treat patients as they deem fit and they need to be adequately remunerated.

This year HASA has invited a number of respected international speakers, what value will they bring to the conference?

The issues that we face in South Africa are no different than the issues being faced in other parts of the world when it comes to healthcare. So instead of reinventing the wheel we can raise the debate in South African and learn from other international experiences.

During the HASA 2017 Conference the CEO of Hospital Beneficencia de São Paulo, Denise Soares dos Santos, and the CEO of the Instituto de Estudos de Saúde Suplementar (IESS), Luiz Augusto Carneiro, from Brazil will be talking about how their public system contracts private providers within the universal healthcare system. And the Senior Director at FTI Consulting, Victoria Barr, will be discussing how public systems can go about setting prices for public patients, be they delivered by private or public providers, based on her experience in the UK pricing system.

Another important subject is private medical education. Private medical education is not allowed in South Africa but it’s the cornerstone of healthcare in India, Brazil and the US. Harvard and Yale are private institutions that produce the highest calibre of professionals but we aren’t yet able to leverage the opportunity that private medical education has to offer. We’ve invited the Vice Chancellor of Manipal University, Dr Vinod Bhat, from India to present on this topic based on his significant experience in training doctors in the region. We’ve also invited the Chair of the Private Healthcare Information Network (PHIN), Andrew Vallance-Owen, to talk to us about how to benchmark quality based on his experience of overseeing quality initiatives in the UK.

What is your overriding message for the conference?

My key message around this conference is that I really believe there’s significant possibility of greater engagement between the private and public health systems. We don’t have to wait for NHI because there’s a great desire from private providers to see an improvement in access to care in South Africa. We are in desperate need of it and so we should start engaging with immediate effect.

The HASA 2017 Conference will feature a number of international and local speakers who will together explore how to respond to the global healthcare puzzle through integrating healthcare. The world-class conference and exhibition will take place from Monday, 25 September to Wednesday, 27 September 2017 at the Cape Town International Convention Centre (CTICC). More information about the event can be found here.

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