Posted on Oct 20, 2010 by Sergio Ulloa
In order to ensure that hospitals comply with the accreditation requirements to be eligible as suitable facilities, set under the proposed National Health Insurance (NHI) system, the Health Minister of South Africa, Dr. Aaron Motsoaledi, is said to have plans to institute a regulatory body that will ensure such compliance.
In the system envisioned by Dr. Motsoaledi, hospitals are required to pass a series of tests before being accredited as ready to provide healthcare services under the National Health Insurance (NHI) system. A regulatory body would be tasked to monitor that hospitals comply with all the criteria required to obtain NHI approval.
In the words of Dr. Motsoaledi: "We hope we can start the process of developing an Act of Parliament to establish the office of standards and accreditation. However, it is not yet decided that we're going to establish a Quality Care Commission. This is what they have established in the UK. All we're saying is that we believe there should be some office that checks standards, which inspects facilities, even one that can engage the public. The bottom line is that there must be consequences to everything and that is what is lacking in South Africa."
The extent of the powers given to this proposed regulatory body has yet to be debated around the country. It would also provide the public with a platform to have their say on the closure of healthcare facilities with a poor performance record, as shutting down medical facilities is a sensitive issue, especially in rural areas, where the provision of healthcare is scarce and in many cases, under-equipped and under-staffed and the closure of even sub-par facilities may have a negative effect.
To improve the quality of the healthcare provided to the people of South Africa, the Health Department has identified six key issues as being the most critical. Dr. Motsoaledi said: "We believe these 6 issues, which are basics, need to be looked at urgently. Issues of cleanliness, safety, long queues in hospitals, drug stock outs, etc; the lack of accountability, culture of mediocrity rather than excellence, staff feeling de-motivated and helpless, even an erosion of professional ethics. Those should all be basics in our field of work, but are all to blame. We really need to examine this erosion of ethics when we deal with quality of health services."
During the development of the South African NHI, the Health Department has sought the advice from other countries that have implemented a National Health Insurance system, with the former Chief Executive of the National Health System (NHS) in the United Kingdom, Lord Nigel Crisp, sharing his experience summarised with these words: "We used to get a number of complaints from people about having to sleep one night in hospital before receiving attention. So, we brought five hospitals together, we asked them to decide what one thing was needed to improve it. They all took little practical steps to change things around. Some changed staff, and some allowed nurses to order X-rays. To cut down the process, change the system a bit. The interesting thing is that the smallest hospital in England showed most change. A patient would be seen by a most senior nurse before being allowed further, as opposed to waiting in the line only to be passed down to another person."
Systems were improved as a result of the proposals, with Lord Nigel Crisp further explaining: "Waiting lists came down; one of our targets of reducing mortality from cancer, as opposed to HIV/AIDS came down; satisfaction came up; the patients were seen within four hours."
One other area to improve is the attitude of nursing staff, which in the view of Dr. Motsoaledi must be changed, as many people are currently unhappy with the treatment received from them.
The NHI planning stage is nearing completion, and now relevant officials will have to look for possible financial sources to provide sustainable, long-term funding.