SPEECH BY THE MINISTER OF HEALTH: SOUTH AFRICA DR AARON MOTSOALEDI INTERNATIONAL SYMPOSIUM ON DESIGN AND HEALTH IN QATAR, DOHA

Transcription

1 SPEECH BY THE MINISTER OF HEALTH: SOUTH AFRICA DR AARON MOTSOALEDI INTERNATIONAL SYMPOSIUM ON DESIGN AND HEALTH IN QATAR, DOHA ROLE OF INFRASTRUCTURE IN THE NATIONAL HEALTH AGENDA IN AFRICA NOVEMBER

2 Thank you very much for inviting me to this very important Symposium, to share knowledge in the trend of Design and in order to improve the quality of health infrastructure. I have decided to focus my attention on the African Continent because I believe it is the one better placed to demonstrate my message. Ladies and Gentlemen, a great transition seems to be sweeping the Globe, changing how healthcare is financed and how health systems are organised. 2 This transition is called Universal Coverage with countries adopting different terminologies to describe it Obamacare in America; NHS in the UK; NHI in Thailand, Finland, Norway; Seguro Popular in Mexico and in my own country, the envisaged NHI.

3 According to the British Medical Journal, the Lancet, there have been two transitions in the history of the World the 1 st one occurring in the 18 th Century, called Demographic Transition. It was when public health improvements were instituted in the form of basic sewerage and sanitation. This greatly reduced premature death in the World. The 2 nd Transition, called the Epidemiological Transition, began in the 20 th Century to reach even the most challenged country in the 21 st Century. This was when vaccines were introduced to eradicate or control Communicable diseases on a scale never imagined. Universal Coverage is to be the 3 rd Global Transition in. It would have been achieved when every citizen, in every part of the Globe, has a right to access to good quality, affordable healthcare, and that access not to be determined by the socioeconomic condition of the individual. 3 Deloitte

4 According to the World Organisation (WHO), a healthcare system has got six (6) building blocks. 1. Leadership and Governance; 2. Access to essential medicines and other commodities; 3. workforce (Human Resources); 4. Systems Financing; 5. Information systems; and 6. Service delivery systems. Over the years, many countries around the world concentrated on the others and avoided System Financing at worst or at best paid some form of lip service to it. This left millions around the world without proper access to good healthcare. 4

5 The World is now waking up to realise that this pillar of healthcare, i.e Systems Financing, can no longer be ignored. That is why it is being regarde as a great transition. But because it is going to bring in millions and millions of previously marginalised people into the healthcare system. If you bring a large number of people into health care systems that were generally designed for a previlaged few, the chances of collapse of quality if there is no good planning are always a threat. Hence the concept of good quality healthcare has to become a central focus. 5 I chose to concentrate on the African Continent because once Universal Coverage sweeps the Globe, Africa is definitely going to experience a serious problem on the issue of quality.

6 In addressing the World Assembly, an annual gathering of all Ministers of from the 194 Member States of the United Nations, in May this year, the World Bank Group President, Dr Jim Yong Kim, on the very subject of Universal Coverage, pointed that this Universal Coverage has three (3) dimensions to it, i.e 1. Access; 2. Quality; and 3. Affordability. In my understanding access and Quality can simply not happen without proper infrastructure. It is just impossible. 6 This is where the issue of Design and fits in, i.e to provide access to good quality health care!!

7 Dr Kim further had this to say: To end poverty and boost shared prosperity, countries need robust, inclusive economic growth. And to drive growth, they need to build human capital through investments in health, education and social protection for all their citizens. To free the World from absolute poverty by 2030, countries must ensure that all of their citizens have access to quality, affordable health services. Coming back to why I wish to focus on the African Continent, the Director of the World Organisation (WHO) Africa Region, Dr Luis Sambo, convened all Ministers of and of Finance (Treasuries) of the African Continent in Tunisia in July 2012, to discuss this concept of Universal Coverage. 7

8 In his address he outlined the purpose of Universal Coverage as being to: meet population health needs; remove financial barriers to healthcare; reduce incidences of catastrophic health expenditures; facilitate the attainment of nationally and international agreed health goals; and ultimately contribute to better quality of life, poverty alleviation and human development. He said however, for this concept and its purpose to take root on the African Continent, four (4) thrusts are proposed. I will for now, leave the other three (3) and concentrate rather on the 1 st one and I quote: 8

9 First, strengthening the capacity of public health infrastructure to provide effective, safe and quality health services. Infrastructure includes staffing; buildings; technologies; utilities such as power and water supply; waste management; transport and communication; and financing investments, maintenance and recurring costs. infrastructure entails public investments and Governments will have to explore innovative ways of harnessing the resources of the private sector, Non- Government Organisations (NGOs) and Communities. If you do not come from the Continent of Africa, you may not understand the immensity of this approach by Doctor Sambo. I fully affiliate to it for I appreciate why such an approach is essential. Hence in South Africa, the whole concept of NHI is being planned along these very thrusts as proposed by Dr Luis 9 Sambo.

10 Within the Department of in South Africa, we have established a special unit called Infrastructure Unit System Support (IUSS). Ordinarily, this never used to be the case in South Africa, because the whole function of Infrastructure was placed within another Ministry the Ministry of Public Works. But we have recognised the centrality of a health infrastructure to the provision of good quality healthcare. Furthermore, the World Organisation (WHO) has developed a Service availability and readiness assessment methodology to provide a standard health facility assessment tool, to assess, map and monitor service availability and readiness. 10

11 It is designed to support health facility census with a focus on the care functional capacities availability of services. Among the more or less ten (10) standards assessed in this tool, is facility infrastructure and amenities, such as availability of water supply, telecommunications and electricity. In following this methodology, we in South Africa have already sent assessment teams to facilities to assess the infrastructure along similar lines. To demonstrate what I was saying, I need to show you a few slides. 11

12 Leadershi p and Governan ce Service Delivery Systems WHO ( World Organization) The six building block of a health care system Access to essential Medicine Work force The spikes of the wheel of the six building blocks are red so it can not turn System Financin g

13 Service Delivery Systems Leadershi p and Governan ce WHO ( World Organization) The six building block of A health care system System Financing Access to essential Medicine Work force Over the years many countri es turned only five spikes to green

14 Service Delivery Systems Leadershi p and Governan ce WHO ( World Organization) The six building block of a health care system System Financin g Access to essential Medicine Work force The third Global transition of health care (Universal Coverage) Countri es now realise that unless the sixth spike is also green, no movem ent

15 Leadershi p and Governan ce Service Delivery Systems WHO ( World Organization) The six building block of a health care system Access to essential Medicine Work force Now the wheel can turn! System Financin g

16 Affordability of the health system Service Delivery Systems Leadershi p and Governan ce WHO ( World Organization) The six building l of a health care system System Financing Access to essential Medicine Work force Good quality health care Continuit y and sustaina bility of the moveme nt depends on Good Quality health care and Affordabi lity

17 Buildings Transp ort, commu nication Good quality of health care depends on good infrastructure Water supply

18 Preventio n of diseases Modificati on of mind set Appropriate Facility design Must reflect all these corner stones Less curative health facility design Promotio n Salutog enic health infrastru cture corner stones of affordabl e health care system

19 9 19 Deloitte Source: CSIR:

20 20 Deloitte Source: CSIR:

21 District Hospital Assessments: Compilation of Report Section A Photo Report. Section B Asset Maintenance Plan Section C Work Instructions Section D Reference Photographs Section E Specifications Section F Asset Register Section G Schematic Layout Plans The Work Instructions compiled for each facility include the following: Building Structural: include all building structural elements i.e. roofs, doors, walls, ironmongery, etc. Building Wet Services: items include all plumbing, drainage and sanitary related items Electrical: includes light fittings, switches, sockets, etc. Civil Infrastructure: external water and sewer reticulation, roads, storm water, fencing, cleaning and site keeping Mechanical Equipment and Installations: HVAC, Steam Generation, Steam Distribution, Hot Water Generating, Kitchen Equipment and Laundry Equipment 21 Deloitte

22 The Photo Report of each of the District Hospitals were compiled as an overview of the Specific Hospital: Structural and Building work Plumbing & Wet Services Electrical Fencing, Cleaning and Site Keeping Water- and Sewer reticulation Roads and Storm water External lighting Air-conditioning Mechanical Equipment Fire fighting equipment The Asset Maintenance Plan for each facility will divided into the following: Scope Maintenance Control Mandatory Periodical Servicing Operation of Installations Reference photographs have been included for each work instruction individually: Work Instruction Reference Photo Photo Number Layout Drawing Reference Number included on Layout Drawing 22 Deloitte

23 Pretoria West District Hospital Sanitary and Brassware fittings Electrical fittings. 103 External light fittings m Palisade Fencing m 2 Asphalt Surface m 2 Interlocking Paving. 58 Air-conditioning units. 235 Fire Fighting Equipment fittings. 1 Standby Generator 42 Mechanical Fixtures

24 The main envisaged infrastructure projects under considerations in South Africa are six mega hospitals attached to medical schools. These are regarded as health flagship projects. They are going to serve two purposes, Provide quality care under universal health coverage Improve human resources by doubling or even trebling the number of trained health workers But the most talked about envisaged health infrastructure project is the Nelson Mandela Children Hospital. It is also going to serve two purposes To provide good quality health care for childern of Southern Africa, not only South Africa To serve as everlasting legacy project for the World Icon That is why this hospital is going to be built with money raised through fund raising from corporate business, philanthropist and even ordinary South Africans, who started contributing individually on Nelson Mandela 24 Deloitte Day.

25 Thank You 25