article July 15 2020……
Hopes for transversal tendering by 2025/26
….Dr Gail Andrews, Chief Operations Officer at Department of Health (DoH), told Parliament that the department hopes to have a “public transversal contract” in place before 2025 for core health supplies and low-value equipment, this installed with the principle in mind of reducing buy-outs and deriving economies of scale”. She was speaking at an annual up date to parliamentarians on the department’s annual plans for the current year.
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Dr Andrews also told MPs that it is DoH’s hope that such a single process will “do away with stock outs on medicines in 100% of state health facilities
and achieve the required target of having 100% of all primary health care facilities, with attached cost accounting centres.”
Dr Andrews was with Deputy Minister of Health, Deputy Minister, Dr Joe Phaahla, who said that the current allocation for DoH was R55.5 bn of which R49.2bn was for operational costs and the balance grants and special funds.
He noted that life-expectancy in SA is currently at 64.7 years of age, the highest it has ever been with an upward trajectory. In the next 5 years, the department aims to achieve a life expectancy of 70 years by 2030 in line with UN developmental goals, which the country subscribes to. He said the National Health Insurance Bill was one of the pillars supporting this goal.
Through its proposed package of services, he said, the NHI Fund will have “transversal process which will distribute to the population based on equity and cost effectiveness.” The definition of “transversal”, as far as we can establish is ‘govspeak’ for a horizontal management control line through a multitude of different factors.
When Audrey Maleka (ANC) asked how Covid 19 had affected DoH plans to institute NHI once the Bill was processed through Parliament, Dr Andrews said that lockdown has done two things. It had reduced the potential mortality by about two million citizens and had pushed forward the peak of Covid 19 infection by about six weeks.
However, lockdown has disrupted access to health services badly, she told MPs, pushing back both TB and HIV programmes in time frames, mainly thought to be as a result of lack of access to public transport.
DoH has been working with the provinces frantically for the last two weeks developing catch up plans ramping up the centralised chronic medication dispensing and distribution system and by increasing the duration of medication packages to lessen the frequency of patients returning to dispensary points, Dr Andrews said.
An initial budget of R20m is earmarked, parliamentarians were told, for the establishment of the NHI to put interim structures in place before the passing of the Bill with R995m being the set-aside sum towards the funding of the NHI scheme. The Health Patients Registration System currently has over 40 million people registered, she said, and one of the measures put in place to prepare for the Bill’s implementation.
DoH hopes to see 46 million people registered on the Health Patients Registration System; to have a national accreditation framework for primary healthcare facilities and general practitioners in place; and a service benefit framework primary healthcare system up and running before the Bill is law.
Dr Andrews concluded that DoH had to ensure that a master health facility list was published on an electronic platform which gave the overall and total number of facilities reporting stock for its central surveillance centre.
Prof. Jannie Rossouw (Wits), and economist Mike Holland, then addressed the Committee in virtual telling MPs that they had calculated that NHI as a health system would cost, in totality, some R226bn in the form of financing by 2026, both noting that the actual financing gap would be R166.5bn, based on 2010 figures, but allowing for a hike now of 12,3% for 2019.
They suspected that a ‘revenue search’ would include looking at income tax; companies tax; possibly from a payroll tax or even VAT. Both noted that Treasury had earlier said that the roll out of the NHI in their view would require an addition of R33bn to revenue requirements in possibly the 2025/26 financial year, which they both saw as a possible year of implementation.