The National Health Insurance (NHI) is a project with all South Africans as stakeholders. Many have endured decades of disillusionment with the country’s healthcare system. They are often sceptical about when, and even if, the universal healthcare promised to them as a right under the Constitution will ever be delivered.
At the Innovative Pharmaceutical Association of SA (Ipasa), we recognise the socioeconomic injustices, imbalances and inequities of the past, the need to establish a society based on democratic values, social justice and fundamental human rights, and the need to improve the quality of life of all citizens.
Accordingly, we embrace the department of health’s attempts to address these issues and wholeheartedly support the concept of universal healthcare and its implementation through the NHI. We are enthusiastic about offering our inputs to the NHI Bill.
Ipasa, however, emphasises the importance of addressing these issues in a reasonable, legally permissible, practical and sustainable manner.
The NHI policymakers and implementation teams are aware of the risk of simply rebranding the all too familiar public health system as the new answer to everybody’s prayers. But the complexity of constructing, financing and implementing a new system, together with the challenge of winning acceptance and approval from the millions of South Africans the system will serve, will be the challenge.
As an association of international pharmaceutical companies, Ipasa aims to promote a sustainable environment for the pharmaceutical industry to invest in the research and development of innovative pharmaceuticals, contribute to a patient-centred health system and bring the benefits of breakthrough treatments to patients across the country.
Ipasa unequivocally and completely supports the stated objective of the NHI Bill which is to “achieve universal access to quality healthcare services in the republic”. However, as the bill currently stands, it gives rise to various fundamental legal and practical issues.
In Ipasa’s view, these may detrimentally affect not only the rights of the members of Ipasa but also third parties, including, most importantly, the general public.
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We have our concerns as an industry and want to be an active partner in this health reform process. We believe we can help contribute to increasing access to healthcare and ensuring that patients are the ones who benefit most from the effective universal healthcare we all strive to establish.
In Ipasa’s view, the department cannot and should not adopt a “one size fits all” approach to the NHI. Instead, it should consider the specific circumstances of South Africa – including the economy and current public health infrastructure – and then determine the most appropriate healthcare funding system for the country.
Our members are mostly multinational pharmaceutical companies that have vast knowledge resources they can draw on and share. We believe that this can help the department as its working groups draw up vital position papers and policies.
Ipasa members can share data on what has worked and why, in healthcare systems worldwide. They can highlight potential issues that might emerge when implementing universal healthcare so that our new healthcare system is prepared to cope with these or, better still, where possible avoid such hurdles altogether.
In our view, treatment protocols should be based on evidence-based treatments. This is the process of conscientious, explicit and judicious use of current evidence in making decisions about the care of individual patients.
Essential medicines approved by the department, for example, are defined as those that are the most needed. This does not, of course, mean that other drugs are not useful. However, the department would do well to consider medicines beyond the essential list when procurement decisions are made.
We recommend establishing a process of regular review of treatment guidelines, protocols and formulary. It should be based on the principles of evidence-based medicine and include the full participation of clinicians.
Currently, a number of treatment guidelines are lagging behind the most appropriate treatments available because they have not been reviewed for decades.
Including this approach in the NHI Bill would be a win for patients and their families. It would be a win for healthcare budgets and facility patient loads, and for the country’s economy as patients are able to contribute productively to the workforce once again.
This is truly healthcare equity in action. Let’s have the conversation.
Sebati is CEO of the Innovative Pharmaceutical Association of SA