PO Box 1097 Newcastle 2940, KwaZulu-Natal, South Africa
E-mail: pauleyes@mweb.co.za
INTRODUCTION
Recently, the South African Optometric Association (SAOA) hosted a group of optometry stakeholders to charter a path in preparation for 2030. The delegates represented academia, private sector (independent and franchise), public sector medical aid networks and the Professional Board for Optometry and Dispensing Opticians (PBODO). The SAOA as the custodian of the optometry and dispensing optician professions recognises that everything is dynamic, hence to sustain the future of the professions; cognisance has to be taken of the factors and forces which impact the arena in which it operates. According to Harry Rosen, CEO of the SAOA, “the best way to predict the future is to create it. Also, the future is not what it used to be.”
PROF MORGAN CHETTY
Prof Chetty presented a paper titled, Healthcare Challenges in Africa- To Re-imagine Future Healthcare
Covid taught us that we live in a global village. It did not need a VISA but visited every nook and cranny of the world. Treatment should be participative, personalised, with the patient being the most important person in the journey. Major challenges facing health systems in Africa include:
- Africa has 25% burden of disease of the world – communicable and vaccine preventable diseases and rising non-communicable diseases (NCDs).
- Under-resourced and under-funded
- Unstable and fragile health platforms
- High rate of injuries and trauma
- Africa has to 60% of its need to be provided by 2063
- 70 to 90% import of health product into South Africa , losing foreign exchange
- We have outward migration (so called brain drain) of scientists and skilled practitioners.
Medical neighbourhood is the terminology that embraces all health disciplines emanating from Obama Care era. Without access to essential medicines, Africa is susceptible to three killer diseases: Malaria, TB and HIV/AIDS. Globally, 50% of children under 5 years die of pneumonia , diarrhoea, measles, HIV, TB and malaria from Africa. Africa has some of the world’s highest rates of preventable neonatal and maternal mortality and deaths from infectious diseases, antimicrobial resistant infections and malnutrition.
United Nation’s 17 Sustainable Development Goals
The future public Health in Africa is dependent on 5 C’s: collaboration, cooperation, coordination, communication and centred on the patient. South-south cooperation is a collaborative framework between developing countries to share knowledge, resources and skills and achieve development goals. It can occur in the political, economic, social, cultural, environmental and technical domains.
Triangular cooperation involves southern driven partnerships between two or more developing countries supported by a developed country/ies or multilateral organisation(s) to implement developmental cooperation programmes and projects.
United Nations General Assembly (UNGA) Resolution On Vision
“An eye examination for a child can be the difference between inclusion and/or exclusion, a pair of prescription glasses, the difference between access to information and seeking a livelihood and not corrective eye treatment, the difference between improved sight and total loss of sight. The gift of sight for the 1.1 billion people living with preventable sight is within reach if we ensure world leaders deliver on this moment.”W.Aubrey. Ambassador to the United Nations.
DR SIMON STRACHAN
Dr Simon Strachan presented a paper on Future of South Africa Healthcare Initiatives (FOSHI).
FOSHI focus areas are Practice digitisation, Practice commercial models, Doctor training and support, People-centred population health management and showcasing excellence in our healthcare system
Practice digitisation involves electronic health records (EHRs), AI powered clinical and admin tools and virtual power interactions.
Practice commercial models include practice organisational models and doctor payment principles and models.
Doctor training and support involves clinical and business competencies and public private cooperation
People-centred population health management includes advanced data analytics, integrated GP-specialist-hospital models, preventative and value-based care, patient-centred/doctor-guided engagement.
Showcasing excellence in our healthcare system includes clinician conference outcomes and communication, coordination and showcasing of clinician scientist outputs, luminaries
Three-pronged strategy
- Separation of pooling from purchasing
Equitable resource allocation outcomes rely on fair pooling systems which are most logically situated and executed at a national level. Purchasing is decentralised and carried out by- Provincial governments
- District health authorities
- Medical schemes
- Optimise the performance of free public services
Strengthen governance and ensure quality healthcare for households unable to afford their own coverage with three important features:- Hospital and district authority autonomy
- Close localised supervision
- Removal of interference from the executive of government in appointments, procurement and operational decisions
- Optimise the performance of the (paid for) contributory system
- Establish a sustainable contributory health insurance framework for income-earning households
- Contributory systems supplement the maximum levels of coverage attainable financed from general taxes alone.
- This system needs to be properly regulated to address known market failures to and to maximise coverage.
NHI Challenges. Why the NHI is problematic
- It is unaffordable
- Violates Healthcare professionals (HCPs) constitutional rights to practise, choose their workplace and own property.
- Public consultation process flawed and incomplete – unconstitutional.
- Risks severely reducing access to and quality of healthcare
- Centralised payments and procurement increase potential fraud, waste and abuse (FWA).
- Grants excessive, unchecked powers to Minister of Health.
- Focuses on minimising costs, not improving care.
How Will NHI Impact Patients?
Public sector
- Basic basket of care
- No improvements in infrastructure
- Reduced access to healthcare
- Declining number of HCPs
- Freezing of posts
Private sector
- Loss of medical aid cover
- Loss of self-determination in healthcare access
- Lower quality of available healthcare options
- Loss of HCPs from the service
Impact on everyone
- Longer waiting times for healthcare services
- Worsening care for patients with chronic illnesses, leading to declining health outcomes
Bear in mind that Optometry is not mentioned in NHI.
Actions: Participate in the solution, oppose what needs to be opposed, innovate, advocate for healthcare professionals, patients first, collaborate, lead
PANEL SESSIONS
Delegates were divided into 4 groups and provided input for 2 separate panel discussions. The first panel session dealt with trends involving global, national, technology and industry while the second panel session focused on a SWOT analysis of the SAOA. This feedback was further deliberated with the SAOA board the following day. Further engagements will be held to provide a complete 2030 perspective to the membership.
CONCLUSION
The SAOA, the custodian of the optometric and dispensing professions addresses the interests and needs of members by way of advocacy programmes, professional development, the promotion of high ethical standards and support of its membership. Strategy 2030 is indeed a bold and necessary SAOA initiative.