Managing Director at the Board of Healthcare Funders (BHF) of Southern Africa, Dr Katlego Mothudi, talks about putting the health citizen first in the delivery of universal health coverage (UHC) and what can be done to move beyond technical policy evidence towards an action plan driven through participation, collaboration and implementation.
“When we talk about healthcare delivery, first and foremost, the number one priority must be the person who receives the healthcare service; if we can get that mind-set right across the healthcare value chain, we will move closer to achieving UHC,” said Dr Mothudi.
Taking practical steps towards UHC
As healthcare systems around the world move towards achieving UHC much research has been conducted on what needs to be done relating to policy evidence; however, not so much on how this will be achieved.
“We’ve heard a lot about why UHC would be impossible to implement, what we cannot do, and why we cannot do some of the things. It’s time the industry pushes boundaries to look at what is possible and what can be done to implement those pockets of possibilities without having to change regulations or legislation. It’s about identifying the low hanging fruits and kick-starting practical steps towards UHC,” said Dr Mothudi.
“The narrative about the introduction and implementation of UHC in southern Africa has always been that it is unaffordable, government systems are collapsing and are not geared to delivering UHC. Yet we forget the pockets of success in countries such as Rwanda, which ranks as one of the most successful UHC programmes in Africa, and lessons from Ethiopia and Ghana that have also achieved significant milestones in the progress to delivery of UHC.”
While these are pockets of success, the examples go to show that UHC for Southern Africa and for Africa is possible.
According to Dr Mothudi, we can deliver universal healthcare in Southern Africa, but first we need to remove the barriers that we have created in our thinking about UHC. We need to look at what can be done now, without waiting for regulatory reform, and push the boundaries of what we have deemed impossible to realise workable solutions in the delivery of UHC.
“The healthcare sector’s priority should be ensuring that healthcare delivery is more member-centric and not service provider focused. Efforts must be made towards ensuring that the end product delivered to the ‘health citizen’ meets their healthcare needs,” said Dr Mothudi.
According to the BHF, there is a lot that medical schemes can do, working together with governments across the region, without having to wait for regulatory reform to begin driving the implementation of UHC.
Some of the current challenges in universal healthcare include cost escalation, reduced access and poor or non-standard quality of care. For the insured, without a doubt, medical aid contributions required to purchase healthcare are very high, and out-of-pocket payments are increasingly becoming a big challenge to the health citizen. Benefits schedules are also so complex that members don’t know benefits to which they are entitled.
Empowering the health citizen
A common view among the insured is that while contributions are high, there aren’t enough benefits to justify the costs. For the uninsured, of concern across the region is adequate access to healthcare services as well as the quality of healthcare received. Across the board, health citizens do not know what to expect from their healthcare providers and also don’t know what to measure quality care by. As a result, they cannot benchmark to determine whether they are receiving the best available healthcare services or not.
“There needs to be adequate consultation and informed consent to empower the health citizen with appropriate information to influence their choices and compliance to the healthcare services provided to them,” said Dr Mothudi.
“Information prioritisation must focus on empowering the health citizen; there is a need to create awareness of the drivers of costs, cost of services, to create an understanding of the impact of fraud on the health citizen, the impact of choice of care, as well as an understanding of treatment modalities,” continued Dr Mothudi.
According to Dr Mothudi, across the region and continent, there is inadequate accountability for the quality of healthcare. New technologies come into the country and into the region unvetted. There is a lack of standardisation of healthcare measures, which raises the question: whose interests does the healthcare sector seek to serve? If it is for the healthcare citizen, we would be more cautious about these things.
A multi-disciplinary approach to healthcare delivery and regulation alignment will enable a seamless implementation of universal healthcare across the continent.
“This can only be attained through industry collaboration with all the stakeholders in healthcare in order to truly deliver to the needs of the health citizen,” concluded Dr Mothudi.