Minister Botha's address to the Pharmaceutical Society of South Africa

Chairperson of the Pharmaceutical Society of South Africa, Ms Ronel Boshoff
Chairman of Community Pharmacists Sector, Mr. Kobus le Roux
Chairman of the Academy of Pharmaceutical Sciences, Prof Sarel Malan
SA Pharmacy Council members
Past Chairmen, past Presidents of the Society, and Honorary Life Members Guests

Background information:

• The Pharmaceutical Society of SA is the largest professional organization of pharmacists in the country, representing 6000 members from all practice sectors and geographic areas.
• The Western Province branch represents more than 1000 members in the Western Cape.
• The audience is public and private pharmacists.
• 60% work in community pharmacy
• 30% work in hospital and institutional pharmacies
• 10%work in industry or academia

Introduction: 

When Premier Helen Zille was mayor, she was awarded the best mayor in the world. Now she is Premier and she has set her target for this province to be the best-run regional government in the world.

From an economic development point of view, we regard the health sector as one of the most important areas to create economic growth. The Western Cape has the potential to become a popular health destination. On the path to a caring society - Increasing wellness - we have instituted our vision for 2020, called Health Care 2020. At the core of the vision of 2020 is patient-centred quality care. Particularly in the eyes of the patient, the patient experience is as important as the outcome of the treatment, and the respectful treatment of the patient. The Department will put multi-level interventions in place to address staff behaviour and approach towards patients.

A patient-centred health system
An affordable, high quality and easily accessible health system requires both a dependable primary care network - that prevents diseases and treats minor illnesses - and a quality secondary and tertiary network to provide hospital-based care for more serious illnesses.

South Africa's current health system is divided into great extremes of quality, efficiency and customer-friendliness, which has created a situation where no single part of the system is able to meet all the needs of our patients.

NHI
Our research shows that it will actually work against its stated objective to provide improved quality health services for all South Africans. The NHI will create a bureaucratic and inefficient healthcare superstructure that will diminish the quality of public healthcare.

We did extensive research and consulted with economists and professionals before we submitted a comprehensive reply to the Green Paper. In our reply we point out number of reasons why the NHI will not improve the quality of health care to the poor.

1. NHI does not fix the real problem of low-quality healthcare provision in the public sector. Instead, the Green Paper focuses on accessibility and finance, when we already have universal accessibility and enough funding to run a quality public health system. What it lacks is quality, which should be the government's main priority.
2. NHI does not adequately attend to accountability and management structures. While the Green Paper calls for an Office of Standards Compliance - which we support in principle - but its members will be appointed by, and answer to, the Health Minister. It will not be independent, making it vulnerable to political influence and manipulation.
3. We lack the human resources to implement NHI which demands that we triple the 27,000 doctors that we currently have. But we only train enough doctors each year to keep pace with the numbers who retire or emigrate. The state is unable to train the necessary number of doctors to implement NHI.
4. The creation of a centralised fund will over-bureaucratise the public healthcare system rendering it more inefficient and costly than it is currently. The size and scope of our department will be reduced to that of a branch office of the national department. It will also carry an increased risk of major corruption and financial mismanagement. Under the current system, the National Department of Health racked up R43 million worth of irregular expenditure last year alone.
5. Throwing money at a problem does not always solve it. South Africa spends R2 766 on public healthcare per person each year - far more than other developing countries. Malaysia, for instance, spends only R2 180 per person, Thailand just R1 700 per person, Namibia only R1 594 per person and China a mere R846 per capita. These countries enjoy higher levels of life expectancy than South Africa, which suggests that money is not the primary problem with our public healthcare system.

As a provincial government we regard it as extremely important to know our constitutional status within the South African state, and I invite you to explore the possibility for us to implement alternatives - even through provincial legislation.

What then, is the alternative to the NHI - Universal Health Care
Universal Health Care is built on a primary health care basis, from where patients referred to regional and specialised facilities according to their medical needs, and government providing the transport infrastructure. The rest is governance based on good business principles - financial discipline, efficiency, equality, modernization, monitoring and evaluation.

In the Western Cape we offer a model of healthcare provision that leverages our system's strengths, minimizes its deficiencies and delivers good health services in a responsible and sustainable manner. And we do not blame the private sector for any difficulties we face; rather, we seek out public-private partnerships so that we can both participate in the improvement of the province's total health service effort. At the heart of our provincial system is a commitment to accountability, affordability and efficiency - all necessary elements for high-quality health outcomes.

The lesson we have learned in the Western Cape is that we can improve healthcare for everyone

• by strengthening the positive elements of the public sector
• and removing its deficiencies on a planned and sustained basis.

Our policies in the Western Cape are working to achieve this at a provincial level. There is no reason why these strategies can't work for the rest of the country as well.

Public private cooperation
We believe, and international experience supports this, that the most effective model of health care delivery involves a partnership between the state and the private sector.

Within this environment the private sector would co-operate with the state to deploy its expertise, currently only available to a small number of paying patients, to provide quality health care on a far larger scale.

As owners of small- and medium-sized private enterprises, I understand your concerns with regard to larger corporate players such as Clicks and Dischem.

I want to reassure you that there is a role for every industry player, and I would like to take this opportunity to invite you to join the Western Cape Public Private Health Forum, where we address and formulate your concerns and feed them into the Support Services directorate.

There is a great need for us to provide additional access points for basic primary healthcare services to our public patients. Pharmacy sites, prescribing pharmacists and professional nurse-led services will be key in the evolution of such a partnership.

We have no one formula for partnering with the private sector, but are open to discussing proposals and to finding ways to make innovative partnership solutions a reality.

Cost-effective medicine supply
I understand that there are pharmaceutical issues affecting the private sector, but not necessarily pharmacists in the public sector. The intention behind opening up ownership was to make medicine more accessible to all, but exactly the opposite has happened. New pharmacies have opened in the more affluent areas and not in the poor areas.

The legislated application for a licence to non-pharmacists to sell medicines in areas where there are no pharmacies requires proof of a need for such a service. From the beginning this legislation proved erratic and as a result the National Department of Health issues licences without investigating a need for the service. The result is that there is no control over where pharmacies are situated.

In order for the private health sector to operate optimally, the playing field needs to be level for both public and private pharmacists. In order to achieve this, government needs the smaller and medium enterprises. We cannot operate with only the Clicks and the Dischems. I invite you to engage with me on this so that we can find a solution and drive your cause.

It was relatively easy to transact Clicks as a company. The challenge is for our independent pharmacies to organise themselves in an entity with which we can do the same business as with Clicks - strategic partnership outlets.

Tying in with the strategic objective of increasing wellness, we are promulgating the principle of preventing illness through wellness clinics. Smaller pharmacy enterprises - especially in rural areas - can be contracted to become our centres for basic testing such as regular cholesterol and blood pressure tests - and have the potential to become depots for the distribution of chronic medication.

As with the legislation for non-pharmacists, with the introduction of the Single Exit Price system for medicines, the intention was that all tenderers would pay the same price. However, the industry found a way around this, as an innovative entrepreneur should, and now we have the introduction of bonuses, sampling and discounts. I agree that the Medicine Control Council should be monitoring and prosecuting where necessary. The structure and working of the pricing committee should be reviewed.

Distribution of chronic medication
Governments that have brought about real improvements in people's lives are those in which innovation, renewal and the pursuit of excellence have been placed at the centre of government business.

The need for dispensing of medicine for chronic diseases to be done in one facility and dispatched or delivered directly to the patient is growing. No patient should have to spend hours or days in a queue to obtain the medicine they have been prescribed.

Although the Chronic Dispensing Unit has been in operation in select areas of the city, a lot of work needs to be done in this regard. Mechanization in pharmacy is being investigated, and our planning is that patients will be able to collect their medicine from a local pharmacy. If you position yourself correctly, that could be your pharmacy.

The new tender for the distribution of chronic medication was awarded to the largest logistics company in the world - UTi. It is a five year contract and will take care of the packing and packaging of chronic medication, according to international prescriptions. It is our intention to expand this project to cover the whole province.

Implementation of pharmaceutical care
The South African Pharmacy Council conducted a human resource survey and the shortage of qualified pharmacists was again identified. One reason is the shortage in training facilities which cannot produce the necessary numbers needed in the profession. In this regard we have fostered good relationships with the universities, and want to strengthen the output of the Pharmaceutical School at the University of the Western Cape as I regard it as a valuable provincial asset.

Just to put Western Cape numbers in context - in total there are 2170 registered pharmacists in the Western Cape and 38 interns. Western Cape Government Health employs 360 pharmacists, including community service pharmacists, and 23 Interns, but the country needs to train at least 600 pharmacists per year to meet the national demand.

There is also a huge shortage of pharmacy assistants. In an attempt to alleviate this Western Cape Government Health has appointed 110 learner pharmacist's assistants in pharmacies across the province with funds from the Extended Public Works Programme. Pharmacists will be training them on site. These are in addition to the approximately 400 pharmacy assistants who are permanently employed.

At the same time the pharmacist assistant is to be phased out and from next year a more specialised mid-level worker called technical assistants and technicians will start training.

A proposal has been sent to the Ministers of Higher Education and Health to investigate extending the present facilities and/or opening new schools for the specialised training of technical assistants and technicians. We anticipate a crisis in services until the first graduates emerge.

In closing

I would like to institute a formal engagement of this society with me, periodically - say twice a year - and to reiterate my invitation to you to engage with us via the Public Private Health Forum, and via this society, and bring your proposals to the table. For specific proposals, you are also welcome to engage with Amanda Brinkmann, Head of Strategic Partnerships in our province. She is located within the ministry.

We are living at a time in South Africa where there is much room for improvement, and it is only through the active participation of our stakeholders that we are able to effect the right changes.

Due to the political and constitutional independence of the Western Cape, we as a sector - public and private - have the potential to structure our business to suit our requirements and objectives. Use it, or lose it.

Media Enquiries: 

Helene Rossouw
Media Liaison for Western Cape Minister of Health
Cell: 082 771 8834
Tel: 021 483 4426
E-mail: helene.rossouw@westerncape.gov.za