In an attempt to unpack the healthcare challenges experienced over the past few months, and in efforts to identify lessons learnt and challenges in the future relating to the coronavirus (Covid-19) pandemic, the Board Healthcare Funders (BHF) hosted the first of six dialogues under the subject Dialogue 2020 Series. The online engagement brought together industry experts to provide insights on the theme of the first series: Reorganising healthcare systems and putting citizens first in a time of crisis.

Speaking during the online event, Professor Khama Rogo, lead health sector specialist at the World Bank said, “The rest of Africa looks to South Africa for leadership in a lot of areas, and we have seen during this period how a number of countries across the continent have been following South Africa’s steps in the country’s approach to the Covid-19 pandemic. It is critical that whatever strategies South Africa takes, that these insights are kept top of mind as well.”

He pointed out that, “In such difficult times, coming up with solutions through collaboration is the only way we can combat Covid-19.”


Some lessons learnt during Covid-19

Sharing insights on lessons learnt during this period, Dr Sandile Buthelezi, director-general of the National Department of Health (DoH), said, “The department’s main objective has been to flatten the Covid-19 pandemic curve and this has been challenging, especially in the country’s main economic hubs.”

“However, we’ve found that leadership and efforts driven through public-private partnerships have played an important role in decision making and driving impact in efforts in the fight against Covid-19.”

According to Dr Buthelezi, “During this time, we’ve also observed that there needs to be a shift from curative to preventative healthcare services, because every patient who ends up in a hospital represents a failure of the healthcare system. It essentially means that the systems has not been able to ensure that the patient remains healthier.”

He continued, “Primary care practitioners have a critical role to play in making sure that we have proper preventative services to enable people to avoid falling into curative healthcare services.”

According to Ahmed Banderker, group chief executive officer at Afrocentric, “Home-based care services presents opportunities to minimise risk of infection, lower costs and create space for more intensive conditions, especially in instances when the question is who gets hospitalised and who should not; when hospitals are under pressure.”

He said, “There is definite opportunity to review the regulatory environment, to address the cost of health care as well as relook efforts aimed at the implementation of National Health Insurance (NHI) based on these experiences and lessons learnt  during the Covid-19 pandemic.” 

Providing a perspective on primary healthcare, Dr Buddy Modi, a lecturer in family medicine at Wits University, noted that during the first days of the pandemic in South Africa, general practitioners (GPs) had no experience on how to diagnose Covid-19, as there was very little guidance. To respond to this challenge, GPs had to go onto a steep learning curve to adapt through learning on the go, while following guidance from the National Institute of Communicable Diseases. They formed and followed a number of support groups and networks within the GP arena and this collaborative approach has been a critical aspect of some of the critical lessons in the fight against Covid-19.


Challenges ahead

Participants noted that there are a number of challenges within the healthcare system and some specific to Covid-19 that still need to be addressed.

Speaking about the high demand for pharmaceutical products, Stavros Nicolaou, senior executive, Strategic Trade at Aspen Pharmacare noted that, “It has become very clear throughout this period that countries have adopted a nationalistic agenda and started looking at their own countries first in the provision of PPEs and other pharmaceutical products.”

Nicolaou pointed out that, “Africa has the manufacturing ability but is currently not very well positioned to manufacture the vaccine when it arrives,” Nicolaou added. “If we are to manufacture it locally, we need to apply the lessons learnt and have a well-thought-through strategy, better alignment and coherence on how we are going to manufacture at scale.”

Nicolaou emphasised on the importance of public-private partnerships in addressing issues relating to vaccinations during this time.

Barry Childs, joint CEO of Insight Actuaries and Consultants highlighted some challenges experienced in data management during this time, and noted that, “Data is often neglected, not only in health management but across sectors.”

He noted that Insight Actuaries and Consultants observed that during this time for example there has not been enough data available on national monitoring of hospitalisation for Covid-19, because, only a fraction of public hospitals have been reporting data to the NICD.

“Monitoring in healthcare systems remains critical and will play a fundamental role in how we re-organise the system based on the data observed, and because healthcare costs money, whether it’s taxpayer-funded or it comes from insurance contributions –it’s important to understand these data insights in order to effectively understand the cost impact,” said Childs.

He emphasised the need to improve on efforts to protect and support frontline workers, in a way that has not been done before, as these are structural changes that we can take forward into healthcare in the future.

In closing, participants noted that the biggest challenge presented by Covid-19 is its ability to make people lose sight of humanity.

Childs pointed out that, “In all of this, we must do all that we can to guard against inhumane practices and continuously make efforts to retain our humanity as healthcare workers and take these lessons into a future where we put the healthcare of citizens first.”