KABELO A. EBINENG

1. KABELO A. EBINENG HARMONY OF HEALTH POLICY FRAMEWORK: SADC REGIONAL TRENDS, BOTSWANA PRIVATE HEALTH SECTOR PRACTICE AND THINKING Managing Director 10 July 2006

2. OUTLINE • Introduction • Context and problem definition • Emergent perspectives • Are CEOs public officers? • Background on regional policy framework and MDGs • The question of leadership and type of leadership required • Botswana examples on leadership initiatives which are working (up to now) • Conclusion

3. Context • To provide leadership in the form of workable ideas and solutions.

4. Problem Problem Definition • A problem is an unwelcome or harmful matters needing to be dealt with and overcome( Oxford Dictionary). Contextualised problem definition • A problem is something which someone who you cannot ignore believes to be a problem, and that you can actually do something about it. • As leaders in business, in Government and in civil society we are asked to provide good direction in the area of equitable access to healthcare.

5. Emergent Perspectives : the problem • Can the private sector ignore Government and vice versa? • Can Government ignore the electorate? • Can industry/commerce ignore Higher Education Institutions and vice versa? • Can health service providers ignore funders and patients and vice versa? • Can customers be ignored? • Can the interests of business owners and the welfare of workers be ignored?

6. Are CEOs Public Officers? • I think they are. The only difference is that they are public officials without the checks and balances of a democratic ballot box, every so often.

7. Excerpts from the Botswana National Health Policy (1995) • The public health services, the private health services and non-government organisations that provide healthcare constitute the health system of Botswana, and they have to work together to avoid contradictions and duplications. • The health of its citizens is one of the most important resources needed by a nation for the pursuit of most other legitimate national objectives.

8. Excerpts from the Botswana National Health Policy (1995) (cont….) • The Government of Botswana is conscious of the fact that the country is still at a level of development where the disease pattern is predominantly determined by poverty, poor nutrition, low levels of education and undesirable environmental conditions such as poor sanitation.

9. Draft South African Health Charter four (4) guiding principles • Access to health services • Equity in health services • Quality of health services • Broad based black economic empowerment

10. Draft South African Health Charter (cont…..) • The Parties acknowledge that it is essential to ensure the sustainability and efficiency of the health sector • Stakeholders in the health sector are to constructively engage in dialogue ……. • Agreement is there to create for South Africa, a health system that is coherent, patient centred, efficient, cost-effective and quality driven…… • “Health sector”means natural persons and other entities involved in the provision, delivery or funding of health services in one or more of its aspects to people in South Africa.

11. Draft South African Health Charter (cont….) • Information be available relating to health and health services …… in order to promote informed decision-making. • Policies and procedures should be developed with an awareness of the need for sustainability of the national health system ………. • There are geographical inequities in the provision of health care financing which is skewed towards the urban and private sector

12. Millennium Development Goals (MDGs) • Eradicating poverty • Achieving universal primary education • Promoting gender equality and empowerment • Reducing child mortality • Improving maternal health • Combating HIV/AIDS, Malaria and other diseases • Ensuring environmental sustainability • Developing a global partnership for development by the year 2015.

13. Posit of MDGs • To inspire communities and countries to achieve greater or better development results.

14. Link and relevance of Botswana National Health Policy (BNHP), the South African Health Charter to MDGs • The BNHP, the Health Charter and MDGs are about creating and nurturing partnerships that are diverse, and work for and in the interest of society or humanity. • Health services delivery and the limitation of resources feature greatly in that equation. • People have to be healthy in order to be productive. • A limitation of resources means that utmost care and prudence need to be applied … • Partnerships and collaborations are the way to go, …………. • Better communication between the regulators and the operators/stakeholders should result in better mutual understanding of the areas of priority.…….

15. Link and relevance of Botswana National Health Policy (BNHP), the South African Health Charter to MDGs (cont…) • Education and training should lead to greater productivity and development, and, therefore, greater opportunity to reduce poverty. • When operators start harmonising their actions with the policy framework, it will benefit all stakeholders within a country and a region. • Better communication between the regulators and the operators/stakeholders should result in better mutual understanding of the areas of priority.…….

16. Are we prepared to lead properly? • It is fair to ask: Leadership regarding what? • My answer is: leadership regarding change. We, as the private sector, have been challenged by Governments to come to the party. Policy frameworks as discussed earlier have been put forward. Since we cannot argue against them from a viewpoint of principle and from an ethical perspective: we must commit to the doing part. • Doing requires that we demonstrate the ,vision faith and courage.

17. Are we prepared to lead properly? (cont…..) • Adam Smith’s philosophy regarding what in the game theory “the tragedy of the commons.” In his wisdom, the legendary economist presented that to achieve progress individual interests should prevail. • My view is that in the area of healthcare delivery, in particular, the pursuit of individual interests can seriously harm the common good. • Let’s debate and conclude and act.

18. Preparation for change • Improving access in given locations • Broadening access to the disadvantaged and infirm • Empowering and emancipating those that are less endowed in terms of finance, skills, the control of their spiritual destiny etc. • Educating and training more people to improve delivery • Communicating with our customers and enabling them to make the choices that we all desire: as long as this is done equitably and cost-effectively. • Embracing the application of technology as a strategic variable: as long as this is done cost-effectively. • Enhancing productivity as a means to ongoing socio-economic development.

19. Bridging the gap between concept and deed (Botswana example) Management of HIV/AIDS within medical aid schemes • Started in 1990 based on business’ self-interest and the need to guard the interests of society. • Response was trigged by information coming from science and United Nations (UN) agencies in the late 1980s and early 1990s • Private sector in Botswana led in the delivery of anti-retroviral (ARV) services, Gov’t programme started in 2002. • Country has exceeded the 3 by 5 WHO goals and is meeting the needs of individual patients and society.

20. Bridging the gap between concept and deed (cont…) Re-insurance • Early to mid-1990s, private health industry had to choose between external and internal re-insurance. We chose the latter. • Choice considered demographic profile epidemiology and the need for sustainable and wide access • The decision involved great risk, but its working. • Timely action combined with good management and utility (utilitarianism) does make sense and work.

21. Bridging the gap between concept and deed (cont…) PPP for the delivery of ARVs • Systems and a knowledge and skill base were created and evolved into a good foundation for running PPPs. • State must utilise unused private sector • private sector manages the logistics of excess patients, and convenient (close to home) and proper delivery. • The initiative facilitates delivery at low transaction costs upscaling done on a marginal basis, and meets society needs

22. Bridging the gap between concept and deed (cont…) Entry of funders in the service delivery arena. • Pursuit of sustaining access to affordable health services be it in the private or public sector plans are afoot for funders to get involved in the delivery of private hospital services. • Resolution of restricted access due to prohibitive costs that have a potential to adversely impact on scheme membership growth and retention. • This move has not gone down well with certain stakeholders of the supply variety.

23. Conclusion Morally responsible leadership in business, as elsewhere, is about acting out of a sense of care for the world, and being willing to live with the consequences (in tended and unintended) of our actions. We hold ourselves to be leaders and to be responsible. Let us do the necessary. We are at a cross-roads regarding the Health Charter in South Africa, and shaping the future of healthcare delivery. Let us not fail those who see us as capable of solving the problems that they perceive or foresee. As business our rewards and success will come from improved reputation, improved staff loyalty, motivation and retention, and from lower transaction costs. To the best extent possible, let us not unduly induce legislation. Legislation comes at a cost. Summary “There is a responsibility on Governments to provide an appropriate climate for investment, but there is also a growing understanding on the part of business leadership that: it is not only morally good, but good business to invest with a strong sense of social responsibility”.(James D Wolfensohn) In the South African context, Section 7 (2) of the RSA constitution overrides and is the basis of the work which has to be done.

24. Thank you.