NEW Health Minister Aaron Motsoaledi is being taken to court by the National Convention on Dispensing (NCD), a lobby group representing 6 000 drug-dispensing doctors. The association is livid that, after weeks of waiting, Motsoaledi has not effected a "satisfactory" dispensing fee structure. NCD chairman Norman Mabasa said the NCD had given the department time to amend the dispensing fees, but it has not and the NCD is now forced us to reopen the court case. He said nothing less than the publication of the correct gazette with the correct numbers would convince the convention to withdraw. The NCD claims the dispensing mark-up cap, even after it was supposedly "improved" by former Health Minister Barbara Hogan, is still low. During her short stint at health, Hogan engaged the lobby group and averted a showdown by striking a deal with the GPs. Mabasa said Hogan had good intentions, but he believes she was misled by her officials, who were "hellbent" on discouraging doctors from selling drugs. He said the NCD was not against the new Minister but he was the main person and so the buck stopped with him. Mabasa believes the department wants pharmacists and not doctors to dispense medicines, even though pharmacists are unregulated, which enables them to charge any price. Mabasa accused Anban Pillay and Humphrey Zokufa of the Health Department's pricing committee of double standards and trying to force GPs out of dispensing. For his part, Pillay said he was not going to respond to all the incorrect allegations Dr Mabasa had made through the media. Zokufa is also the CEO of the Board of Healthcare Funders (BHF), the same body that represents the medical aid industry body. This, according to Mabasa, has the potential to create a conflict of interest. The BHF has in the past raised "concerns" over drug-dispensing fees by general practitioners but the doctors' group accuses it of being one-sided and turning a blind eye when it came to other service providers. The powerful pricing committee is chaired by Gavin Steele and lists academic Di McIntyre and the Health Department's Ntobeko Mpanza as members. Mabasa said officials at health acted like autopilots, pushing their own agendas and using the department to undermine what the Ministers were trying to do. He said the department frustrated Hogan's efforts to end the feud over dispensing fees that has dragged on since 2004, when Tshabalala-Msimang was still in charge. Last year, the NCD took her to court after failing to force her to replace the 16% mark-up clause with a "realistic" figure. In terms of the clause, GPs were allowed to charge a markup of no more than 16% for drugs sold for less than R100 or a maximum of R16 thereafter. While lauding the ANC for replacing the "intransigent" Tshabalala-Msimang, Mabasa said that was not enough. He said the NCD was worried about the conduct of certain officials and wondered if they should not be removed. Giving in to the doctors' demands looks like the easy way out but it could be tricky given that the officials, like Pillay, who engineered the current pricing structure, are still calling the shots. Pillay has consistently defended the current pricing structure. Motsoaledi has his work cut out for him to return the Department of Health to credibility, and win over service providers - including the disenchanted doctors (in both sectors) even if this means getting rid of some of his generals. He will need more than his medical degrees to cure SA's health system.

Shoks Mzolo: The Financial Mail, 12 June 2009