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EF: From the standpoint of IPASA, what are your top priorities for this year?
BP: This year, we have 3 main priorities: NHI, encouraging member companies to be BBBEE-compliant to be able to work with the public sector, and working on an alternative reimbursement model. The National Assembly and National Council of Provinces have approved the National Health Insurance bill. Now, all that remains is for the President to sign it into law. As this is an election year, this is a very important rallying point. Stakeholders from the private sector brought concerns that need to be solved, and both the President and the Minister of Health appear to agree with. The most important is that NHI cannot be implemented until the public sector's infrastructure has been improved. A commission known as the Health Matters Inquiry (HMI) produced a report in 2018 that included recommendations for reforms aimed at the private healthcare industry. These are some of the problems that show why the proposed NHI law needs to be improved.
Doctors as well as nurses are in low supply. Some doctors are claiming that they will leave the country if aspects of the NHI are implemented. This year, designing a sustainable NHI is our top priority.
As you may know, the Black Economic Empowerment (BEE) initiative emphasizes localization. Businesses cannot obtain government contracts unless they collaborate with local partners. The challenge faced by globally owned multinational corporations is their inability to include locals as shareholders. Consequently, the motor vehicle industry, in collaboration with the relevant department, developed the Equitable Access program, which permits the industry to engage in specific products that guarantee the support of some small local businesses. This allows the industry to continue with its operations while simultaneously contributing to the local entities it collaborates with.
As IPASA, we have encouraged companies to hire professionals who can assist them in achieving certain goals in order to raise their scores. Thus, they are able to accomplish it without giving up any ownership stake.
Another priority is working on alternative reimbursement models (ARMs). Creating a model that can allow for differentiated pricing instead of what we currently have referred to as a single exit price in the private healthcare industry, will allow for particular groups within the community to be able to afford medicines. That's really what alternative reimbursement models are all about: we're advocating for the government to let us sell using differentiated pricing to different segments to maximize medicines access to patients.
EF: Do you believe that the emphasis should once again be on Chronic diseases and their potential long-term effects on South Africa?
BP: Chronic diseases still require attention and are of great importance. Most public health facilities during the COVID-19 pandemic tended to concentrate on treating patients who had COVID-19 infections. This occurred at the expense of those who were infected with HIV, tuberculosis (TB), and other diseases. As a result, there was a regression at the end of the 2 years of the COVID-19 lockdown, particularly with regard to TB in terms of the levels of infection and mortality that existed before COVID-19.
Non-Governmental Organizations (NGOs) went on strike recently, demanding that the government prioritize certain chronic diseases like tuberculosis at the national level. Despite HIV being under reasonable control in South Africa, it should not be overseen. We most likely have the largest HIV treatment program in the world, and it's under strict control. The number of cases of tuberculosis varies, and COVID-19 increased both the incidence of infections and fatalities from the disease. We had 54,000 deaths last year. According to the SDGs, we should have reduced the number of TB-related deaths to 20% by 2020, yet we only managed to achieve 17%. Therefore, tuberculosis remains a concern; nevertheless, it's also critical to monitor non-communicable diseases.
EF: What part can each stakeholder play in resolving education and accessibility, and in what order should these be handled?
BP: There was a remarkable collaboration between the pharmaceutical sector and other stakeholders in Western Europe, namely in the field of oncology, including the medical community, funders, hospitals, healthcare workers, and governments. These parties concurred that the public and private sectors must work together for government efforts to be successful. That's what we as Pharma in South Africa are attempting to accomplish; we collaborate extensively with patient groups, but we have realized that we may not have reached enough of them and that further mobilization is likely required.
The fact that we have met with important Department of Health units in the past year who are eager to collaborate with us is positive. The National Institute of Communicable Diseases is one such example. Even though they specialize in communicable diseases, they also have a section dedicated to treating non-communicable diseases. They have stated that we should focus our assistance on these units as they lack the resources needed to conduct scans across the country for cancer. There is still a great deal to learn from different countries and places throughout the world.
EF: What advice would you offer to other companies that recognize the need to cultivate public-private partnerships?
BP: Excellent instances of public-private cooperation have been observed in countries like Ghana and Rwanda. Despite its small size, Rwanda has succeeded in achieving some of the goals set forth for universal health coverage. What matters is that the government cannot accomplish this on its own. You cannot ignore the private sector in nations with both a public and private sector. The majority of skills and expertise are found in South Africa's private sector.
If the NHI bill is implemented as currently drafted, medical schemes will only provide supplementary funding to patients. Considering that over 80% of the products of the innovative pharmaceutical industry are sold in the private sector and funded by medical schemes, this could lead to the demise of the innovative pharma industry. It is crucial that nations come to understand the necessity of innovation and that, in order for innovation to keep going, the pharmaceutical industry—which is responsible for creating the pipeline of novel medications—must continue to produce innovative medicines. In a few years, this will result in the availability of less expensive generic drugs.
