HEALTH CHARTER

1. HEALTH CHARTER Presentation to the Portfolio Committee August 2005

2. HEALTH CHARTER AREAS OF TRANSFORMATION Access to health care services Equity in health care Quality of health care Broad Based Black Economic Empowerment

3. Access to Health Services • Inadequate access to health services due to: • Geographical • Financial • Physical • Communication • Sociological

4. Access to Health Services • Access to medical schemes is diminishing • Inequitable application of resources results in inadequate access • Providing health services at low cost • Geographical inequities skewed towards urban and private sector

5. Number of Medical Scheme Beneficiaries 1974 - 2003

6. Number of Beneficiaries of Registered Medical Schemes 2000-2004

7. Equity in Health Services • Equal access to equal care for equal need in which resources are efficiently utilised in a fair manner • Inefficient and inequitable distribution of resources between public and private sector relative to population served • Inequity between provinces

8. Equity in Health Services • Private sector membership becoming unaffordable • Membership has decreased • Rapid increases in private hospital expenditure • Increase in non-health expenditure • Out of pocket payments

9. Equity in Health Services SA - Health System 2002/2003 Public sector R33.2 billion Serves 37.9 m Serves 6.9 m Private sector R43 billion Pcap = R875.98 R72.99 pm pp Pcap = R6231.88 R519.32 pmpb

10. Growth in Scheme Expenditure on Private Hospitals, 1997-2003 • In real terms, between 1997 and 2003: • total private hospital benefits grew by 65.8% • ward fees grew by 45.2% • medicine benefits increased by 84.0% • consumables increased by 74.0% • theatre fees increased by 94.3%

11. Proportions of Benefits Paid by Medical Schemes in 1990

12. Proportions of Benefits Paid by Medical Schemes in 2003

13. Benefits Paid on Hospitals in Real Terms (2003 Rands), 1990 to 2003

14. Quality of Health Services • Low cost options should not be low quality options • Current business models • Sustainability: Elimination of inefficiencies, duplication of resources, cost ineffectiveness • Price competition

15. Broad Based Black Economic Empowerment • Levels of ownership • Equity in ownership • Procurement • Employment Equity • Corporate social investment • PPIs

16. Way Forward • In the Charter document the parties make various resolutions and put forward solutions in respect of each key area • The document is released to the broader stakeholder body for comments and inputs. • View constructively, and if you don’t agree put forward alternatives

17. Proposed Solutions & Resolutions ACCESS • Investigating the feasibility of the creation of a category of independent practitioners to be contracted to the state in order to improve access to health care at the primary level; • Appropriately increasing the range of health services available to under serviced communities using solutions tailored to meet the needs of the particular community;

18. Proposed Solutions & Resolutions ACCESS • Provision of information to address the particular needs of vulnerable groups, including people living in rural and under serviced areas and the illiterate; • Public private initiatives to more efficiently utilise available resources, reduce inequities and improve access to provision & financing of health services;

19. Proposed Solutions & Resolutions ACCESS • Providing or sponsoring health profession education, training and development which includes - • Formal health training and education; • Continuing Professional Development education, sponsored programmes and events in relevant categories of health care personnel; • Management & Leadership programme provision or sponsorship;

20. Proposed Solutions & Resolutions ACCESS • Using existing funding mechanisms such as the skills development levy to more efficiently and effectively provide financial support to students who wish to study in the health field. • Sector marketing and career education campaign • Attracting home qualified South Africans

21. Proposed Solutions & Resolutions EQUITY • Developing a minimum defined basic package of care that is available to all patients in both the public and the private sectors • The elimination of inefficiencies from health service delivery; • Zero tolerance of unfair discrimination

22. Proposed Solutions & Resolutions EQUITY • Setting annual targets for recruiting, training and retention of health care personnel; • Setting out milestone leadership programmes with curricula that meet the needs of health organisations; • Developing a code of practice on the ethical recruitment of health professionals;

23. Proposed Solutions & Resolutions • Putting in place programmes that result in the broader representation of black persons in the workplace. • It is the target at all levels in the chain that by 2010 the workplace will be 60% black across the value chain and will comprise 50% women. • Also it is a target that by 2014 the workplace will be 70% black across the value chain and shall comprise 60% women.

24. Proposed Solutions & Resolutions QUALITY • The implementation of benchmarked quality assurance programmes that include the measurement of health outcomes • The consideration of complaints by users and the use of such complaints to inform the planning and delivery of health services so as to be able to continually improve the quality of health care

25. Proposed Solutions & Resolutions QUALITY • Development of low cost health service and financing options accessible to low and middle income groups and that assure value for money in terms of health outcomes; • Conducting regular and sustained training programmes for health care personnel on the rights of patients and the Batho Pele principles;

26. Proposed Solutions & Resolutions BBBEE • Each of the firms or businesses in the healthcare sector shall be at least 26% owned and/or controlled by or black people. This process should commence immediately. • Further, by 2010 at least each of the firms or businesses in the healthcare sector shall be 35% owned and/or controlled by black people. • Equity ownership by black people shall increase to 51% by 2014.

27. Proposed Solutions & Resolutions • Procurement policies favourable to firms owned or controlled by black people will be implemented. Stakeholders commit to supporting government on these initiatives especially in the areas of: • hospitality services and general procurement • pharmaceutical products and medicines • medical equipment • professional services • IT systems • distribution and wholesaling services

28. Proposed Solutions & Resolutions BBBEE • At least 60% of all procurement shall be from black owned firms or black persons by 2010. By 2014 this should increase to 80%. • Private sector expenditure on social responsibility projects providing funding and resources for new and existing community development projects.

29. Proposed Solutions & Resolutions • Development finance must be derived from three sources, partially from DFIs, particularly where the risk profile excludes other sources, with the majority sourced from mainstream financial institutions and vendors themselves. • There must be a concerted effort from both public and private sector to approach parastatal funding institutions to come up with ways of funding BBBEE transactions in the health sector as it is not affordable for current banking institutions to fund such transactions.

30. Implementation • Implementation a process: Flexible to allow for changes and adjustments • Mechanism must be developed to monitor • Health Charter Committee under National Consultative Health Forum • Proposals put forward to enable health sector to go beyond other charters

31. Thank you