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EF: Can you elaborate on the success factors during the COVID period and how they can be extended into the future?

SK: Due to the success rate of the data dashboard around COVID, we've extended that dashboard into the area of tuberculosis, which is one of the many digital innovations that we have at Cape health park. We also have a partnership with and get some funding from the Gates Foundation which has supported our data centre and innovations, championing excitement in the province, in the digital innovation space. It is an excellent example of partnership growth between the public and private sectors.

EF: According to many executives from the private sector, there's a surge in the willingness to work in collaboration with the public sector. Do you see a trend that’s setting the pace in South Africa?

SK: Prior to COVID, we already had collaborations with the private sector which has pharmacies closer to the communities that are bound by a contract. The partnerships with community pharmacies have helped us deliver family planning services to women. There are a lot of contractual obligations that one has when entering a partnership. Pricing differentials and legislative issues must also be considered.
Due to COVID, we entered a very complex set of contextual relationships with the private sector hospital groups because we were concerned about our capacity to counter COVID since we didn't know what to expect. We started negotiating with our private sector partners who are national hospital groups that have localized presence in each of the provinces.

The deal was to have us use a private sector hospital base for public sector patients should the need arise and also develop independent contractual contracts with the specialist groups who were independent of the hospital groups, like physicians, surgeons, and radiologists, which worked successfully. Even with regulatory issues, we were able to agree on prices, which was a huge part of the negotiation, and we also tested the system with a few patients to make sure that it worked and that the payments would be offered. We were able to return the favour and accommodate some private sector patients in the public sector system. We have proven that the collaborative partnerships between the private and public sector work, and could set the baseline for NHI implementation in South Africa.

Another collaborative partnership is working around COVID vaccines. We worked with Discovery, one of the largest medical schemes in South Africa, setting up a large vaccination centre. The partnership was between the private and government sectors, which was successful in setting up the site, the operationalization, and the management.

We also had a successful partnership with Metropolitan Momentum for a similar vaccine site in the Western Cape. Our success disqualified the myth that the private and public sectors can't work together. The private sector brought experience in the management of the flow of events, making sure that there was a return on investment for both parties.

EF: How do you manage the balance between creating awareness about COVID and non-communicable diseases?

SK: It's a difficult and delicate balance. During COVID, other diseases including non-communicable ones were set aside attention-wise in favour of the new menace called COVID. Patients with non-communicable diseases Had difficulty accessing health facilities which affected them taking their medication in some cases whenever there was any surge in COVID cases, like the various waves that we've experienced and successfully coped with that demand in the West Cape province.
Our mission momentarily is to bring TB patients back into care, bring our HIV patients back into care, and focus on all other non-communicable diseases and immunizations of children. It's a reminder for us that we should have a deliberate concern for caring for other diseases like heart attacks, and strokes, in equal measures. This meant the acquisition of additional qualified and unemployed staff to help cope with the menace we were facing.
This enabled us to treat emergency medical conditions like cardiac events, strokes, and other delicate conditions, which we managed, though it had a toll on the staff because for two years, they had to maintain this delicate balance, whilst also implementing a vaccination program. It was our call to manage our resources appropriately since we didn't have an endless supply, in the end, we were pleased to have a very clean audit of our financial expenditure.
It's a delicate balance that we accomplished. There was a rise in the backlog of about 80,000 major and minor surgical operations that had to be cancelled because we were focusing on COVID. Major procedures are defined as the ones that last 30 minutes or more, which are approximately 40,000 cases. We're playing catch-up on the backlog of those non-communicable and elective procedures, like surgeries, TB, and HIV patients back into care.

EF: What’s the economic impact of the Cape Health Technology Park collaboration?

SK: It is one of the ways that we think the health sector could be a significant boost to the economy. We have the full backing of the senior-most person, who is a premier. Different government departments are involved in this collaboration with the private sector. The intention is to create a health technology park partly related to the urban project. It's perfectly situated because, in that vicinity, we have public and private sector facilities.
We have public sector hospitals there, and a large private sector hospital there. South Africa is part of a collaborative effort under the WHO for developing and producing vaccines. This brings the public-private sector collaboration to the next level, creating a massive health park largely focused on digital innovations, and forming a cocktail of health services in one geographic location, which is a significant boost to the economy.

EF: What message do you have for investors to come and invest in Cape town?

SK: I would pitch to them the fantastic public-private sector collaborations that we observe. We have stable governance in the province, demonstrating successful collaborative partnerships on a huge scale, and vaccine innovations, for example.
We have the intellectual capacity to be able to execute these partnerships because we're privileged to have some of the greatest intellectual minds in the province attached to our universities, who do fantastic research. The private sector adds significant value, to turn the intellectual professionals that we have into that intellectual capacity not only for the public good but also for commercial viability.
Ultimately, if there's a shared vision and a trusting relationship between parties, then anything and everything is achievable.

EF: Kindly elaborate on your Healthcare 2030 vision, and the steps you're taking to achieve it.

SK: Our Healthcare 2030 vision is a deliberate plan to achieve quality health service for all, which is a routine observed by many healthcare parties both in the public and private sectors. Despite coming from an unequal healthcare environment in South Africa, we will be allocating many resources to providing world-class quality care services, to 100% of the population, without discrimination of their geographical location. A scheme that will need collaboration efforts between the public and private sectors.

EF: What have you achieved this year that calls for a celebration?

SK: The service that we provide to patients on the ground. We curated a system to work together with higher institutions and the private sector to provide healthcare services for the community, which is ultimately our objective. Our achievement would be to bring all of those partners together with a common vision, to deliver quality health services for all, a constituent of teamwork dedicated to providing dignified health services for everybody. Ultimately, what I would've liked to have achieved is to make sure that everybody has a dignified experience when they engage with our public or private health services. Though ambitious, it's important to stay focused on this goal, since it's everybody's business in the community. We are determined to bring people back to care because it's essentially a framework for action over the medium-term expenditure framework, a local term for a three-year cycle dedicated to bringing people back into care.

We want to be a value-based organization and stewardship of health. We've confirmed this during COVID in the Western Cape, that we are the stewards of health. We have regular engagements with the private sector, hospital groups, and private laboratories including the universities to take responsibility as the Western Cape department of health. Through resilience, we hope to be a healthy society with a trusted equitable health system, providing an honourable experience for our people. Everyone accepts co-accountability for the health of the province.

There has been a surge in the number of non-communicable diseases from 10% as a result of COVID, such as TB, compared to the previous years, escalating to emergency levels in Western Cape. There has been a surge in patients with HIV too, due to the huge backlog standing at about 40,000 cases. Despite this, we were able to treat cardiac events, and strokes and continued making sure that we've managed to immunize the children.

The shared graphs show the kind of quality data we are able to produce through our data centre. We created this data centre to be able to follow up and record different layers in different levels where you can actually look at your local area where you decide this is the population pyramid. It is a live dashboard that helps to accurately register patient records for both public and private institutions on a daily. We have a similar dashboard for TB, which has proven to be efficient.
“Health is Everybody’s Business”, thus each private organization, government department and every individual have a part to play in their own health and the health of our whole province. This is in line with the provincial focus on economic growth. Good health also makes good economic sense.

August 2022
South Africa