SA health welfare starts in small way

Some three weeks ago, the Department of Health (DOH), led by minister of health Dr Aaron Matsoaledi and deputy minister, Dr Gwen Ramokgopa, presented to Parliament the much talked about National Health Amendment Bill seeking to establish an independent entity, the Office of Health Standards Compliance (OHSC), mandated to perform independent oversight on healthcare in South Africa.

At the same time, the minister also named the ten districts in the country identified for the much-awaited pilot of the National  Health Insurance scheme, these pilots to be phased in from 1 April 2012.

The presentation itself focused on Chapter 10 of the Bill, namely the section on “Health Officers and Compliance Procedures” of the Health Act, which involves “six basic core standards for quality healthcare”. The minister said that the Bill sought to enforce cleanliness; safety and security of patients; attitude of health personnel towards patients; infection control inside the institution; management of drug stock-outs in the warehouse and long queues.

84% of the population, he said, received their healthcare in the public sector, resulting in the need for a complete overhaul of the manner in which public hospitals were currently run and added that prices in private healthcare area had to be re-calculated accordingly.

The core question of the presentation, nevertheless, remained the OHSC itself and how it would perform independent oversight on healthcare. Dr Aaron Matsoaledi said OHSC would do this, with or without reference to the Minister, but OHSC, as a body, had to report to the minister.

The OHSC would consist of an inspectorate,  people who had been trained in the United Kingdom, together with “ environment healthcare inspectors”, who would work under the OHSC chief executive.   An ombud would be created which would be in the form of a statutory office that would investigate and decide on accountability. MPs recognised that quite clearly the Bill was a precursor to the proposed National Health Insurance plan discussed and agreed to in principle at cabinet level.

In the past, the Minister took responsibility for any problems that existed in public healthcare but the Bill in this instance also sought to give institutes responsibility and to certify entities that complied with standards and requirements.

The health minister then named the ten districts in the country identified for the much-awaited pilot of the NHI, which will be phased in, he said, from 1 April 2012.

In subsequent parliamentary public hearings, where some forty or fifty presentations have been both made or submitted, the point was made over and over again that clarity did not exist on the surveillance powers of the ombud and the ombud’s inability to settle matters judicially. Many submissions pointed to the lack of cross-reference to consumer legislation recently enacted.

Also the relationship between the ombud and the minister and vice versa were described as unclear and in some cases described as “inoperable”. Some submissions advocated for the use of one set of standards, the ISO 15189, which was stated as being the international standard that the South African National Accreditation System itself used to accredit its laboratories in SA and across the continent.

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