South Africa reported its first case of coronavirus disease 2019 (COVID-19) on 5 March 2020. In the weeks that followed the country saw decisive, strong leadership from President Cyril Ramaphosa. It has also seen significant, important and necessary co-ordination between different ministries. These have included education, justice, health, trade and industry, transport, public works and infrastructure and finance.
The rapid pace at which steps were taken was impressive. More important was the all-encompassing intersectoral approach. Ministries with different mandates and areas of focus are working in concert for a common cause.
Intersectoral action recognises that health and wellbeing is influenced by where and how people live, where they work, what transport they use, and their access to water, sanitation, economic hubs and services. Health is socially determined. To improve health, coordinated action is required between ministries that don’t have health as their core mandate.
This is what “Health in All Policies” is about – a coherent approach to health policies set out by the World Health Organisation that’s been adopted by a number of countries, but by no means all. Without this coordination a long and healthy life for all cannot be achieved.
COVID-19 has dramatically highlighted the need for a more integrated healthcare system.
In a letter published in the South African Medical Journal we argue that the threat that COVID-19 presents has resulted in both leadership from government and apparent willingness of all South Africans to play their part. It presents a number of opportunities that should be exploited to the full.
One stark insight is that pooling resources across the health sector is needed to address this pandemic. This includes the rational use of hospitals, high care beds and laboratory testing capability.
Exemption to help co-ordination
The trend for pooling resources is being encouraged by South Africa’s Competition Commission, which published a COVID-19 block exemption for the healthcare sector.
The exemption seeks to promote co-ordination, sharing of information and standardisation of practice across the entire healthcare sector. The aim is to facilitate cost reduction measures, allowing possible procurement efficiency in purchasing of diagnostic tests, treatment and other preventive measures.
In particular the exemption seeks to promote agreement between the national department of health and the private sector to make facilities available to the public sector. For example, if government wants to use private sector bed capacity it may be able to use its drug related single exit price experience to negotiate the cost.
The makings of a roadmap
Late last year South Africa released a Health Market Inquiry report. It found excessive use of private health care; more care was delivered than could be explained by the level of illness of the private sector population.
The report also found that the sector would benefit from better regulation.
It made a number of recommendations that promote standardisation and knowledge-sharing as well as a method to deal with pricing within the functions of the proposed supply-side regulator.
The supply-side regulator includes systems which would allow for a real time description of:
providers – which ones exist and where they’re operating
where beds are located, their purpose (medical or surgical) and level of care (general, high care or intensive care), and
information on utilisation rates.
The report set out how the regulator could rationalise various functions which are currently poorly coordinated or absent across the private and public sector.
The report emphasised that the efficiency of, and access to, care required having information about health sector capability and quality across the entire health sector. This would enable resources to be used rationally.
The COVID-19 pandemic has underscored that such an approach is essential.
Set up this way, the regulator would form an essential mechanism going forward to ensure that South Africa was prepared for possible future emergencies.
Learning from COVID-19
There are two lessons here. For the health sector the need for more coherent integration is undeniable. Perhaps this exemption and working together to protect South Africa from the effects of this pandemic can build trust between players and will ease South Africans into a more rational and integrated healthcare system.
The second lesson is about intersectoral action and Health in all Policies that South Africa has seen illustrated to mitigate the threat of COVID-19. Poverty, inequality and unemployment similarly threaten the wellbeing of individuals in South Africa.
Equally urgent is the need to develop a mindset that understands that all policies aimed at development require integrated action. This means involving a range of players across government departments, across the public private divide, and must include social mobilisation and engagement with communities. The response to COVID-19 illustrates this well.
South Africa has managed to do this for health. It must be possible to do it in other areas of public policy. This needs to be extended further to build a more equal South Africa.