|TARGET #||DESCRIPTION||SA STATUS
(PER 2019 COUNTRY REPORT)
|3.8||Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality and affordable medicines and vaccines for all
|The 2019 Country Report provides no status for this target but according to a 2019 media report, less than 20% of our population of 58 million could afford private healthcare while the majority have to queue at understaffed state hospitals short of equipment
|3.b||Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to quality medicine for all
|Gradual increase in vaccine uptake from 2010 to 2017. This can be seen by the change in the
proportion of the target population covered by all vaccines included in their national programme:
Pneumococcal conjugate: 52,1%
HPV (2015): 64%
Pneumococcal conjugate: 78,8%
Proportion of health facilities with core essential, affordable medicines available on a sustainable basis:
74,2% (2013), increased to 90% in 2018
|3.c||Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing states
|The 2019 Country Report provides no status for this target but the WHO’s website state that they estimate a projected shortfall of 18 million health workers by 2030, mostly in low- and lower-middle-income countries. They further state that there is a chronic underinvestment in education and training of health workers in some countries and also a mismatch between education and employment strategies in health systems
A world with many needs provides numerous opportunities to get involved in making it a better place. When Dr Gideon Both CA(SA) stumbled onto a quote by Aristotle, ‘Where your talents and the needs of the world cross, there lies your vocation’, he discovered that his passion was to make the world a better place. Gideon’s aptitude and talent for academics enabled him to complete his PhD on the topic ‘A framework for price tariffs in the costing structures of South African private hospitals’. This research provides a model that can help private hospitals determine their price tariffs and thus make healthcare more affordable and accessible to a greater number of people.
The model recommended by Gideon’s PhD dissertation took into account concerns raised by the Market Health Care Inquiry regarding the cost of private healthcare and the journey towards the implementation of National Health Insurance. Gideon made his suggested model practical and easy to implement so that it is not just an ‘academic theory’.
His model is currently being used in a pilot study in Namibia for catheterisation lab procedures for three hospitals and will be piloted in South Africa in 2021. The outcomes of the pilot study will inform price tariffs and hopefully policy in the not-too-distant future.
The completion of Gideon’s PhD and the commencement of his pilot study helped him to understand that his technical knowledge as a CA(SA) and his love for research are helping South Africa to achieve SDG 3 as it provides us with valuable guidance on how to implement universal healthcare.1 It is evident that the achievement of the SDGs is not limited to a certain skill set − the most important step for Gideon on this journey was to start.
If you are interested in learning more about this topic, over the next few months, academic articles and articles on price tariff determination in private health care will be posted on Gideon’s website (www.gideonbotha.com).
In South Africa the price tariffs are very high, which limits the ability of the majority of South Africans to obtain treatment in the private healthcare system. This brought about the need to create National Health Insurance which will pay for patient treatment on behalf of all South Africans. In order for this system to work the price charged / paid to healthcare services providers needs to make commercial sense (cover their costs and include an adequate profit margin). Gideon’s PhD provides a unit costing model that can be used to determine the cost of the resources used to treat the patient and the price tariff payment model (used to charge the price tariff) that is applied to onward charge the price tariffs. Gideon’s model enables price tariffs to be based on the resources used to treat a patient while ensuring that the price tariffs reward service providers based on achieving healthcare outcomes. This improves value for the patient.
The model that Gideon developed not only provides a basis for determining price tariffs but also helps to implement a sustainable National Health Insurance for South Africa.
 One of the biggest problems in achieving universal healthcare coverage is the determination of the price tariffs (prices charged) to the patient for the care provided by healthcare service providers.