Pharmacists must broaden the scope of services they provide
Dr Anban Pillay
Department of Health Deputy Director-General
As the health department’s preparations for the introduction of the National Health Insurance continue, Department of Health Deputy Director-General, Dr Anban Pillay, has called on pharmacists to carefully think about the services they provide to their communities and the ways in which pharmacists could be freed from dispensing duties to better interact with patients. He advised delegates at the 2nd National Pharmacy Conference that pharmacists needed to broaden their outlook on the services they provided.
Dr Pillay, Deputy Director-General for Health Regulation and Compliance Management at the National Department of Health, informed conference goers that the National Health Insurance (NHI) would fundamentally shift the delivery of healthcare services in South Africa as it tackled inequality issues. Consequently, pharmacists should broaden their outlook on the services they provided in their businesses.
Beyond traditional dispensing services, additional services include screening, clinic facilities, medical devices, beauty products, chronic disease management, direct patient interventions, immunisations and the ability to promote healthy lifestyles.
Pillay believes pharmacists should also be encouraged to treat minor illnesses including upper respiratory infections and allergies as South Africa continues rolling out the first phase of the NHI initiative aimed at providing primary healthcare. This element of the NHI implementation aims for early identification or prevention of diseases; integrated school health services, including dental and eye checks and psychological analysis; and initiating district clinical specialist support teams.
His comments followed those delivered by Health Minister Dr Aaron Motsoaledi during the conference’s opening ceremony where he highlighted the concept of universal healthcare financing aimed to ensure every citizen globally has access to equitable healthcare based on their health requirements and not their socio-economic status.
“South Africa does not have a debate about the quality of healthcare, since the reality is the depth of the pocket determines the level of care. We need to serve citizens in line with international conventions,” said Motsoaledi.
Motsoaledi said the NHI was not calling for private healthcare to be closed down to introduce a ‘poor public healthcare system that is corrupt, inefficient and unable to deliver’, but South Africa must recognise the current private healthcare system was expensive in global terms. Currently, while 16% of the population belong to medical aid schemes, Motsoaledi said a Competition Commission enquiry into the private healthcare system had identified only 10% of citizens can afford to use it.
Pillay said in a country suffering the world’s highest Gini co-efficient, specifically the measure of income distribution within a nation and commonly used to measure inequality, the NHI aimed to level the disparity between South Africans. This was particularly relevant knowing the country deals with ‘the cocktail of four colliding epidemics’, namely maternal and newborn health, HIV, Aids and tuberculosis (TB), non-communicable diseases and violence.
“The reality is the poorest South Africans have the highest healthcare needs and lowest access … when (the private sector) can pay more, it attracts services away from the poorer areas,” Pillay said.
While the country’s healthcare expenditure as a percentage of gross domestic product (GDP) was better than Russia, India and China – three of its partners in the BRICS (Brazil, Russia, India, China and South Africa) trading bloc – there was an indisputable disparity within that spending.
This underpinned the government’s thinking towards ‘social solidarity’ in healthcare provision where taxes funded everyone’s healthcare requirements – in times of health, an individual funded the health requirements of an ill South African, and during their times of need, funding was provided by another individual.
Pillay said the key areas in which pharmacists would play a role in the NHI was in location and reimbursement for their services, specifically as an accredited service provider. Retail pharmacies concentrated in urban areas would need incentives to encourage them into rural neighbourhoods.
Pillay also believes the current fee for service reimbursement method could be revised as there was a potential incentive to dispense all the medicines available or push more expensive products.
North West University School of Pharmacy’s Medicine Usage in South Africa (MUSA) leader Prof Martie Lubbe said research between 2004 and 2016 reflected the number of new pharmacies established across South Africa exceeded the population growth over the period. This means the country has improved its population to pharmacy ratio across every sector, including community pharmacies.