Amendments suggested to National Health Bill

1. Amendments suggested to National Health Bill Presenters: Lee Padayachee Almo Lobowski Andre Jacobs Joint presentation by BUSA and FPI to the portfolio committee on Health: 16 March 2012

2. An overview of BUSA • Business Unity South Africa is a confederation of business organisations including chambers of commerce and industry, professional associations, corporate associations and unisectoral organisations. It represents South African business, including small and medium enterprises, on macro-economic and high-level issues that affect it at the national and international levels. • BUSA’s function is to ensure that business plays a constructive role in the country’s economic growth, development and transformation and to create an environment in which businesses of all sizes and in all sectors can thrive, expand and be competitive. • As the principal representative of business in South Africa, BUSA represents the views of its members in a number of national structures and bodies, both statutory and non-statutory. BUSA also represents Business' interests in the National Economic Development and Labour Council (NEDLAC).

3. An overview of the FPI • The Financial Planning Institute (FPI) is the premier independent professional body in the financial services sector with over 30 years of service in being the forerunner in setting financial planning standards and representing professional Financial Planners in South Africa. • The FPI currently has approximately 7 000 members and is affiliated to the Financial Planning Standards Board (FPSB), the Ethics Institute of South Africa and to Business Unity South Africa (BUSA). The FPI is also involved in a number of work streams of the Financial Services Board(FSB).

4. An overview of the FPI • The role of the financial planner particularly in the highly regulated healthcare environment has changed substantially. The financial planner is in a position where they are the trusted friend and advisor on tax, investments, financial planning and personal wellness. • The FPI members are highly skilled individuals who are proficient in employer, employee and trade union engagement related to a number of human resources matters. This positions the financial planner as an expert in risk assessments as well as communicator of the impact of the various risks and product solutions. • The advice, guidance, training and communication of NHI and other healthcare solutions should be no different. The focus has been placed on what the planner/advisor earns for services but the focus has not been on what the planner/advisor does and is required to deliver in the face of various pieces of legislation.

5. An overview of the FPI • According to the Council for Medical Schemes R1.3 billion was paid to independent advisors for the year. This equates to 2.44 million (average of R44.4 per member) members represented by advisors. This is an indication of how well financial advisors are positioned within the healthcare sector to add continuous value. • FPI as an organisation can equip people who will be employed in NHI management and employee structures to understand the complex healthcare and financial environment they will be operating in. The FPI upholds high levels of standards as well as focussing on the code of conduct necessary in the regulatory frameworks. • Information, training material as well as exams, where necessary, are readily available through the use of technology through the FPI, giving people easy access throughout the country.

6. General comment on the Health Amendment Bill • Support establishment of: • Office of Health Standards Compliance (OHSC) • Office of a health Ombud. • Additions to the National Health Bill as proposed - in line with the 10-point health plan government embarked on. • The additions will lay the foundation to improve healthcare delivery and protect consumers of health care. • The transformation of the healthcare system in South Africa - catalyst for social cohesion ( Mexico). • Require involvement of all stakeholders to in concert with societies needs co-design and manage a transformed quality and affordable healthcare system that is responsive to the needs of all citizens. • The expertise of business, Organised Labour and Civil Society should be leveraged to ensure that adequate governance and checks and balances are established to enhance the accountability of the OHSC and the Ombud.

7. Specific amendments to the National Health Bill for consideration • Appointment of the CEO of the OHSC: Amend proposed section 79A (1) to read as follows: “ The Minster must, after consultation with NEDLAC, subject to the laws governing the public service, appoint a fit and proper and suitably qualified South African citizen as the Chief Executive Officer of the Office” • Appointment of the Ombud: Amend proposed section 81 (1) to read as follows: “ The Minster must, after consultation with NEDLAC, appoint a fit and proper and suitably qualified South African citizen as Ombud” • Functions of the Ombud: Amend proposed section 81A to add an additional sub section to read as follows: “The Ombud to consult where appropriate and desirable with the Consumer Commissioner”

8. The WHO definition of a Health system A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health . This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services. It includes, for example, a mother caring for a sick child at home; private providers; behaviour change programmes; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well known determinant of better health.  Source: Everybody business : strengthening health systems to improve health outcomes : WHO’s framework for action. ISBN 978 92 4 159607 7 World Health Organization 2007

9. The WHO Health System Framework Source: Everybody business : strengthening health systems to improve health outcomes : WHO’s framework for action. ISBN 978 92 4 159607 7 World Health Organization 2007

10. The WHO on leadership and governance The leadership and governance of health systems, also called stewardship, is arguably the most complex but critical building block of any health system. It is about the role of the government in health and its relation to other actors whose activities impact on health. This involves overseeing and guiding the whole health system, private as well as public, in order to protect the public interest. It requires both political and technical action, because it involves reconciling competing demands for limited resources, in changing circumstances, for example, with rising expectations, more pluralistic societies, decentralization or a growing private sector. There is increased attention to corruption, and calls for a more human rights based approach to health. There is no blueprint for effective health leadership and governance. While ultimately it is the responsibility of government, this does not mean all leadership and governance functions have to be carried out by central ministries of health Source: Everybody business : strengthening health systems to improve health outcomes : WHO’s framework for action. ISBN 978 92 4 159607 7 World Health Organization 2007

11. The WHO on leadership and governance The leadership and governance of health systems, also called stewardship, is arguably the most complex but critical building block of any health system. It is about the role of the government in health and its relation to other actors whose activities impact on health. This involves overseeing and guiding the whole health system, private as well as public, in order to protect the public interest. It requires both political and technical action, because it involves reconciling competing demands for limited resources, in changing circumstances, for example, with rising expectations, more pluralistic societies, decentralization or a growing private sector. There is increased attention to corruption, and calls for a more human rights based approach to health. There is no blueprint for effective health leadership and governance. While ultimately it is the responsibility of government, this does not mean all leadership and governance functions have to be carried out by central ministries of health Source: Everybody business : strengthening health systems to improve health outcomes : WHO’s framework for action. ISBN 978 92 4 159607 7 World Health Organization 2007

12. Precedent in South Africa supporting the proposal • The Private sector, civic organisations and organised labour play a vital role in combatting HIV/AIDS. (SPEECH DELIVERED BY E CAPE, M.E.C. FOR HEALTH, DR BM GOQWANA, TO MARK OPENING OF NEW CLINICS IN TABANKULU & MALUTI, 14 & 15 September 2000) • The governance model of the UIF Fund consists of the Private sector, civic organisations and organised labour and government. • The State President consult the Judicial Services Commission before the appointment of Judges. • Members of the Council for Medical Schemes are appointed from the private sector after open nominations.

13. Advantages of the proposal • The Private sector, civic organisations and organised labour play become part of the solution: • Health reform is every body’s responsibility • Co-design and ownership of health reform • Reduce polarisation between healthcare reform and the private sector • Accelerated delivery: • Appointment need not be justified • Appointee can focus on task at hand and need not justify his or her appointment

14. Concluding remarks BUSA and it’s members are committed to in concert with societies needs co-design and co-manage a transformed quality and affordable healthcare system that is responsive to the needs of all citizens. BUSA and FPI appreciate the opportunity to be able to share our views , commitment and support with the Portfolio Committee on health. Thank you.