The Durban Chamber's Health Professionals Business Forum met for a discussion on the Universal Health Insurance Coverage as a sustainable building block for the reform of the South African health system from a KZN Perspective. Presented by: Mfowethu M Zungu Deputy Director – General: Macro Policy, Planning and National Health Insurance in the Department of Health, KwaZulu-Natal (June 2016 - present) Responsible for Strategic Leadership of Health Reforms Macro Policy Planning, Development and implementation in the Province of KwaZulu-Natal in line with the National Department of Health NHI policy direction.

1. KwaZulu-Natal
Department of Health
Presentation by the DDG at the Durban
Chamber of Commerce and Industry Health
Professionals Business Forum – 06/04/2017
Theme: Universal Health Coverage as a Sustainable building block for
South African Health Systems Reforms from a KZN Perspective
MM ZUNGU
Deputy Director - General: MACRO POLICY, PLANNING & NHI

2. All individuals & communities receive the health services they need without suffering
financial hardships
Everyone to access the services that address the most important causes of disease
Protecting people from out of pockets payments (which pushes people to poverty)
NHI in South Africa is promised from same pillars of UHC.
(a) The International Context
1. UN Declaration - SDGs
 UN SDG – Goal 3: Ensure healthy lives and promote well-being for all at all
ages (increasing general life expectancy)
 Strategic focal areas: improved child health, maternal health, eradication
of new HIV/AIDS infections, malaria and other diseases.
 Managing the effects of socio-economic determinants of health.
2. WHO UHC
 All individuals & communities receive the health services they need without
suffering financial hardships
 Everyone to access the services that address the most important causes of disease
 Protecting people from out-of-pockets payments (which pushes people to poverty)
 NHI in South Africa is premised from same pillars of UHC.

3. (b) Domestic Health Systems Context
3. South African Health System
Faced with multiplicity of problems both structural and diseases burden.
Structural challenges:
•Cost drivers in public sector
•Costly private health sector
•Poor quality of health services in the sector (public & private)
•Curative hospi-centric focus of the health system
•Mal-administration and inadequate HR
•Fragmentation in funding pools
•Out of pocket payments; and
•Financing systems that punishes the poor

4.  Burden of disease challenges:
• HIV/AIDS and TB
• Maternal and child mortality
• NCDs
• Injury and Trauma
4. KZN Strategic health goals 2014 – 2019
 Strengthening the health system effectiveness
 Reduce the burden of disease
 Universal Health Coverage
 Strengthen HR for Health
 Improve quality of Health

5. 5. Land Scape of KZN Health platform
a)Demographic Profile
The province is situated on the Eastern Coast of South Africa and shares borders
with the Eastern Cape, Free State, Lesotho, Mpumalanga, Swaziland and
Mozambique
o1 Metropolitan
o10 Districts
o50 Municipalities
o828 Wards
oFour Districts (Ugu, Umzinyathi, Zululand and Harry Gwala Municipality
(Umzimkhulu) have been declared Rural Develeopment Nodes
o3 National Health Insurance (NHI) Districts – Umgungundlovu, Umzinyathi and
Amajuba Districts.

6. 5. Land Scape of KZN Health platform
b) Although UHC include both insured and uninsured population, the
immediate challenge is to improve access to the significant proportion
the uninsured population in KZN.

7. 6. HUMAN RESOURCES FOR HEALTH6. HUMAN RESOURCES FOR HEALTH
• Between 2014/15 and 2015/16:
 Vacancy rate 12.3% to 8.4%
 Annual turnover rate 8.6% to 7.4%
 PN: 137.7 to 161.3/100 000 (141.3)
 MO: 28.5 to 28.8/100 000 (33.9)
 Specialist: Remain 6.9/100 000 population
 Pharmacist: 7.4 to 7.7/100 000
COE funding will decrease over the MTEF

8. 7. Disease burden in KZN
a)Total PHC and under 5 head count

9. 7. Disease burden in KZN
b)Child Health
Between 2014/15 and 2015/16
Under 5 pneumonia case fatality rate remained 2.7% (2.4%)
Under 5 diarrhoea case fatality rate from 3% to 2.2% (3.2%)
SAM case fatality rate from 10.4% to 7.7% (8%)
Pnuemonia incidence (under 5) from 86.1/1000 to 74.5/1000 (88.9)
Diarrhoea with dehydration incidence from 11.6/1000 to 10.4/1000 (12.9)
SAM incidence from 6.3/1000 to 5.3/1000 (5.5)

10. Funding Source in table below
7. Disease burden in KZN
C) NCDs
New clients on treatmentNew clients on treatment
2012/13 2013/14 2014/15 2015/16
Hypertension 55 041 54 601 48 925 48 837
Diabetes 23 856 18 931 17 051 27 641

11. 7. Disease burden in KZN
d) Oncology Services
Oncology Services Platform (Private Sector):
•7 Centres of Oncology Management
Parklands Hospital (32 Oncologists)
Hopelands Cancer Centre / Hilton Hospital (10 Oncologists)
Kingsway Hospital (6 Oncologists)
St Annes Hospital (8 Oncologists)
Westville Hospital (1 Gynae-Oncologist)
Capital Oncology (3 Medical Oncologists & 1 Surgical)

12. 7. Disease burden in KZN
d) Oncology Services
Oncology Services Platform (Public Sector):
•2 Centres of Oncology Management
Ethekwini District – Inkosi Albert Central / Addington
Umgungundlovu District – Greys Hospital
•Due to an unprecedented & rapidly growing number of cases including the
attrition of Oncology Specialists, the Public Sector has critical backlogs.
•Public Sector services 87% (uninsured) of the entire population.

13. 7. Disease burden in KZN
Top 5 Cancer Diagnosis
Cancer Group 2015 2016 2017 (Jan –
March)
Ca Breast 1149 1147 493
Ca Cervix 867 867 294
Ca Colo-rectal 384 367 153
Leukaemia 357 405 242
Non-Hodgkins
Lypmphoma
339 - 154
Ca Skin - 368 -

14. 8. The NHI First 5 years in KZN
Access and quality services (PHC Re-Engineering: 136 FHTs, 209 SHTs, 109 Pas,
89 GPs, 10 DCSTs
Improving pharmaceutical services: CCMDD (610 794), Rx Solution, 2069 Pups
for CCMDD
Establishment of an integrated National Health Information Repository and
data system: EMRS in 124 PHC facilities, HPRS (884 813 patients), 100 network
connectivity
Health Systems improvements: 3 video conference facilities, 429 Senior and
Middle managers gone through extensive Leadership Development Programme.
Quality of Service: OHSC assessments and improvements plans, NCS, ICRM,
Procurement of basic Medical equipment for all PHC and District hospital.
Health Systems reforms research documentation (focus on NHI Intervention
impacts and improvement impediments.

15. 8. The NHI First 5 years in KZN
Investment to HRH
3036 nurse in training
728 doctors in training Cuba
Interns and Community service (
9.The next 5 years of NHI implementation
Establishment of the NHI fund
Purchasing of services to be funded by NHI
Mobilization of additional resources (especially financial and HRH)
Establishment of NHI fund management & governance structures
Population registration processes
Amendments to the Medical Schemes Act

16. 10. The final high level health reforms will focus on the following:
Introduction of mandatory pre-payments for NHI
Contracting of accredited private hospital and specialist services
Finalization of the Medical Schemes Amendments Act (to allow Medical
Schemes to evolve and consolidate to provide complimentary cover, and tapping
into their expertise in managing a publicly administered NHI single payer).
11. In Conclusion
Access to basic quality health services to all is a mandate
Health care cannot continue to be a profit commodity in SA
All health activists and practitioners are to contribute to this social solidarity
course
Together we move SA forward.

17. Department of Health KwaZulu Natal 2017/18 Exp.
Estimates R39 548 473
Funding Source in table below
% voted funds 2017/18: 19.7% and declining over the MTEF
KZN DoH (R thousands) Yr 2016/17 Yr 2017/18 Yr 2018/19 Yr 2019/20
Conditional Grant, incl.
R6,363m roll over NHI Grant
7 313 167 8 085 518 8 804 721 9 616 367
Voted Funds, incl. adjustments
budget R450,670m
29 725 833 31 462 955 33 154 853 35 376 361
Grand Total 37 039 000 39 548 473 41 959 574 44 992 728
Conditional Grant 19.7% 20.4% 21.0% 21.4%
Voted Funds 80.3% 79.6% 79.0% 78.6%

18. THANK YOUTHANK YOU