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EF: (At the time in which Brexit is going on) If you are offered a job tomorrow which you have to take, and the options are either to be Prime Minister of the UK or CEO of SoftBank, the Japanese multinational conglomerate company, which position would you choose and why?
ZM: I would go with being the CEO of SoftBank because it is important to invest wisely for development. Applied to South Africa, we also have some similar problems. To prevent the economy to continue limping, it is important to invest time and resources to create trust and develop the country. We need to invest in low-level entrepreneurs to drive innovation. The economy of South Africa is problematic in the sense that there is a dichotomy: on one side, it seems a first-world economy, successful, sustainable, connected, fiscally competitive with quality products; then, there is another side that has been left behind after many years of colonization and apartheid. The systems we have inherited are not adequate to look after that particular sector. With the rise of unemployment, we need to create opportunities for employment to allow the young generation to innovate and create new solutions. We need them to take advantage of IT, to link up to a world corporation where they can make an impact. To make a difference and change South Africa, a lot of investment has to happen, particularly at the level of youth and women entrepreneurship, where inequality is felt the most. We need to invest in village and township economy, we have a huge mushrooming of warehouses all over the country, we could pool them together into one designated area around a highly-populated area to give it protection and good terms and invest. This is direct access to economic opportunity for people and at the same time, they could work where they live. This would reduce their out-of-pocket expenditure, as transport would not be needed. Most importantly, people would be brought out of the shell of poverty, which has been prescribed by the past apartheid architecture. The government should also see to bank investment in low course high rise density housing programs for people with limited income in the big city centers like what was done in Hong Kong where the old model of house planning was broken -rich white in the city centers and poor in the suburbs. The interpretation of what is needed is very important, and I would encourage investments in further infrastructure and development where needed: in the case of South Africa, looking particularly at the issues of roads, rails, hospitals. A lot of which need revamping or even putting in high-speed rail which should be done soon in any event. In transportation, the biggest challenge is on the roads, mainly due to their state and damage: all linked to the fact that distributors use trucks, as opposed to rail distribution. Even in high densely populated areas, transportation is done in thousands of buses that are 16 seaters, whereas a couple of trains could carry hundreds of people in one go. I would like to ensure that SoftBank would be more sensitive to the needs of the people and their development. I believe we can offer a huge number of opportunities, grow and turn the economy around. I hope I get the job because if there is something I wouldn’t want to touch, its Brexit.
EF: On your current job, what was the mission you were given when appointed and where are you today?
ZM: My mission is to develop a sustainable framework for country development while respecting institutions and representing all South Africans. To conduct this, we need to attain quality healthcare for the South African population, upgrade infrastructure, ensure the supply of medicine and reengineer the system so we can create a platform for National Health Insurance with equitable access for all with quality of service. We have already started the process of dealing with the bill, it is currently taking public hearings. After the consultative process, the bill will go to Parliament and thereafter to the National Council of Provinces. The bill is on course for adoption sometime next year, and then internally the department will create a structure, an NHI unit for the future, staffed with people with the required skills for National Insurance. A structure will be put in place, we already have a person to run that process, and we are at a point where we are allocating people to move from the main department to the new unit. At some point, we will be hiring people from the outside to man that unit.
We have started the process of internal savings to have direct funds to deal with the issue of staff shortages. In early November, we announced the employment of 2.400 interns, which covers almost twice as much of what we have always employed, and we are continuing on other professional categories to ensure we reduce the vacancies to a minimum. We are working on strengthening the tracking of medicine supply into hospitals through various programs using a system called CCMDD which allows for the delivery of drugs so that patients don’t have to come into the hospitals. The focus of NHI is to enhance healthcare, and maximizing patient’s experience and reduction of queues at the hospitals are also part of it.
We also have a Visibility System which monitors the movement of drugs across the whole value chain, from manufacturing to the hospital to reduce the loss or inadequate supply and management of the budget for medicine supply. We have a team looking at different ways of delivering infrastructure. Currently, we have a backlog of 90 billion rands on infrastructure that needs to be revamped and refurbished, and we are looking to create ways of partnering with the private sector to rebuild these hospitals within the shortest time possible.
This package goes together with the whole idea of upgrading and training leaders to draft and build a sustainable insurance model, so teams on health both national and provincial levels are going to various countries to be exposed directly to other insurance systems. One group is traveling to the UK, and other groups are traveling to Thailand, Turkey, Japan, and France. We are taking advantage of some bilateral agreements focusing on the support of our development of universal health coverage, as we want our people in leadership positions to see how these systems work on the spot, and acquire best practices. I have already been to Turkey and looked at their system, and I will be going to Thailand at the beginning of 2020, to attend a huge NHI conference going on there. We will invite specialists to come to South Africa in the course of next year to train our people in different aspects of the insurance: information management systems, management for hospitals for NHI, reimbursement systems and processes, costing and medication. We are looking to reorganize primary healthcare bringing in commuter workers as well as private family practitioners to work with us on that level. We believe that by the time the bill is passed, we will have cleared the way for the structure to able to go ahead. Retraining, education, and reallocation of tasks are all underway at the moment.
EF: You are working for what is urgent today while planning for what is important tomorrow. How do you manage this double task?
ZM: The team that is working on this started working with the end in mind, and therefore worked backward. If we want to implement NHI in five years, there are certain things that need to be done within this period, and this is a way of managing it. It is a scenario planning where we put in place what we need to be able to be ready by then. In five years, all the preliminary work will be in place. By 2026, the bill will be passed, the preliminaries would be in place, the infrastructure and the staffing would be there, the medication availability would be ensured, and training for NHI entrenched in the country will be delivered.
EF: How critical factor is Technology for NHI?
ZM: Technology plays a crucial role when it comes to managing National Healthcare. It will be the base on which NHI will be built, we will have a system that will be national and operate effectively in any part of the country and we will have to work very hard for there to have good connectivity and good electricity in all areas, so the clinics will not be undermined by those lacks. Secondly, we must finalize the health patient record which gives the beneficiary registration. Right now, we have around 42 million records, and we should be expanding it. We are exploring a system that will be very helpful with the issue of patient clinical records, where doctors will go into the system to access the patient’s information, and all transactions will be recorded there, even lab info and x-rays. The management of the accounts of the patients will allow us space to ensure that reimbursement happens fairly quickly, as well as standardization of all the payments. We will also be standardizing clinical products and treatment guidelines. The approach we are taking is to standardize first for primary healthcare, then secondary, then tertiary. All digital information will be inoperable across hospitals in the different provinces, so our system will be all connected. As far as IT is concerned, we have been exposed to health information management systems which can give us benchmarking across different countries as well as the stages of digitalization within the system, so a patient can be seen and recognized as a beneficiary in any part of the country and thus can access healthcare within the system from wherever they are. The concept of lost records will disappear. Technology will also help with prescriptions in pharmacies as pharmacists can look at the prescription and correct it online, and doctors anywhere can still make the prescription available and it will be easily interpreted due to standardization. All the above together will create a framework where digitization is the enabler of efficiency.
EF: What are the biggest burdens of disease in South Africa?
ZM: HIV still remains one of the biggest challenges and TB one of the top killers. And this is due to our history with these infections; we have had huge advancements in the past ten years where we have introduced antiretroviral treatments and together with the prophylaxis and treatment for TB, we have mounted the largest programs in the world. Originally it was for 4 million people but we have recently decided to upscale it to 5 million people and we are aiming at a target of 7 million people by the end of 2020. We have regions reaching the 90-90-90 target, 90% have been tested and of those 90% are on treatment and by the end of this year we will be able to identify 3 out of 52 districts that will have achieved that target and by early next year we will have achieved 14 districts which means we will have covered close to 40% of the issue. This for our two main non-communicable diseases which are the biggest burdens. Over the years we have eliminated other health issues such as gastroenteritis which existed due to the problems with water and sanitation, we have also reduced some petty respiratory track malfunctions and malnutrition-related problems. Malaria is a huge challenge all over the continent and we are moving for its elimination in 2 or 3 years especially, in the low transmission areas. On a general trend, the country has shifted to non-communicable diseases and they are on the rise; cardiovascular diseases are a big challenge now and they are a major cause of death. Diabetes is also a challenge, as 35% of patients with diabetes present complications and 3 out of 5 diabetic patients do not even know they have it. A third area is an oncology, as the antiretrovirals are giving us a huge improvement in the life expectancy of about 10 years or more, so people now are living long enough to suffer from non-communicable diseases (heart diseases and diabetes). So the success on one side is forcing us to be better on the other. This way, we are building a structure to be resilient and able to confront epidemics.
EF: Could you define what access means to you?
ZM: Access to quality healthcare means that the disease condition must determine the access to high-quality healthcare, and to the intervention the particular disease complication requires. Health access should not be compromised because of poverty, unemployment, or lack of medical insurance. We need to reduce what we call catastrophic payments, which is the choice between either health services or buying food or household requirements. South Africa must have access to quality healthcare in staff service, technical intervention, medical devices and medication and a good level of specialist care required. Thus we can improve the life expectancy and quality of South Africans.
EF: If you had to give a message to the country’s business leaders to inspire them to invest in the healthcare industry, what would that message be?
ZM: First, the healthcare industry is and will be critical in creating a healthier population, so it is an investment in human capital, which is why we are focusing on this now. Studies have been done and they demonstrate that the improvement of the economy does follow the improvement in the quality of life and health of the people. Secondly, it would mean an opportunity to work closely together with the health department as we will be requiring a lot of skills, medication, medical devices, and with NHI we will need volumes at an affordable price. We are asking SAHPRA to reduce the backlog and clear the license applications and open up South Africa to be a pharmaceutical manufacturing harbor, which can be available for neighboring countries as well, allowing them space to grow in the continent and strengthen the pharmaceutical industry. We believe a lot must be done for specific targets or areas where there are constraints in manufacturing and where it can be encouraged for example in active pharmaceutical ingredients for South Africa and become a hub in the manufacturing of devices, of generic and original drugs. There will be institutions that will train different skills in so far as the health industry is concerned and it will be important for the business leaders to be vigilant to the opportunities offered. Improving the healthcare system regionally will mean an economic spillover for the continent; in fact the continent has already put together an arrangement where the regulatory authorities must all work together on harmonization, to have coordination, to deal with counterfeit trials, poor quality trials, inspection, quick licensing and standardization of quality of products produced in the continent. The African Union has actually endorsed that’s the way we need to go. The professionals of the regulatory councils are doing similar activities to standardize the training looking for harmonization across the different countries. We are an integral part of this continent and for us to do any sort of contribution is a special privilege, but we also know the continent expects any advantages that are available in South Africa should ensure that there are multiple growth points over the continent. We believe that over the next few years the African market will be very significant with almost 1.2 billion people mostly young, so if we are able to strengthen our skill sets and training, invest in youth, we will find that there will be a huge surge. The WHO has held a meeting where they have encouraged the whole African continent to embrace universal healthcare coverage or move in that direction. The G20 has also health summits where they consider no country must be left behind and South Africa feels a responsibility in that it must justify the delay. We have had leaders of other countries encouraging us, for example, the president of Chile and the former prime minister of Norway have both been very encouraging as has the former director-general of WHO. In the last United Nations General Assembly, a high-level summit, many heads of state have expressed their commitment to universal coverage. A big advantage for us is our president is at the head of the change and has put a very strong team in place to support the movement forward. There is no other way for South Africa then to move forward. NHI has to happen, and people will see the difference we can make.
