More healthcare news snippets ...

Motsoaledi injects donors with a shot of confidence

Health Minister Aaron Motsoaledi has launched a framework to "harmonise" donor money for the public health sector. The Minister wants money from donors to be channelled to where it is most needed, and also to be audited. Motsoaledi said the Government had to do things differently to fix the country's ailing health system. He said Government was painfully aware that South Africa was spending more money than many countries - but getting poorer results, adding that co-ordination and relations with South Africa's development partners, both local and international needed improvement. Official development aid contributes between one and two percent to the country's gross domestic product. Representatives from the US, UK, European Union, Canada, Japan, Cuba and the UN voiced their support for Motsoaledi's plan. Problems with development assistance in health include many diverse donors and a focus on specific illnesses, resulting in imbalances in the sector, duplication of funding objectives and pursuit of "parallel agendas". The Government has also identified the "deliberate by-passing" of its "existing policies and systems of official development assistance" which has resulted in a "lack of ownership, leadership and co-operation from the government". Motsoaledi said he was ready and willing to assume leadership. The framework was consistent with the Paris Declaration on Aid Effectiveness. Donor aid under the framework would support the government's health policies and its drive to deliver quality healthcare. It would also help South Africa's attempt to reach its Millennium Development Goals of reducing the country's child mortality rate and maternal mortality rate, halving the spread of HIV by 2015 and reversing the rate of malaria and other major diseases. Motsoaledi further said a quality and complaints office for the healthcare system had to be fast-tracked. The office would help improve the quality of healthcare in public and private facilities. It would be divided into three units: an inspectorate, an office for accreditation and an ombudsman for complaints. It would address cleanliness, staff attitudes, safety and security of patients and long queues, a common feature in the public health sector. The National Health Amendment Bill will be released for public comment this week.

SAPA, 22 January 2011

TB research appeals for funding

Scientists from the South African Tuberculosis Vaccine Initiative (Satvi) have appealed to Parliament to help them lobby for more financial support from the government, saying HIV research was getting a disproportionate share of the funds. Satvi is the biggest clinical research site for tuberculosis (TB) vaccines, and is involved in four global projects to test potential shots. Satvi co-director, Willem Hanekom, said that worldwide, TB was as big a problem as HIV, yet 5c gets spent on TB for every dollar spent on HIV. He noted that South Africa was no exception to this trend. South Africa has the world's second-highest incidence of TB, with the Western Cape being hardest hit with 900 cases per 100 000 people - and the world's worst HIV rate. Briefing members of parliament's portfolio committee on health, Prof Hanekom said most of Satvi's funding came from overseas donors. These include the Bill and Melinda Gates Foundation, the Wellcome Trust, the US National Institutes of Health, the European Union and the global TB vaccine foundation Aeras. Satvi's budget last year was R70m, he said. He said the drawback of donor funding was that it was earmarked for specific projects, and did not cover line items such as the day-to-day operations of its facilities, funding the long-term storage of TB samples in liquid nitrogen, or support for its professional development initiatives. Prof Hanekom told MPs that support from within South Africa was needed and that Satvi had applied to various agencies, but the kind of support from organisations like the Medical Research Council and the National Research Foundation were relatively small compared to that from international agencies. He said that the South African AIDS Vaccine Initiative enjoyed strong government support, adding that that kind of model could work for TB vaccine research. The portfolio committee's chairman, Bevan Goqwana, said TB did not get sufficient attention, and researchers needed more government support to develop better vaccines to prevent people getting the disease.

Tamar Kahn: Business Day, 26 January 2010

Good news for ill people

South African consumers could pay between 20% and 30% less for medicines after the Department of Health introduces regulations to prevent drug companies from charging more for their drugs than in other markets. Drug manufacturers may also have to justify to government why they charge the prices they do.

"Medicine prices have come down significantly since price regulation was introduced in 2004," says Anban Pillay, cluster manager for financial planning and health economics at the Health Department. "The next phase of the process is to compare our medicine prices with those charged overseas and to consider the cost-effectiveness of particular medicines compared with that of alternative therapies."

According to the department, the introduction of a single exit price requiring drug companies to sell their products at the same price to all customers in 2004 resulted in an immediate drop of 19% in prices. The Council for Medical Schemes says that between 2000 and 2009 expenditure on medicines increased by only 10% in real terms and decreased as a proportion of benefits paid from 27% in 2000 to 17% over the past five years. After peaking in 2001, medicine costs per capita expenditure fell 8% in real terms until 2007.

International benchmarking will now allow government to compare the price of medicines sold locally against the prices charged in a basket of countries, including Australia, Canada, New Zealand and Spain. These countries were chosen, says Pillay, as they have regulatory authorities that license and ensure the quality of medicines. They also have accessible pricing information that is regularly updated.

To help drug companies plan for the reduction in earnings, they have three years to work towards the lowest price charged in the basket. "Some have already been charging prices in line with what they charge in other countries for years," says Pillay. "There will be less of an effect on their revenues."

Companies that have chosen to charge higher prices since 2004 could see their prices fall by 40%-50%.

Pharmaceutical Industry Association of SA COO, Vicki St Quintin, says the industry worries that by using the lowest price in the basket, companies will be required to match the price of just one country at a particular time. "The results could be arbitrary, especially if that particular country implements a price cut during the period," she says. "Using an average price would avoid this."

But Pillay responds: "Because medicines are sold commercially in these countries, we can assume that the lowest price is financially feasible."

According to pharma-economic valuation draft regulations also published, drug manufacturers could be asked to provide economic analysis of their products to demonstrate the value-for-money for patients.

"The process of comparing the best value for money is already happening on an ad hoc basis, with some medical schemes requiring patients to motivate why they need an expensive medicine," says Pillay. "We aim to formalise the process of considering the cost-effectiveness of drugs through the medicine pricing commission, which would evaluate whether the benefits of the medicine justify its cost."

He says these recommendations could be used to inform the reimbursement criteria determined by medical schemes.

Pillay says most countries use across-the-board price cuts and price freezes to address price distortions in existing products, and international benchmarking mainly for new products.

"But different products experience different degrees of pricing distortion, and the committee believes international benchmarking is better than generalised price cuts as it is more able to discriminate between products."

St Quintin says price regulation should ensure continued supply of quality medicines and access to new drugs, as well as taking into account the industrial policy objectives of the department of trade & industry to encourage local medicine manufacture.

"Under a National Health Insurance System, the regulations might need to be used differently to increase access to newer and better medicines for a broader section of the population," she says.

Jacqui Pile: The Financial Mail, 28 January 2010

SA experts welcome liver cell breakthrough

Local medical experts have welcomed news that scientists in Germany have managed to grow human liver cells on tiny scaffolds made of material similar to surgical sutures, a development that takes them a small step closer to transplanting liver cells into patients waiting for an organ donation. Around the world, liver donors are in scarce supply and many patients with liver disease die for lack of a replacement organ. South Africa is no exception: in 2009 there were only 37 liver transplants, according to the Organ Donor Foundation's Cape Town project manager, Samantha Volschenk. In the private sector alone, about 30 patients are awaiting liver transplants, said Santie Adams, transplant co-ordinator for Johannesburg's Donald Gordon Medical Centre, one of South Africa's two liver transplant facilities. The other is Groote Schuur Hospital in Cape Town, which has 25 patients awaiting transplants, according to Prof Wendy Spearman, head of hepatology at the University of Cape Town. Scientists have until now isolated human liver cells, frozen them and then transplanted them into patients, but the technique has had limited success, said Dr Joerg-Matthias Pollok of the University Medical Centre in Hamburg. Dr Pollok and his colleagues isolated liver cells from 12 human livers that were not suitable for donation, and used tissue engineering techniques to grow them on a biodegradable polymer scaffold. The cells proliferated across the matrix, and retained key functions such as detoxifying and making proteins. After being cultured for two days, the liver cells formed tightly packed clumps of cells called spheroids. After four days, the number of spheroids had doubled in any given area. This is the first time the technique has been used on human liver cells. The research was published in the latest edition of the journal Liver Transplantation, published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases. In an accompanying editorial, Dr Humphrey Hodgson of UCL Medical School in London said liver transplantation had huge clinical potential, as a bridge while patients awaited a full transplant or to replace an organ. Prof Patrick Arbuthnot, director of the University of the Witwatersrand's antiviral gene therapy research unit, said the research was promising, but more work was needed to establish whether the human liver cells grown in the laboratory could safely be transplanted into animals and humans. He said that the exciting part was that the German team used human liver cells, and had shown they could be grown in a culture. Prof Spearman added that the big challenge with liver cell transplants was maintaining the viability of the cells.

Tamar Kahn: Business Day, 24 January 2010

Rise in malaria cases

There has been a "considerable" rise in South Africans showing malaria symptoms in recent weeks, according to Dr Pete Vincent, a spokesman for Netcare Travel Clinics. He said most of these individuals visited malaria areas where above average rainfall resulted in hot and humid conditions. Families who visited places such as Mozambique and the northern parts of South Africa such as Mpumalanga and Limpopo as well as Maputaland in KwaZulu-Natal should be vigilant, he said. According to the National Institute of Communicable Diseases, 3 470 cases have been reported in South Africa so far this malaria season. 61% were reported in Limpopo, 27% in Mpumalanga and the rest in KwaZulu-Natal. Vincent said a multi-pronged approach to the prevention of the disease was necessary.

SAPA, 31 January 2011

Fewer teens giving birth

South African Institute of Race Relations (SAIRR) research has revealed that far fewer teenagers are giving birth at present than two decades ago. The research also found no link between teenage pregnancies and child-support grants. In 1998 there were 81 births per 1 000 teenagers, between the ages of 15 and 19. In 2008 there were 58. Between 1998 and 2008, births per 1 000 decreased by 28%. Institute researcher Nachi Majoe said this could be attributed to increased access to contraceptives.

According to the survey, in 2003 there were nearly 20 000 pupils who fell pregnant. Over the following two years, this figure decreased by 25%. The decrease in pregnancy was similar to the trend in births and could also be attributed to access to contraceptives and changes in sexual behaviour. Majoe said the number of child-support grant beneficiaries increased substantially over the years. However, the overall decrease in births per 1 000 teenagers and pupils who fell pregnant shows that there is no direct correlation between the number of teenagers who fell pregnant and the number of grant beneficiaries. Majoe said this data contradicted the view that the child-support grant was an incentive for teenage pregnancy.

SAPA, 1 February 2011