PRESENTATION TO THE SOUTH AFRICAN MEDICAL DEVICE … · AFRICAN MEDICAL DEVICE INDUSTRY ASSOCIATION...

Universal Health Coverage

The Third Transition of Health 26 February 2016

PRESENTATION TO THE SOUTH AFRICAN MEDICAL DEVICE

INDUSTRY ASSOCIATION (SAMED)

National Health Insurance (NHI)

WHAT IS NHI?

• NHI is a health financing system that pools funds to provide access to quality health services for all South Africans based on their health needs and irrespective of their socio-economic status

• This is the only way to guarantee Universal Health Coverage (UHC) as adopted in September 2015 as one of the United Nations Sustainable Development Goals, NDP, African Claims (1943), Gluckman Commission (1944), Freedom Charter (1955)

2

Historical Context of Health Care Financing Reforms

South Africa has a rich history of several proposals and attempts to implement health financing reforms namely: • the 1928 Commission of Old Age Pension and NHI; • 1941 Collie’s Committee of Inquiry into NHI; • the 1943 African Claims that proposed equal treatment in the scheme of Social

Security; • the Gluckman’s National Health Services Commission of 1943 to 1944 that

proposed NHI (Dr Henry Gluckman); • The Freedom Charter as adopted by the Congress of the People, 1955; • Ministerial Committee on Health Care Financing, 1994; • the Ministerial Committee of Inquiry into NHI,1995 (Broomberg and Shisana

Report); • Social Health Insurance Working Group 1997; • Taylor’s 2002, Committee of Inquiry into a Comprehensive Social Security

System; • Ministerial Task Team on Social Health Insurance and now the current Ministerial

Advisory Committee on NHI, 2009.

3

African Claims Under The African Claims in South Africa the Charter on Health states :- “a drastic overhauling and re-organisation of the health

services of the country with due emphasis on preventive medicine with all that implies in modern public health sense.., strongly urged the establishment of free medical and health services for all sections of the population; …the establishment of a system of School Medical Service with full staff of medical practitioners, nurses and other health visitors… increased hospitals and clinic facilities both in the rural and in urban areas; Increased facilities for the training of African doctors, dentists, nurses, sanitary inspectors, health visitors (and) a coordinated control finance of health services for the whole Union.”(14 December, 1943).

4

Freedom Charter

There shall be Housing, Security and Comfort for

All:

“A preventative health scheme shall be run by the state;

Free medical care and hospitalisation shall be provided for All with special care for mothers and young children”

5

Declaration of Alma-Ata

International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978

Declaration: I The Conference strongly reaffirms that health, which is a state of

complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

II The existing gross inequality in the health status of the people

particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.

HEALTH FOR ALL BY THE YEAR 2000

6

National Development Plan

7

UN Sustainable Development Goals (SDGs)

• Declaration:

“On behalf of the People we serve, we have adopted a historic decision on a comprehensive, far-reaching and people-centred set of Universal and transformative goals and target. We commit ourselves to working tirelessly for full implementation of this agenda by 2030

• As we embark on this great collective journey, we pledge that no one will be left behind. Recognising that dignity of the human person is fundamental, we used to see the goals and targets met for all nations and people, and for all segments of society. And we will endeavour to reach the furthest behind first”.

8

UN Sustainable Development Goals (SDGs) contd.

• “This is an agenda of unprecedented scope and significance. It is accepted by all countries and is applicable to all, taking into account different national realities, capacities and levels of development and respecting national policies and priorities. These are Universal goals and targets which involve the entire world, developed and developing countries alike”

9

UN Sustainable Development Goals (SDGs) contd.

• Goal 3.8

“Achieve Universal Health Coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines, and vaccines for all”.

10

WHY UHC? But what is UHC?

THE PURPOSES OF UNIVERSAL HEALTH CARE COVERAGE ARE:

• to meet population health needs;

• to remove financial barriers to health care;

• to reduce incidence of catastrophic health expenditure

• this should facilitate the attainment of national and internationally agreed health goals; and

• ultimately contribute to better quality of life, poverty alleviation and human development

11

Global Structural Problems of Health

Care Systems

Dr Margaret Chan Director-General (WHO) • That is – (i) rising health care costs yet poor access to essential

medicines, especially affordable generic products; (ii) an emphasis on cure that leaves prevention by the

wayside; (iii) costly private care for the privileged few, but second-

rate care for everybody else; (iv) grossly inadequate numbers of staff, or the wrong mix

of staff; (v) weak or inappropriate information systems; (vi) weak regulatory control; and (vii) schemes for financing care that punish the poor.

12

WHAT IS WRONG WITH THE PRESENT SYSTEM?

13

WHAT IS WRONG WITH THE PRESENT SYSTEM?-WHOLE SYSTEM

14

0%

20%

40%

60%

80%

100%

% share of benefit % share of need

Poorest 20% of population Second poorest 20% Middle 20% Second richest 20% Richest 20%

WHAT IS WRONG WITH THE

PRESENT SYSTEM? (Private Sector)

15

16

17

18

19

20

21

22

23

24

25

26

27

Cost per hospital day as a ratio of GHI (2012)

28

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

Cost of MRI Scan as a ratio of GHI (2012)

29

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Cost of Hip Replacement as a ratio of GHI (2012)

30

0%

10%

20%

30%

40%

50%

60%

70%

80%

Cost of Angiogram as a ratio of GHI (2012)

31

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

Canada Switzerland Spain France SouthAfrica_Adj

Chile SouthAfrica

U.S.A.

Cost of Bypass surgery as a ratio of GHI (2012)

32

Cost of Normal Vaginal Delivery as a ratio of GHI (2012)

33

Cost of Caesarean Section as a ratio of GHI (2012)

34

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

35

Charges (Complaints laid with the Minister)

• R18,000 for D&C

• R30,000 for peri-anal abscess

• R67,000 for evaluation after a car accident (patient came into hospital walking)

• R500,000 for a laparatomy for peritoneal abscess (in addition separate surgeon’s fee of R23,000; separate anesthetists fee of R3,000)

Another R700,000 for repeat laparatomy (but patient died before that)

38

Some Practices Bordering on Criminality

• For instance

–Root canal treatment in a 10 year old child

–Motive?

–R20,000 procedure instead of R200

39

WHAT IS WRONG WITH THE

PRESENT SYSTEM? (Public Sector)

40

What is wrong in the Public Sector 1. Human Resources:

– Wrong people appointed in wrong places – Patronage and cronyism – Poor planning , development and management of HR

2. Financial Management - Unfavourable Audit outcomes except at National and 3 Provinces 3. Procurement / Supply Chain

– Simplest of equipment and devices unavailable or out of order for long periods of time

– Absence of most essential medicines and drugs due to corruption or non-payment of pharmaceutical companies

– Huge tenders issued for non-essential equipment (wrong procurement choices)

4. Infrastructure – Poor or non-existent maintenance of infrastructure – Collapse of essential infrastructure due to corrupt procurement practices – Poor workmanship in the construction of new infrastructure

41

Developments in Post-Colonial Africa

• Ghana – Kwame Nkrumah, 1957

• Angola – Augustinoh Neto, 1975

• South Africa – Nelson Mandela, 1996

42

Dr Sambo’s address

• WE WISH TO PROPOSE FOUR MAJOR THRUSTS FOR ATTAINING UNIVERSAL HEALTH COVERAGE:

• First, strengthening the capacities of public health infrastructure to provide effective, safe, and quality health services. Infrastructure includes “staffing, buildings, technologies; utilities such as power and water supply; waste management; transport and communication; and FINANCING investments, maintenance and recurring costs”. Health infrastructure entails public investments and Governments will have to explore innovative ways of harnessing the resources of the private sector, NGOs and communities. 43

White markers indicate position of Deloitte Drawing Guides

7.40 cm

2.91 Inches

6.00 cm

2.36 Inches

8.00 cm

3.15 Inches

11.70 cm

4.61 inches

0.50 cm

0.2 inches

0.50 cm

0.2 inches

11.70 cm

4.61 inches

To view Deloitte drawing guides:

1. Right-click on slide and select ’Grid and Guides...’

2. Check ’Display drawing guides on screen’

3. Select ’OK’

Infrastructure Optimization Tool Kit applied for the selection of clinics to

be built in four provinces of EC, FS, LP and MP NHI Districts

44

White markers indicate position of Deloitte Drawing Guides

7.40 cm

2.91 Inches

6.00 cm

2.36 Inches

8.00 cm

3.15 Inches

11.70 cm

4.61 inches

0.50 cm

0.2 inches

0.50 cm

0.2 inches

11.70 cm

4.61 inches

To view Deloitte drawing guides:

1. Right-click on slide and select ’Grid and Guides...’

2. Check ’Display drawing guides on screen’

3. Select ’OK’

Infrastructure Audit-Prioritization of Clinics for replacement, upgrading and Repairs-NHI District, Vhembe LP

45

1 <20 Very poor

NATIONAL DEPARTMENT OF HEALTH 2 20 - 40 Poor

ANALYSIS OF THE NATIONAL HEALTH AUDIT DATA TO GUIDE THE NEED FOR NEW/REPLACEMENT CLINICS 3 40 - 60 Fair

Data sorted by district, average condition of the facilities, and total space score 4 60 -80 Good

to select clinics that are in very poor condition for possible replacement. 5 >80 Very good Space

District Sub-District FacilityExternal Walls

Condition

External

Water supply

Condition

External

Electrical

Supply

Condition

Electrical

Condition

Ceiling

Material

Condition

Plumbing

Toilet

Condition

Plumbing

Internal Water

Condition

Plumbing

basins

Condition

Internal Walls

Condition

Internal

Water Supply

Condition

Floor Material

Condition

Waste Water

Disposal

Condition

Roof Material

Condition

Sewerage

Condition

Waiting

Area Score

Space Service

and Patient

needs Score

Total Space

Score

Average condition

of facilities

Total Space

Score

Weighted Population

more than 5km from

facility

Identified by the

province

lp Vhembe District Municipality lp Makhado Local Municipality Louis Trichardt Clinic 60.0% 50.0% 50.0% 60.0% 6.0% 50.0% 0.0% 60.0% 44.0% 50.0% 50.0% 60.0% 60.0% 50.0% 100.0% 75.0% 40% 4 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Magwedzha Clinic 40.0% 40.0% 60.0% 60.0% 35.0% 60.0% 30.0% 60.0% 20.0% 40.0% 50.0% 60.0% 60.0% 60.0% 50.0% 100.0% 75.0% 41% 4 #N/A

lp Vhembe District Municipality lp Makhado Local Municipality Kulani Clinic 40.0% 50.0% 60.0% 60.0% 20.0% 60.0% 58.0% 52.0% 40.0% 50.0% 60.0% 60.0% 50.0% 60.0% 100.0% 100.0% 100.0% 42% 5 #N/A

lp Vhembe District Municipality lp Mutale Local Municipality Thengwe Clinic 46.0% 100.0% 100.0% 100.0% 20.0% 20.0% 100.0% 20.0% 58.0% 100.0% 20.0% 0.0% 68.0% 100.0% 0.0% 0.0% 0.0% 42% 1 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Makonde Clinic 26.0% 60.0% 60.0% 46.0% 60.0% 56.0% 60.0% 58.0% 36.0% 60.0% 56.0% 60.0% 38.0% 52.0% 50.0% 100.0% 75.0% 43% 4 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Sibasa Clinic 40.0% 60.0% 60.0% 40.0% 50.0% 44.0% 40.0% 44.0% 40.0% 60.0% 46.0% 60.0% 40.0% 60.0% 100.0% 100.0% 100.0% 43% 5 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Mulenzhe Clinic 60.0% 80.0% 80.0% 80.0% 30.0% 60.0% 40.0% 60.0% 40.0% 80.0% 60.0% 60.0% 40.0% 60.0% 50.0% 100.0% 75.0% 46% 4 #N/A

lp Vhembe District Municipality lp Makhado Local Municipality Manavhela Clinic 52.0% 60.0% 60.0% 60.0% 50.0% 50.0% 60.0% 50.0% 52.0% 60.0% 46.0% 40.0% 32.0% 50.0% 100.0% 100.0% 100.0% 46% 5 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Dzingahe Clinic 56.0% 60.0% 60.0% 60.0% 56.0% 42.0% 58.0% 54.0% 54.0% 60.0% 20.0% 60.0% 56.0% 60.0% 100.0% 100.0% 100.0% 48% 5 #N/A

lp Vhembe District Municipality lp Makhado Local Municipality Olifantshoek Clinic 60.0% 60.0% 60.0% 60.0% 58.0% 40.0% 60.0% 50.0% 58.0% 60.0% 6.0% 60.0% 60.0% 50.0% 100.0% 100.0% 100.0% 48% 5 9 384

lp Vhembe District Municipality lp Makhado Local Municipality Kutama Clinic 50.0% 60.0% 60.0% 60.0% 50.0% 46.0% 50.0% 40.0% 50.0% 60.0% 46.0% 60.0% 50.0% 50.0% 50.0% 100.0% 75.0% 49% 4 #N/A

lp Vhembe District Municipality lp Makhado Local Municipality Riverplaats Clinic 48.0% 60.0% 60.0% 60.0% 46.0% 58.0% 56.0% 60.0% 48.0% 60.0% 58.0% 60.0% 52.0% 28.0% 100.0% 100.0% 100.0% 50% 5 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Sterkstroom Clinic 33.0% 60.0% 60.0% 60.0% 52.0% 60.0% 60.0% 60.0% 56.0% 60.0% 60.0% 60.0% 58.0% 58.0% 0.0% 0.0% 0.0% 52% 1 #N/A

lp Vhembe District Municipality lp Makhado Local Municipality Beaconsfield Clinic 58.0% 60.0% 60.0% 60.0% 60.0% 40.0% 60.0% 50.0% 58.0% 60.0% 26.0% 60.0% 60.0% 60.0% 50.0% 100.0% 75.0% 52% 4 #N/A

lp Vhembe District Municipality lp Makhado Local Municipality Tshakhuma Clinic 48.0% 60.0% 60.0% 60.0% 54.0% 52.0% 58.0% 56.0% 52.0% 60.0% 54.0% 60.0% 54.0% 56.0% 100.0% 100.0% 100.0% 52% 5 #N/A

lp Vhembe District Municipality lp Makhado Local Municipality Tshimbupfe Clinic 48.0% 60.0% 60.0% 60.0% 48.0% 52.0% 60.0% 50.0% 54.0% 60.0% 56.0% 60.0% 58.0% 60.0% 50.0% 100.0% 75.0% 53% 4 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Matiyani Clinic 60.0% 56.0% 60.0% 60.0% 46.0% 56.0% 54.0% 50.0% 52.0% 56.0% 56.0% 60.0% 54.0% 50.0% 50.0% 0.0% 25.0% 54% 2 #N/A

lp Vhembe District Municipality lp Makhado Local Municipality Matsa Clinic 50.0% 60.0% 60.0% 56.0% 60.0% 54.0% 60.0% 60.0% 52.0% 60.0% 52.0% 60.0% 54.0% 60.0% 50.0% 100.0% 75.0% 54% 4 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Dzwerani Clinic 60.0% 50.0% 60.0% 50.0% 54.0% 50.0% 50.0% 60.0% 60.0% 50.0% 40.0% 60.0% 56.0% 60.0% 50.0% 0.0% 25.0% 54% 2 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Mavambe Clinic 60.0% 60.0% 60.0% 60.0% 50.0% 56.0% 60.0% 60.0% 60.0% 60.0% 40.0% 60.0% 60.0% 60.0% 100.0% 100.0% 100.0% 54% 5 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Vhurivhuri Clinic 48.0% 60.0% 60.0% 60.0% 58.0% 60.0% 60.0% 60.0% 50.0% 60.0% 58.0% 60.0% 58.0% 60.0% 50.0% 100.0% 75.0% 54% 4 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Mhinga Clinic 60.0% 50.0% 60.0% 50.0% 37.0% 48.0% 58.0% 58.0% 58.0% 50.0% 59.0% 60.0% 58.0% 60.0% 50.0% 100.0% 75.0% 54% 4 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Muledane Clinic 60.0% 80.0% 80.0% 60.0% 40.0% 56.0% 80.0% 60.0% 40.0% 80.0% 74.0% 80.0% 60.0% 60.0% 50.0% 100.0% 75.0% 55% 4 #N/A

lp Vhembe District Municipality lp Makhado Local Municipality Khomela Clinic 50.0% 60.0% 20.0% 60.0% 56.0% 50.0% 60.0% 58.0% 58.0% 60.0% 56.0% 62.0% 54.0% 40.0% 100.0% 100.0% 100.0% 55% 5 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Murangoni Clinic 60.0% 60.0% 60.0% 60.0% 35.0% 50.0% 60.0% 60.0% 60.0% 60.0% 60.0% 20.0% 60.0% 20.0% 0.0% 0.0% 0.0% 55% 1 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Nghezimani Clinic 60.0% 60.0% 60.0% 60.0% 60.0% 60.0% 40.0% 60.0% 60.0% 60.0% 35.0% 60.0% 60.0% 60.0% 100.0% 100.0% 100.0% 55% 5 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Sambandou Clinic 52.0% 60.0% 60.0% 60.0% 56.0% 46.0% 40.0% 60.0% 54.0% 60.0% 58.0% 60.0% 56.0% 60.0% 0.0% 0.0% 0.0% 55% 1 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Lambani Clinic 52.0% 60.0% 60.0% 60.0% 58.0% 40.0% 58.0% 50.0% 54.0% 60.0% 54.0% 60.0% 58.0% 60.0% 50.0% 0.0% 25.0% 55% 2 1 248 600

lp Vhembe District Municipality lp Makhado Local Municipality Valdezia Clinic 50.0% 60.0% 60.0% 60.0% 54.0% 60.0% 60.0% 60.0% 58.0% 60.0% 60.0% 60.0% 54.0% 60.0% 100.0% 100.0% 100.0% 55% 5 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Tshifudi Clinic 60.0% 60.0% 60.0% 60.0% 67.0% 54.0% 60.0% 60.0% 60.0% 60.0% 30.0% 60.0% 60.0% 60.0% 0.0% 0.0% 0.0% 55% 1 #N/A

lp Vhembe District Municipality lp Makhado Local Municipality Vuvha Clinic 52.0% 60.0% 58.0% 60.0% 54.0% 52.0% 58.0% 57.0% 54.0% 60.0% 60.0% 60.0% 58.0% 57.0% 50.0% 100.0% 75.0% 56% 4 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Mukula Clinic 60.0% 60.0% 60.0% 60.0% 58.0% 60.0% 40.0% 60.0% 40.0% 60.0% 60.0% 60.0% 60.0% 60.0% 0.0% 0.0% 0.0% 56% 1 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Ntlhaveni C Clinic 55.0% 60.0% 60.0% 52.0% 54.0% 58.0% 57.0% 60.0% 56.0% 60.0% 58.0% 60.0% 56.0% 60.0% 50.0% 0.0% 25.0% 56% 2 #N/A

lp Vhembe District Municipality lp Thulamela Local Municipality Tshisaulu Clinic 60.0% 80.0% 80.0% 80.0% 60.0% 56.0% 40.0% 40.0% 60.0% 80.0% 40.0% 80.0% 60.0% 80.0% 0.0% 0.0% 0.0% 56% 1 #N/A

2 -TOTAL

SPACE

SCORE

1- AVERAGE

CONDITION OF

THE FACILITY

3- WEIGHTED

POPULATION

MORE THAN 5KM

FROM THE

FACILITY

White markers indicate position of Deloitte Drawing Guides

7.40 cm

2.91 Inches

6.00 cm

2.36 Inches

8.00 cm

3.15 Inches

11.70 cm

4.61 inches

0.50 cm

0.2 inches

0.50 cm

0.2 inches

11.70 cm

4.61 inches

To view Deloitte drawing guides:

1. Right-click on slide and select ’Grid and Guides...’

2. Check ’Display drawing guides on screen’

3. Select ’OK’

Infrastructure Audit-Prioritization of Clinics for replacement, upgrading and Repairs-NHI District, Gert Sibande, MP

46

1 <20 Very poor

NATIONAL DEPARTMENT OF HEALTH 2 20 - 40 Poor

ANALYSIS OF THE NATIONAL HEALTH AUDIT DATA TO GUIDE THE NEED FOR NEW/REPLACEMENT CLINICS 3 40 - 60 Fair

Data sorted by district, average condition of the facilities, and total space score 4 60 -80 Good

to select clinics that are in very poor condition for possible replacement. 5 >80 Very good Space

District Sub-District FacilityExternal Walls

Condition

External

Water supply

Condition

External

Electrical

Supply

Condition

Electrical

Condition

Ceiling

Material

Condition

Plumbing

Toilet

Condition

Plumbing

Internal Water

Condition

Plumbing

basins

Condition

Internal Walls

Condition

Internal

Water Supply

Condition

Floor Material

Condition

Waste Water

Disposal

Condition

Roof Material

Condition

Sewerage

Condition

Waiting

Area Score

Space Service

and Patient

needs Score

Total Space

Score

Average condition

of facilities

Total Space

Score

Weighted Population

more than 5km from

facility

Identified by the

province

lp Vhembe District Municipality lp Makhado Local Municipality Louis Trichardt Clinic 60.0% 50.0% 50.0% 60.0% 6.0% 50.0% 0.0% 60.0% 44.0% 50.0% 50.0% 60.0% 60.0% 50.0% 100.0% 75.0% 40% 4 #N/Alp Vhembe District Municipality lp Makhado Local Municipality Muila Clinic 60.0% 60.0% 58.0% 59.0% 58.0% 45.0% 58.0% 59.0% 60.0% 60.0% 80.0% 60.0% 58.0% 60.0% 100.0% 100.0% 100.0% 63% 5 #N/A

mp Gert Sibande District mp Govan Mbeki Local Langverwacht Clinic 0.0% 20.0% 20.0% 60.0% 80.0% 20.0% 0.0% 20.0% 20.0% 20.0% 20.0% 20.0% 60.0% 20.0% 50.0% 0.0% 25.0% 36% 2 933

mp Gert Sibande District mp Msukaligwa Local New Scotland Clinic 60.0% 20.0% 60.0% 20.0% 40.0% 40.0% 20.0% 20.0% 60.0% 20.0% 60.0% 40.0% 20.0% 40.0% 50.0% 0.0% 25.0% 48% 2 #N/Amp Gert Sibande District mp Dipaleseng Local Greylingstad Clinic 80.0% 60.0% 60.0% 28.0% 32.0% 28.0% 46.0% 50.0% 46.0% 60.0% 58.0% 60.0% 26.0% 80.0% 100.0% 0.0% 50.0% 48% 3 186 073

mp Gert Sibande District mp Govan Mbeki Local Langverwacht Ext 14 Clinic 60.0% 60.0% 20.0% 60.0% 60.0% 20.0% 60.0% 40.0% 60.0% 60.0% 60.0% 20.0% 20.0% 20.0% 0.0% 0.0% 0.0% 52% 1 933

mp Gert Sibande District mp Albert Luthuli Local Carolina Clinic 60.0% 60.0% 60.0% 40.0% 80.0% 20.0% 0.0% 20.0% 60.0% 60.0% 20.0% 60.0% 60.0% 60.0% 0.0% 0.0% 0.0% 56% 1 370 719mp Gert Sibande District mp Mkhondo Local Mkhondo Town Clinic 60.0% 0.0% 80.0% 80.0% 80.0% 60.0% 80.0% 60.0% 60.0% 0.0% 20.0% 80.0% 60.0% 80.0% 0.0% 100.0% 50.0% 56% 3 #N/A Mkhondo

mp Gert Sibande District mp Albert Luthuli Local Silobela Clinic 60.0% 60.0% 80.0% 80.0% 80.0% 20.0% 20.0% 40.0% 60.0% 60.0% 60.0% 40.0% 20.0% 20.0% 100.0% 100.0% 100.0% 56% 5 0mp Gert Sibande District mp Pixley Ka Seme Local Ezamokuhle Clinic 0.0% 80.0% 80.0% 80.0% 70.0% 80.0% 100.0% 80.0% 70.0% 80.0% 80.0% 70.0% 70.0% 80.0% 0.0% 0.0% 0.0% 58% 1 2 274

mp Gert Sibande District mp Albert Luthuli Local Fernie 1 Clinic 46.0% 76.0% 76.0% 76.0% 68.0% 62.0% 80.0% 60.0% 58.0% 76.0% 64.0% 70.0% 60.0% 60.0% 50.0% 0.0% 25.0% 59% 2 0

mp Gert Sibande District mp Mkhondo Local Driefontein Old Stands Clinic 52.0% 60.0% 70.0% 70.0% 76.0% 46.0% 60.0% 78.0% 54.0% 60.0% 70.0% 0.0% 56.0% 60.0% 50.0% 100.0% 75.0% 62% 4 48 534mp Gert Sibande District mp Albert Luthuli Local Diepdale Clinic 44.0% 80.0% 80.0% 80.0% 50.0% 76.0% 80.0% 60.0% 64.0% 80.0% 74.0% 80.0% 80.0% 80.0% 0.0% 100.0% 50.0% 62% 3 0

mp Gert Sibande District mp Albert Luthuli Local Betty'sgoed Clinic 72.0% 80.0% 80.0% 72.0% 66.0% 68.0% 80.0% 80.0% 60.0% 80.0% 60.0% 80.0% 60.0% 80.0% 0.0% 100.0% 50.0% 64% 3 0

mp Gert Sibande District mp Albert Luthuli Local Glenmore Clinic 58.0% 80.0% 80.0% 78.0% 76.0% 76.0% 68.0% 70.0% 60.0% 80.0% 72.0% 70.0% 60.0% 80.0% 0.0% 0.0% 0.0% 65% 1 11 458mp Gert Sibande District mp Msukaligwa Local Kwazanele Clinic 60.0% 60.0% 80.0% 66.0% 66.0% 74.0% 60.0% 80.0% 60.0% 60.0% 60.0% 60.0% 80.0% 60.0% 100.0% 100.0% 100.0% 65% 5 0

mp Gert Sibande District mp Govan Mbeki Local Emzinoni Clinic 79.0% 80.0% 78.0% 51.0% 62.0% 76.0% 80.0% 37.0% 74.0% 80.0% 80.0% 78.0% 40.0% 80.0% 100.0% 100.0% 100.0% 67% 5 0mp Gert Sibande District mp Albert Luthuli Local Nhlazatshe 6 Clinic 60.0% 76.0% 80.0% 68.0% 80.0% 60.0% 80.0% 80.0% 60.0% 76.0% 58.0% 80.0% 80.0% 40.0% 50.0% 0.0% 25.0% 68% 2 94 429 Nhlazatshe 6

mp Gert Sibande District mp Mkhondo Local Derby/Rustplaas Clinic 40.0% 80.0% 80.0% 60.0% 80.0% 20.0% 0.0% 80.0% 60.0% 80.0% 80.0% 20.0% 80.0% 20.0% 0.0% 100.0% 50.0% 68% 3 #N/A

mp Gert Sibande District mp Albert Luthuli Local Tjakastad Clinic 80.0% 0.0% 60.0% 60.0% 80.0% 60.0% 80.0% 0.0% 80.0% 0.0% 60.0% 80.0% 40.0% 80.0% 50.0% 0.0% 25.0% 68% 2 0mp Gert Sibande District mp Albert Luthuli Local Avontuur Satellite Clinic 68.0% 20.0% 40.0% 40.0% 68.0% 60.0% 0.0% 60.0% 76.0% 20.0% 60.0% 40.0% 68.0% 40.0% 50.0% 100.0% 75.0% 68% 4 #N/A

mp Gert Sibande District mp Albert Luthuli Local Fernie 2 Clinic 80.0% 80.0% 80.0% 70.0% 44.0% 68.0% 80.0% 64.0% 60.0% 80.0% 78.0% 76.0% 80.0% 60.0% 50.0% 100.0% 75.0% 68% 4 0

mp Gert Sibande District mp Albert Luthuli Local Swallowsnest Clinic 60.0% 80.0% 60.0% 80.0% 80.0% 70.0% 80.0% 70.0% 60.0% 80.0% 74.0% 80.0% 70.0% 80.0% 100.0% 100.0% 100.0% 69% 5 0mp Gert Sibande District mp Msukaligwa Local Thussiville/MN Cindi Clinic 80.0% 80.0% 80.0% 61.0% 74.0% 74.0% 80.0% 80.0% 70.0% 80.0% 76.0% 80.0% 46.0% 80.0% 0.0% 0.0% 0.0% 69% 1 #N/A

mp Gert Sibande District mp Msukaligwa Local Chrissiesmeer/Kwachibikhulu 80.0% 80.0% 80.0% 60.0% 80.0% 80.0% 80.0% 80.0% 60.0% 80.0% 88.0% 80.0% 40.0% 80.0% 0.0% 0.0% 70% 1 0mp Gert Sibande District mp Msukaligwa Local Davel Clinic 74.0% 80.0% 80.0% 76.0% 80.0% 80.0% 80.0% 80.0% 60.0% 80.0% 60.0% 60.0% 76.0% 60.0% 50.0% 100.0% 75.0% 70% 4 0

mp Gert Sibande District mp Albert Luthuli Local Arnhemburg Clinic 80.0% 80.0% 80.0% 80.0% 68.0% 68.0% 74.0% 64.0% 56.0% 80.0% 68.0% 80.0% 80.0% 80.0% 100.0% 100.0% 100.0% 70% 5 #N/A

mp Gert Sibande District mp Albert Luthuli Local Hartebeeskop Clinic 80.0% 80.0% 76.0% 68.0% 68.0% 60.0% 60.0% 70.0% 78.0% 80.0% 70.0% 80.0% 60.0% 80.0% 37.5% 100.0% 68.8% 71% 4 27 229mp Gert Sibande District mp Lekwa Local Municipality Morgenzon Clinic 76.0% 60.0% 80.0% 80.0% 58.0% 80.0% 60.0% 80.0% 74.0% 60.0% 93.0% 60.0% 58.0% 60.0% 50.0% 100.0% 75.0% 72% 4 44 017

mp Gert Sibande District mp Lekwa Local Municipality Stanwest/Azalia Clinic 100.0% 100.0% 40.0% 60.0% 40.0% 80.0% 100.0% 100.0% 60.0% 100.0% 100.0% 100.0% 60.0% 100.0% 0.0% 0.0% 0.0% 72% 1 0mp Gert Sibande District mp Msukaligwa Local Ermelo Clinic 60.0% 80.0% 60.0% 60.0% 80.0% 20.0% 80.0% 60.0% 60.0% 80.0% 80.0% 80.0% 80.0% 80.0% 100.0% 100.0% 100.0% 72% 5 920 609

mp Gert Sibande District mp Pixley Ka Seme Local Wakkerstroom Clinic 78.0% 80.0% 80.0% 80.0% 77.0% 70.0% 79.0% 70.0% 72.0% 80.0% 58.0% 80.0% 78.0% 80.0% 50.0% 0.0% 25.0% 73% 2 0

mp Gert Sibande District mp Mkhondo Local Dirkiesdorp Clinic 60.0% 80.0% 80.0% 80.0% 76.0% 70.0% 80.0% 80.0% 78.0% 80.0% 78.0% 40.0% 80.0% 40.0% 0.0% 0.0% 0.0% 74% 1 96 297mp Gert Sibande District mp Albert Luthuli Local Nhlazatshe Clinic 80.0% 80.0% 80.0% 80.0% 68.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 66.0% 80.0% 50.0% 100.0% 75.0% 75% 4 94 429

mp Gert Sibande District mp Albert Luthuli Local Mooiplaas Clinic 78.0% 78.0% 80.0% 74.0% 79.0% 70.0% 60.0% 68.0% 76.0% 78.0% 76.0% 72.0% 70.0% 72.0% 50.0% 100.0% 75.0% 76% 4 0

mp Gert Sibande District mp Msukaligwa Local Emthonjeni Clinic (Msukaligwa) 80.0% 100.0% 60.0% 40.0% 80.0% 20.0% 80.0% 40.0% 80.0% 100.0% 60.0% 80.0% 80.0% 20.0% 50.0% 0.0% 25.0% 76% 2 #N/A Emthonjeni

2 -TOTAL

SPACE

SCORE

1- AVERAGE

CONDITION OF

THE FACILITY

3- WEIGHTED

POPULATION

MORE THAN 5KM

FROM THE

FACILITY

White markers indicate position of Deloitte Drawing Guides

7.40 cm

2.91 Inches

6.00 cm

2.36 Inches

8.00 cm

3.15 Inches

11.70 cm

4.61 inches

0.50 cm

0.2 inches

0.50 cm

0.2 inches

11.70 cm

4.61 inches

To view Deloitte drawing guides:

1. Right-click on slide and select ’Grid and Guides...’

2. Check ’Display drawing guides on screen’

3. Select ’OK’

Infrastructure Audit-Prioritization of Clinics for replacement, upgrading and Repairs-NHI District, Thabo Mofutsanyane, FS

Deloitte 47

1 <20 Very poor

NATIONAL DEPARTMENT OF HEALTH 2 20 - 40 Poor

ANALYSIS OF THE NATIONAL HEALTH AUDIT DATA TO GUIDE THE NEED FOR NEW/REPLACEMENT CLINICS 3 40 - 60 Fair

Data sorted by district, average condition of the facilities, and total space score4 60 -80 Good

to select clinics that are in very poor condition for possible replacement. 5 >80 Very good Space

District Sub-District FacilityExternal Walls

Condition

External

Water supply

Condition

External

Electrical

Supply

Condition

Electrical

Condition

Ceiling

Material

Condition

Plumbing

Toilet

Condition

Plumbing

Internal Water

Condition

Plumbing

basins

Condition

Internal Walls

Condition

Internal

Water Supply

Condition

Floor Material

Condition

Waste Water

Disposal

Condition

Roof Material

Condition

Sewerage

Condition

Waiting

Area Score

Space Service

and Patient

needs Score

Total Space

Score

Average condition

of facilities

Total Space

Score

Weighted Population

more than 5km from

facility

Identified by the

province

ec Oliver Tambo District ec Nyandeni Health sub- Isilimela Gateway 20.0% 80.0% 100.0% 80.0% 20.0% 20.0% 20.0% 20.0% 20.0% 80.0% 20.0% 20.0% 20.0% 20.0% 100.0% 0.0% 50.0% 20% 3 12 426

fs Thabo Mofutsanyane

District Municipality

fs Mantsopa Local

MunicipalityExcelsior Clinic 80.0% 80.0% 80.0% 80.0% 72.0% 60.0% 60.0% 60.0% 60.0% 80.0% 0.0% 80.0% 60.0% 76.0% 100.0% 100.0% 100.0% 54% 5 55 279

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityBolata Clinic 60.0% 80.0% 80.0% 60.0% 40.0% 60.0% 40.0% 80.0% 60.0% 80.0% 56.0% 80.0% 50.0% 0.0% 25.0% 55% 2 0

fs Thabo Mofutsanyane

District Municipality

fs Setsoto Local

MunicipalityMatwabeng Clinic 60.0% 80.0% 60.0% 56.0% 60.0% 28.0% 60.0% 80.0% 44.0% 80.0% 68.0% 80.0% 50.0% 100.0% 75.0% 58% 4 0

fs Thabo Mofutsanyane

District Municipality

fs Setsoto Local

MunicipalityKokelong Clinic 80.0% 80.0% 80.0% 38.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 32.0% 80.0% 100.0% 100.0% 100.0% 62% 5 0

fs Thabo Mofutsanyane

District Municipality

fs Mantsopa Local

MunicipalityBorwa Clinic 80.0% 60.0% 80.0% 60.0% 60.0% 50.0% 70.0% 60.0% 80.0% 60.0% 32.0% 60.0% 60.0% 60.0% 50.0% 100.0% 75.0% 62% 4 0

fs Thabo Mofutsanyane

District Municipality

fs Mantsopa Local

MunicipalityTweespruit Clinic 72.0% 80.0% 80.0% 80.0% 40.0% 68.0% 84.0% 80.0% 80.0% 80.0% 76.0% 80.0% 60.0% 80.0% 100.0% 100.0% 100.0% 66% 5 0

fs Thabo Mofutsanyane

District Municipality

fs Phumelela Local

MunicipalityVrede Clinic 60.0% 80.0% 76.0% 62.0% 64.0% 80.0% 60.0% 80.0% 80.0% 80.0% 68.0% 80.0% 50.0% 0.0% 25.0% 66% 2 153 478

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityTebang Clinic 80.0% 80.0% 74.0% 72.0% 70.0% 80.0% 60.0% 80.0% 52.0% 70.0% 76.0% 60.0% 0.0% 0.0% 0.0% 68% 1 0

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityMalesaona Clinic 80.0% 80.0% 80.0% 56.0% 40.0% 80.0% 50.0% 60.0% 80.0% 80.0% 80.0% 64.0% 80.0% 100.0% 100.0% 100.0% 68% 5 1 952

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityPaballong Clinic 80.0% 80.0% 20.0% 62.0% 60.0% 80.0% 80.0% 76.0% 80.0% 60.0% 80.0% 68.0% 80.0% 100.0% 0.0% 50.0% 69% 3 0

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityNthabiseng Clinic 80.0% 80.0% 80.0% 68.0% 40.0% 70.0% 60.0% 80.0% 70.0% 80.0% 74.0% 80.0% 100.0% 0.0% 50.0% 70% 3 0

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local Municipality

Thaba Bosiu

Clinic70.0% 80.0% 70.0% 70.0% 68.0% 20.0% 80.0% 76.0% 80.0% 66.0% 76.0% 72.0% 66.0% 50.0% 0.0% 25.0% 71% 2 0

fs Thabo Mofutsanyane

District Municipality

fs Mantsopa Local

Municipality

Manyatseng

Clinic100.0% 80.0% 80.0% 100.0% 40.0% 80.0% 80.0% 80.0% 80.0% 80.0% 56.0% 60.0% 80.0% 100.0% 100.0% 100.0% 100.0% 71% 5 0

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityMakoane Clinic 60.0% 80.0% 80.0% 68.0% 50.0% 80.0% 80.0% 74.0% 80.0% 80.0% 80.0% 76.0% 60.0% 0.0% 0.0% 0.0% 72% 1 0

fs Thabo Mofutsanyane

District Municipality

fs Mantsopa Local

MunicipalityIkaheng Clinic 80.0% 80.0% 80.0% 80.0% 58.0% 60.0% 80.0% 80.0% 80.0% 80.0% 80.0% 76.0% 60.0% 80.0% 50.0% 100.0% 75.0% 72% 4 0

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityIntabazwe Clinic 80.0% 80.0% 80.0% 66.0% 72.0% 80.0% 80.0% 80.0% 62.0% 50.0% 72.0% 80.0% 50.0% 0.0% 25.0% 72% 2 #N/A

fs Thabo Mofutsanyane

District Municipality

fs Phumelela Local

MunicipalityMemel Clinic 72.0% 80.0% 74.0% 68.0% 78.0% 80.0% 72.0% 80.0% 72.0% 72.0% 76.0% 80.0% 50.0% 100.0% 75.0% 72% 4 #N/A

fs Thabo Mofutsanyane

District Municipality

fs Mantsopa Local

MunicipalityHobhouse Clinic 80.0% 20.0% 40.0% 60.0% 56.0% 58.0% 74.0% 56.0% 72.0% 20.0% 80.0% 20.0% 74.0% 20.0% 0.0% 100.0% 50.0% 72% 3 0

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityQholaqhwe Clinic 80.0% 80.0% 74.0% 62.0% 40.0% 80.0% 80.0% 80.0% 80.0% 68.0% 80.0% 74.0% 80.0% 50.0% 0.0% 25.0% 73% 2 0

fs Thabo Mofutsanyane

District Municipality

fs Dihlabeng Local

Municipality

Relebohile

(Rosendal) Clinic62.0% 80.0% 60.0% 68.0% 74.0% 74.0% 80.0% 80.0% 74.0% 80.0% 80.0% 80.0% 74.0% 80.0% 100.0% 100.0% 100.0% 73% 5 0

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityNamahali Clinic 80.0% 80.0% 62.0% 70.0% 64.0% 80.0% 80.0% 80.0% 80.0% 68.0% 72.0% 74.0% 72.0% 50.0% 0.0% 25.0% 74% 2 0

fs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityBoiketlo Clinic 80.0% 80.0% 50.0% 68.0% 64.0% 20.0% 80.0% 70.0% 80.0% 76.0% 80.0% 80.0% 80.0% 100.0% 0.0% 50.0% 75% 3 0

fs Thabo Mofutsanyane

District Municipality

fs Nketoana Local

MunicipalityPetsana Clinic 80.0% 80.0% 80.0% 68.0% 80.0% 80.0% 72.0% 80.0% 80.0% 80.0% 74.0% 80.0% 100.0% 100.0% 100.0% 75% 5 0

Petsana

Clinicfs Thabo Mofutsanyane

District Municipality

fs Maluti a Phofung

Local MunicipalityTina Moloi Clinic 80.0% 80.0% 72.0% 70.0% 78.0% 100.0% 80.0% 76.0% 80.0% 77.0% 100.0% 72.0% 100.0% 50.0% 100.0% 75.0% 75% 4 0

Tina Moloi

Clinic

fs Thabo Mofutsanyane

District Municipality

fs Dihlabeng Local

MunicipalityPaul Roux Clinic 60.0% 80.0% 80.0% 80.0% 80.0% 80.0% 0.0% 80.0% 76.0% 80.0% 80.0% 20.0% 80.0% 20.0% 50.0% 100.0% 75.0% 75% 4 #N/A

Paul Roux

Clinic

2 -TOTAL

SPACE

SCORE

1- AVERAGE

CONDITION OF

THE FACILITY

3- WEIGHTED

POPULATION

MORE THAN 5KM

FROM THE

FACILITY

White markers indicate position of Deloitte Drawing Guides

7.40 cm

2.91 Inches

6.00 cm

2.36 Inches

8.00 cm

3.15 Inches

11.70 cm

4.61 inches

0.50 cm

0.2 inches

0.50 cm

0.2 inches

11.70 cm

4.61 inches

To view Deloitte drawing guides:

1. Right-click on slide and select ’Grid and Guides...’

2. Check ’Display drawing guides on screen’

3. Select ’OK’

Infrastructure Audit-Prioritization of Clinics for replacement, upgrading and Repairs-NHI District OR Tambo, EC

48

1 <20 Very poor

NATIONAL DEPARTMENT OF HEALTH 2 20 - 40 Poor

ANALYSIS OF THE NATIONAL HEALTH AUDIT DATA TO GUIDE THE NEED FOR NEW/REPLACEMENT CLINICS 3 40 - 60 Fair

Data sorted by district, average condition of the facilities, and total space score4 60 -80 Good

to select clinics that are in very poor condition for possible replacement. 5 >80 Very good Space

District Sub-District FacilityExternal Walls

Condition

External

Water supply

Condition

External

Electrical

Supply

Condition

Electrical

Condition

Ceiling

Material

Condition

Plumbing

Toilet

Condition

Plumbing

Internal Water

Condition

Plumbing

basins

Condition

Internal Walls

Condition

Internal

Water Supply

Condition

Floor Material

Condition

Waste Water

Disposal

Condition

Roof Material

Condition

Sewerage

Condition

Waiting

Area Score

Space Service

and Patient

needs Score

Total Space

Score

Average condition

of facilities

Total Space

Score

Weighted Population

more than 5km from

facility

Identified by

the province

ec Oliver Tambo

District

Municipality

ec Nyandeni Health

sub-District

Isilimela

Gateway Clinic20.0% 80.0% 100.0% 80.0% 20.0% 20.0% 20.0% 20.0% 20.0% 80.0% 20.0% 20.0% 20.0% 20.0% 100.0% 0.0% 50.0% 20% 3 12 426

ec Oliver Tambo

District

Municipality

ec Mhlontlo Health

sub-District

Nessie Knight

Clinic20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 50.0% 100.0% 75.0% 20% 4 #N/A

ec Oliver Tambo

District

Municipality

ec Qaukeni Health

sub-DistrictFlagstaff Clinic 20.0% 52.0% 80.0% 60.0% 20.0% 20.0% 20.0% 74.0% 20.0% 52.0% 50.0% 20.0% 20.0% 20.0% 0.0% 0.0% 0.0% 26% 1 #N/A

ec Oliver Tambo

District

Municipality

ec Nyandeni Health

sub-DistrictCwele Clinic 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 50.0% 40.0% 0.0% 0.0% 0.0% 33% 1 2 152

ec Oliver Tambo

District

Municipality

ec King Sabata

Dalindyebo Health

sub-District

Tyelebana Clinic 20.0% 0.0% 100.0% 80.0% 20.0% 40.0% 0.0% 20.0% 20.0% 0.0% 40.0% 0.0% 70.0% 0.0% 50.0% 0.0% 25.0% 34% 2 33 154

ec Oliver Tambo

District

Municipality

ec Qaukeni Health

sub-DistrictMagwa Clinic 60.0% 68.0% 72.0% 62.0% 50.0% 48.0% 56.0% 52.0% 0.0% 68.0% 56.0% 70.0% 36.0% 58.0% 100.0% 100.0% 100.0% 40% 5 49 383

ec Oliver Tambo

District

Municipality

ec Mhlontlo Health

sub-DistrictLotana Clinic 40.0% 60.0% 40.0% 32.0% 60.0% 40.0% 44.0% 60.0% 0.0% 0.0% 0.0% 43% 1 9 410

Lotana

Clinic

ec Oliver Tambo

District

Municipality

ec Nyandeni Health

sub-District

Bambisana PHC

Clinic40.0% 40.0% 60.0% 60.0% 40.0% 60.0% 60.0% 60.0% 40.0% 40.0% 40.0% 60.0% 0.0% 0.0% 0.0% 44% 1 6 537

Bambisana

Hospital

ec Oliver Tambo

District

Municipality

ec Nyandeni Health

sub-District

Mtambalala

Clinic40.0% 20.0% 20.0% 20.0% 54.0% 46.0% 20.0% 72.0% 56.0% 20.0% 26.0% 46.0% 50.0% 46.0% 50.0% 0.0% 25.0% 45% 2 3 902

ec Oliver Tambo

District

Municipality

ec Mhlontlo Health

sub-DistrictSt Lucy's Clinic 40.0% 20.0% 60.0% 40.0% 48.0% 40.0% 20.0% 40.0% 44.0% 20.0% 60.0% 60.0% 36.0% 60.0% 100.0% 100.0% 100.0% 46% 5 5 068

ec Oliver Tambo

District

Municipality

ec Nyandeni Health

sub-District

Canzibe

Gateway Clinic20.0% 80.0% 80.0% 80.0% 60.0% 60.0% 60.0% 60.0% 20.0% 80.0% 68.0% 40.0% 72.0% 40.0% 0.0% 0.0% 0.0% 48% 1 22 484

ec Oliver Tambo

District

Municipality

ec Mhlontlo Health

sub-District

Sidwadweni

Clinic40.0% 80.0% 80.0% 60.0% 60.0% 40.0% 20.0% 70.0% 40.0% 80.0% 50.0% 20.0% 60.0% 20.0% 50.0% 100.0% 75.0% 50% 4 2 437

ec Oliver Tambo

District

Municipality

ec Nyandeni Health

sub-DistrictNkanga Clinic 50.0% 40.0% 80.0% 80.0% 48.0% 40.0% 20.0% 50.0% 60.0% 40.0% 40.0% 20.0% 60.0% 20.0% 0.0% 100.0% 50.0% 52% 3 16 309

Nkanga

Clinic

ec Oliver Tambo

District

Municipality

ec Nyandeni Health

sub-DistrictBomvini Clinic 60.0% 20.0% 60.0% 60.0% 60.0% 20.0% 20.0% 20.0% 52.0% 20.0% 40.0% 20.0% 50.0% 20.0% 100.0% 100.0% 100.0% 52% 5 0

ec Oliver Tambo

District

Municipality

ec Nyandeni Health

sub-District

St Barnabas

Gateway Clinic60.0% 80.0% 80.0% 64.0% 50.0% 48.0% 80.0% 60.0% 60.0% 80.0% 50.0% 60.0% 50.0% 60.0% 50.0% 100.0% 75.0% 54% 4 16 848

ec Oliver Tambo

District

Municipality

ec King Sabata

Dalindyebo Health

sub-District

Zitulele

Gateway Clinic60.0% 40.0% 20.0% 20.0% 20.0% 60.0% 60.0% 40.0% 60.0% 40.0% 0.0% 0.0% 0.0% 55% 1 0

ec Oliver Tambo

District

Municipality

ec Qaukeni Health

sub-DistrictMalangeni Clinic 52.0% 20.0% 20.0% 20.0% 46.0% 20.0% 20.0% 60.0% 52.0% 20.0% 66.0% 20.0% 60.0% 20.0% 50.0% 0.0% 25.0% 55% 2 188 828

2 -TOTAL

SPACE

SCORE

1- AVERAGE

CONDITION OF

THE FACILITY

3- WEIGHTED

POPULATION

MORE THAN 5KM

FROM THE

FACILITY

BUT HOW DID WE ARRIVE HERE

49

PRIVATE SECTOR

50

The private hospital market in metropolitan areas (50%+ of medical scheme population) was concentrated by 1999..

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

1996 1998 2000 2002 2004 2006

Pe

rce

nta

ge o

f to

tal a

cute

be

ds

Life Medi-Clinic Netcare Independent

Market becomes

concentrated

Only 12.3% of private hospital beds were outside three main hospital groups by 2006… 51

Private hospital real cost trends (2009 prices)

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.01

99

0

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

Re

al p

er

cap

ita

exp

en

dit

ure

Coincides with market concentration

?

52

Cost of debt

Return on Investment

…hospitals demonstrated a large growth in their return on investment…

53

Competition Commission Ruling (2004)

1. Price negotiation as price fixing

2. Health as market commodity

3. Patient supposed to negotiate directly with their doctors

4. Minister of Health supposed to be a neutral arbiter

54

WHERE IS THE MONEY GOING TO

55

Medical Schemes Expenditure in 2010

• Total medical scheme spend on health – R84.7bn

• Hospitals – R31.1bn, private R30.8bn (10%), public R281 (2.6%).

• Specialists - R19bn

• Medicines - R14bn (5.6%)

• GPs - R6.2bn (9%)

• Dentist - R2.5bn (13.2%)

• Allied - R6.7bn (11.5%)

• Total non healthcare- R11.6bn (6.9%)

56

57

...but Discovery still has very high non-health costs...

117 114107 105 103 99 97 96 96

36

0

20

40

60

80

100

120

140

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

Best

med

Reso

lutio

n

Disc

over

y

Med

ihel

p

Hos

med

Fedh

ealth

Libe

rty

Keyh

ealth

Aver

age

open

sch

emes

GEM

S

Per c

apita

exp

endi

ture

(mon

thly

)

Bene

ficia

ries

Average beneficiaries Administration Expenditure (pabpm)

Administration fees should be low in large schemes

58

…broker fees increased sharply up to 2005 but has declined slightly since then…

-

20

40

60

80

100

120

140

160

180

200

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

pab

pa

(R)

CMS Annual Report 2010 - 2011

800% increase in five years

59

CONSEQUENCES TO MEDICAL SCHEMES

60

Premium Increase

• For the past decade and a half, premiums have been increasing at more than CPIX

• Benefits dropping at a very fast pace

• Even measures such as PMBs worsened the situation

• Workers demanding higher medical aid subsidies in a failed endeavour to stem the situation

61

62

Consolidation: Small-sized restricted schemes

144 Schemes in 2000

4741 41 37 33

27 26 25 24 23

84 83 81 8277 73 71 68

63 60

131124 122 119

110100 97 93

87 83

0

20

40

60

80

100

120

140

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Nu

mb

er o

f sc

hem

es

Open schemes Restricted schemes All

Trend in the number of schemes

GLOBAL TRENDS IN HEALTH CARE FINANCING

63

WHAT IS HAPPENING GLOBALLY?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Per

cen

t o

f to

tal h

ealt

h c

are

exp

end

itu

re

Mandatory pre-payment Voluntary pre-payment Out-of-pocket

WHO National Health Accounts dataset (2009 data) 64

Africa – Disaster in the making

65

SOUTH AFRICA IS THE ODD ONE

66

South Africa is an outlier: world’s largest share of spending from VHI

Source: WHO estimates for 2012, countries with population > 600,000 68

World Health Report of the WHO

• The 2008 World Health Report of the WHO details three trends that undermine the improvement of health outcomes globally, namely: – Hospital centrism, which has a strong curative

focus

– Fragmentation in approach which may be related to programmes or service delivery

– Uncontrolled commercialism which undermines principles of health as a public good

69

Solutions

70

Format of the White Paper on NHI

1. White Paper consists of 10 Chapters with 433 paragraphs /sections (as in sections in a legislation)

2. A set of Annexures designed to respond to the National Planning Commission’s visions:

“Furthermore, the NDP envisions that by 2030 there should have been a significant shift in equity, efficiency, effectiveness and quality of healthcare provision......”

These Annexures are:

Annexure A: Ideal Clinic Realisation and Maintanance,

PHC Package, District Hospital Service Package Patient Referral System

Annexure B: Regional, Tertiary and Central Hospital Service Annexure C: Management and Governance of Public Sector Hospitals under NHI Annexure D: Pathology / Radiology and Emergency Medical Services under NHI

71

THE WHITE PAPER ON NHI

72

Way Forward Establishment of NHI Work-streams

• Establishment of the NHI Fund Work Stream 1

• Design of NHI Service benefits Work Stream 2

• Prepare for the purchaser-provider split Work Stream 3

• Future role of medical schemes

Work Stream 4

• Completion of NHI Policy and Development of NHI Legislation

Work Stream 5

• Preparation of the District Health System

Work Stream 6

73

NHI Work-Streams (1) 1. Establishment of the NHI Fund

Lead: 1. Prof Diane McIntyre Full-time 2. Dr Jane Doherty 3. Dr Aquina Thulare Part-time 4. Professor Narnia Bohler-Muller 5. Dr Mark Blecher 6. Ms Wendy Fanoe 7. Dr Joseph Kutzin (WHO)

2. Design of NHI Service benefits

Lead: 1. Dr Yogan Pillay Full-time 2. Dr Jane Doherty 3. Mr Kuben Pillay Part-time 4. Dr Terence Carter 5. Professor Charles Hongoro 6. Prof Diane McIntyre 7. Dr Filip Meheus 8. Professor Karen Hoffman 9. Dr Kalipso Chalkidou (NICE-UK) 10.Mr. Moremi Nkosi 11. Dr Joseph Kutzin (WHO)

74

NHI Work-Streams (2) 3. Prepare for the purchaser-provider split

Lead: 1. Dr Anban Pillay Full-time 2. Mr Kuben Pillay 3. Dr Thabiso Makola Part-time 4. Professor Diane McIntyre 5. Dr John Ataguba 6. Mr Moremi Nkosi 7. Dr Joseph Kutzin (WHO)

4. Future role of medical schemes

Lead: 1. Mr Vishal Brijlal Full-time 2. Mr Moremi Nkosi Part-time 3. Mr Thulani Matsebula 4. Dr Keith Shongwe 5. Dr Aquina Thulare 6. Dr Humphrey Zokufa 6. Dr Joseph Kutzin (WHO)

75

NHI Work-Streams (3)

5. Completion of NHI Policy and Development of NHI Legislation

Lead: 1. Dr Aquina Thulare Full-time 2. Mr Moremi Nkosi Part-Time 3. Professor Diane McIntyre 4. Dr John Ataguba 5. Professor Narnia Bohler-Muller 6. Professor Charles Hongoro 7. Dr Joseph Kutzin (WHO)

6. Preparation of the District Health System

Lead

1. Mr Ramphelane Morewane

Full-time

2. Dr Thabiso Makola

Part-time

3. Professor Jannie Hugo

4. Dr Yogan Pillay

5. Ms Jeanette Hunter

76

THANK YOU

77