Latest news with #AaronMotsoaledi
Daily Maverick
4 hours ago
- Health
- Daily Maverick
Rethinking HIV treatment with tailored solutions for improved patient engagement and outcomes
The health department has R622-million extra to prop up South Africa's HIV treatment programme in the wake of foreign aid cuts. But it's only about a fifth of the total gap. We look at how data can help drive decisions to make the most of this lifebuoy. Just over two weeks ago, Health Minister Aaron Motsoaledi announced that the Treasury had given R622-million of emergency funding to his department to prop up South Africa's HIV treatment programme, with about R590-million for provinces' HIV budgets and R32-million for the chronic medicine distribution system, which allows people to fetch their antiretroviral treatment from pick-up points other than clinics, closer to their homes. This extra budget is just over a fifth of the roughly R2.8-billion funding gap that the health department says the country needed after US President Donald Trump's administration pulled the plug on financial support for HIV in February. (The Pepfar/Aids relief budget for this financial year was just under R8-billion, but the health department calculated that it could fill the void with R2.8-billion if it trimmed extras and ruled out duplicate positions.) So, how to get the best bang for these limited bucks — especially with the health department wanting to get 1.1-million people with HIV on treatment before the end of the year and so reach the United Nations targets for ending Aids as a public health threat by 2030? By getting really serious about giving people more than one way of getting their repeat prescriptions for antiretroviral (ARV) medicine (so-called differentiated service delivery), said Kate Rees, the co-chairperson of the 12th South African Aids Conference to be held later this year, from Kigali last week, where she attended the 13th IAS Conference on HIV Science. At another Kigali session, Lynne Wilkinson, a public health expert working with the health department on public health approaches to help people stay on treatment, said: 'People who interrupt their antiretroviral treatment are increasingly common, but so are people who re-engage, or in other words start their treatment again after having stopped for a short period.' A big part of South Africa's problem in getting 95% of people who know they have HIV on ARVs (the second target of the UN's 95-95-95 set of cascading goals) is that people — sometimes repeatedly — stop and restart treatment. For the UN goals to be reached, South Africa needs to have 95% of people diagnosed with HIV on treatment. Right now, the health department says, we stand at 79%. But the way many health facilities are run makes the system too rigid to accommodate real life stop-and-start behaviour, says Rees. This not only means that extra time and money are spent every time someone seemingly drops out of line and then comes back in, but also makes people unwilling to get back on board because the process is so inconvenient and unwelcoming. Rees and Wilkinson were the co-authors of a study published in the Journal of the International Aids Society in 2024, whose results helped the health department update the steps health workers should follow when someone has missed an appointment for picking up their medicine or getting a health check-up — and could possibly have stopped treatment. 'We often have excellent guidelines in place, built on solid scientific evidence,' says Rees, 'but they're not necessarily implemented well on the ground.' To make sure we track the second 95 of the UN goals accurately, we need a health system that acknowledges people will come late to collect their treatment and sometimes miss appointments. This doesn't necessarily mean they've stopped their treatment; rather that how they take and collect their treatment changes over time. 'The standard ways in which the public health system works mostly doesn't provide the type of support these patients need, as the resources required to provide such support is not available,' says Yogan Pillay, the health department's former deputy director-general for HIV and now the head of HIV delivery at the Gates Foundation. 'But with AI-supported digital health solutions and the high penetration of mobile phones, such support now can — and should — be provided at low cost and without the need to hire additional human resources.' We dived into the numbers to see what the study showed — and what they can teach us about making the system for HIV treatment more flexible. Does late equal stopped? Not necessarily. Data from three health facilities in Johannesburg that the researchers tracked showed that of the 2,342 people who came back to care after missing a clinic appointment for collection medication or a health check, 72% — almost three-quarters — showed up within 28 days of the planned date. In fact, most (65%) weren't more than two weeks late. Of those who showed up at their clinic more than four weeks after they were due, 13% made it within 90 days (12 weeks). Only one in 14 people in the study came back later than this, a period by which the health department would have recorded them as having fallen out of care. (Some incomplete records meant the researchers could not work out by how much 8% of the sample had missed their appointment date.) The data for the study was collected in the second half of 2022, and at the time national guidelines said that a medicine parcel not collected within two weeks of the scheduled appointment had to be sent back to the depot. 'But it's important to distinguish between showing up late and interrupting treatment,' notes Rees. Just because someone was late for their appointment doesn't necessarily mean they stopped taking their medication. Many people in the study said they either still had pills on hand or managed to get some, despite not showing up for their scheduled collection. Pepfar definitions say that a window of up to 28 days (that is, four weeks) can be tolerated for late ARV pick-ups. Pepfar is the US HIV programme that funds projects in countries like South Africa, but most of them were cut in February. Research has also shown that for many people who have been on treatment for a long time already, viral loads (how much HIV they have in their blood) start to pass 1,000 copies/mL — the point at which someone could start being infectious again — about 28 days after treatment has truly stopped. Sending back a parcel of uncollected medicine after just two weeks — as was the case at the time of the study — would therefore add an unnecessary administration load and cost into the system. (Current health department guidelines, updated since the study and in part because of the results, say that a medicine pick-up point can hold on to someone's medicine for four weeks after their scheduled appointment.) Does late equal unwell? Not always. In fact, seven out of 10 people who collected their next batch of medication four weeks or more late had no worrying signs, such as possible symptoms of tuberculosis, high blood pressure, weight loss or a low CD4 cell count, when checked by a health worker. (A low CD4 count means that someone's immune system has become weaker, which is usually a sign of the virus replicating in their body.) Moreover, given the large number of people without worrying health signs in the group for whom data was available, it's possible that many of those in the group with incomplete data were well too. When the researchers looked at the patients' last viral load results on file (some more than 12 months ago at the time of returning to the clinic), 71% had fewer than 1,000 copies/mL in their blood. A viral count of fewer than 1,000 copies/mL tells a health worker that the medicine is keeping most of the virus from replicating. It is usually a sign of someone being diligent about taking their pills and managing their condition well. Yet clinic staff often assume that people who collect their medicine late are not good at taking their pills regularly, and so they get routed to extra counselling about staying on the programme. 'Most people don't need more adherence counselling; they need more convenience,' says Rees. Offering services that aren't necessary because of an inflexible process wastes resources, she says — something a system under pressure can ill afford. Rees says: 'With funding in crisis, we really have to prioritise [where money is spent].' Does late equal indifferent? Rarely. Close to three-quarters of people who turned up four weeks or more after their scheduled medicine collection date said they had missed their appointment because of travelling, work commitments or family obligations. Only about a quarter of the sample missed their appointment because they forgot, misplaced their clinic card or for some other reason that would suggest they weren't managing their condition well. Part of making cost-effective decisions about how to use budgets best is to offer 'differentiated care', meaning that not every patient coming back after a missed appointment is treated the same way, says Rees. Health workers should look at by how much the appointment date was missed, as well as a patient's health status to decide what service they need, she says. Giving people who've been managing their condition well enough medicine to last them six months at a time can go a long way, Wilkinson told Bhekisisa's Health Beat team in July. 'Getting 180 pills in one go reduces the number of clinic visits [only twice a year], which eases the workload on staff. But it also helps patients to stay on their treatment by cutting down on their transport costs and time off work,' Wilkinson said. Zambia, Malawi, Lesotho and Namibia have all rolled out six-month dispensing — and have already reached the UN's target of having 95% of people on medicine at a virally suppressed level. According to the health department, South Africa will start rolling out six-month dispensing in August. 'But not everyone wants this,' said Wilkinson, pointing out that experiences from other countries showed that 50 to 60% of people choose six-monthly pick-ups. It speaks to tailoring service delivery to patients' needs, says Rees, rather than enforcing a one-size-fits-all system when more than one size is needed. Says Rees: 'Facing funding constraints, we really need tailored service delivery to keep the [HIV treatment] programme where it is.' DM
Zawya
14 hours ago
- Health
- Zawya
Committee on Health Welcomes Findings of Health Ombud
The Chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo, notes and welcomes the report issued by the Health Ombudsman into the treatment and deaths of psychiatric patients at two Northern Cape hospitals. Dr Dhlomo said, the report tabled on Wednesday by the Health Ombud, Dr Taole Mokoena is concerning and disturbing as it reveals a deep lack of care at Northern Cape Mental Health Hospital, and Robert Sobukwe Hospital. 'The findings of the report are unacceptable, they exposed patients did not receive the quality care that they duly deserve,' said Dr Dhlomo. Mental healthcare is of paramount importance and must always remain under public scrutiny, especially in the light of the tragic event at Life Esidimeni, stated Dr Dhlomo. The report highlights the necessity of ensuring that mental health should always be placed under the microscope as it affects vulnerable people. The committee commends the proactive steps initiated by the Minister of Health, Dr Aaron Motsoaledi who lodged a complaint to the Health Ombud. 'This demonstrates a commitment of accountability by the Minister and the department to uncover challenges within psychiatric hospitals and the healthcare system,' added Dr Dhlomo. In ensuring that the committee provides adequate oversight, the committee will schedule a meeting and invite the Department of Health so that Members of the committee receive a comprehensive briefing. 'The transformation of mental health needs to be safeguarded so that patients are treated with dignity,' emphasised Dr Dhlomo Distributed by APO Group on behalf of Republic of South Africa: The Parliament.
IOL News
21 hours ago
- Health
- IOL News
Misuse and wastage of medication in the health sector
A letter writer raises concern about the misuse and wastage of medication in government health facilities. Image: Pixabay Open letter to Health Minister Dr Aaron Motsoaledi Sir, do you know the wastage and misuse of drugs that is occurring in our health facilities, costing the taxpayer millions?* There are hundreds of much-needed medical personnel who are unemployed, with the Department of Health citing lack of budgets as an excuse for such unemployment. Yet the gratuitous wastage and shrinkage in health facilities and the misuse of medication add to this growing scourge. This spans across major state hospitals to Community Health Centres (CHCs) to peripheral clinics, and budgets are exhausted long before the financial year end, placing facilities in an invidious position of not providing essentials and life-saving drugs. When last, if ever, did you or any of your directors-general do a spot oversight visit to a health facility to ascertain even a cursory look at how the facility is being run and the control measures implemented? Do you have any idea as to how drugs are being prescribed to the patients, and at times, misused in the manner in which they are prescribed? Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Advertisement Next Stay Close ✕ The EDL (Essential Drugs List), which is used as a tool from which to prescribe drugs, has become meaningless - oftentimes, many of the drugs are not available due to non-payment to suppliers. Lazy or incompetent doctors (some, not all) prescribe drugs as if it were a grocery shopping list - up to 18 to 20 items per script. Is this even necessary? There are some doctors who simply add items onto a script at the behest of a patient - this goes beyond the pale, especially noting the fact that a doctor should know better, but panders to the pleadings of a patient. Sadly, this goes unchecked, but importantly it ultimately burdens the taxpayer significantly. Have you implemented any strict due diligence at all health facilities in the country to help prevent the theft of medication by staff, in one form or another? The fact that drug suppliers are not paid duly and withhold medical supplies handicaps medical practitioners from effectively implementing proper and cost-effective health care. Ask any state pharmacist the amount of unused drugs that are returned to the facility beyond the expiry date rendering such drugs unusable - strict patient compliant measures and control need to be implemented - are they? Sir, do not use the lack of funds as an excuse - change what is changeable, even if it is not palatable to the unscrupulous who care less about cost, and the availability of funds will increase exponentially. As the minister responsible for a critical aspect of our society, it is incumbent upon you not to be an ivory tower administrator but rather an activist of change and progress, and I hope that you do just that - else our failing state health care system will degenerate even further. I do not want to get started on the National Health Insurance (NHI) - that elephant in the room, in my candid opinion, will become tuskless - in time. THE MERCURY
News24
2 days ago
- Health
- News24
Patients died cold and uncared for: Health Ombud exposes collapse of psychiatric care in Northern Cape
The Health Ombud report reveals that two psychiatric patients died and one was left permanently bedridden. The mental health hospital operated without electricity for year, leaving life-saving equipment useless. Leadership failures and staff shortages caused the systemic collapse of the patient care system. The Health Ombud found that two psychiatric patients died and one was left permanently bedridden due to neglect and poor care. Northern Cape Mental Health Hospital went without electricity for a year, leaving life-saving equipment unusable and patients exposed to extreme temperatures. These are some of the findings in a damning report by Health Ombud Professor Taole Mokoena, who investigated the treatment, complications and deaths of psychiatric patients at the Northern Cape Mental Health Hospital and the Robert Mangaliso Sobukwe Hospital. The report cites leadership failures, staff shortages and collapsing infrastructure as the main reasons for the breakdown in patient care. Emergency machines stood useless as they had not been charged. Calls for help could not go out as the phone lines were down. Some patients died. Others were sent out in critical condition. One will never walk again. The investigation followed a complaint made by Health Minister Aaron Motsoaledi in October last year. The report details how systemic neglect, infrastructure collapse, poor staffing and lack of leadership directly led to suffering, medical complications and death. Four psychiatric patients were closely examined in the report – two died, one suffered permanent disability and another experienced complications due to poor monitoring. In his report Mokoena states: The general care provided was substandard, and patients were not attended to in a manner consistent with the nature and severity of their health condition. Taole Mokoena The situation was made worse by a yearlong power outage at Northern Cape Mental Health Hospital, caused by cable theft and vandalism. While neighboring hospitals had their power restored within days, this one was left without electricity due to delays in the provincial department's supply chain processes. 'Because of the lack of electricity, resuscitation equipment could not be used, heating and cooling systems failed, and patients had to endure extreme weather conditions without proper clothing or bedding. The report What happened Cyprian Mohoto was transferred to Robert Mangaliso Sobukwe Hospital on 13 July last year after he experienced serious complications. A chest X-ray revealed that he had pneumonia, but this was never treated. For three days, his deteriorating condition was ignored by both nurses and doctors. He died on 16 July in the emergency unit. Tshepo Mdimbaza was found unresponsive in his bed at Northern Cape Mental Health Hospital on 3 August. When staff attempted to resuscitate him, they discovered that the equipment was not prepared or functional. His vital signs had not been properly monitored. A post-mortem found he had died from 'exposure to the elements'. John Louw, a patient at Northern Cape Mental Health Hospital, suffered a brain injury known as a subdural haemorrhage. After emergency surgery, including a craniotomy and craniectomy, was performed on 7 July and 23 July respectively, complications have left him permanently bedridden. Petrus de Bruin collapsed in ward M2 at Northern Cape Mental Health Hospital on 30 July and was transferred to Robert Mangaliso Sobukwe Hospital's Emergency Centre. He was stabilised and admitted for hypoglycaemia. While emergency care was appropriate, nursing monitoring was inadequate. The report highlighted a deep leadership crisis and operational failure at both facilities. At Northern Cape Mental Health Hospital, there was no emergency preparedness, collapsing infrastructure, poor medicine control, a shortage of staff and a lack of proper record keeping, the report revealed. The Ombud found that: The clinical manager had written to the acting head of the provincial department of health, warning about the harmful conditions patients were facing, but no action was taken. At Robert Mangaliso Sobukwe Hospital, the problems included overcrowding, missing patient files, poor supervision of nurses and staffing shortages across all departments. 'Leadership instability in the Northern Cape provincial department of health negatively affected service delivery, patient safety and the overall quality of care,' said Mokoena. Recommendations The Ombud called for urgent action to fix the broken system. This includes: 'This level of systemic collapse must never be allowed to happen again in our health system,' Mokoena added.
Eyewitness News
2 days ago
- Health
- Eyewitness News
Motsoaledi pleased no donor funds were wasted in illicit procurement of oxygen plant
JOHANNESBURG - Health Minister Aaron Motsoaledi said he's pleased no donor funding was wasted in the illegal procurement of service providers to supply the infrastructure to provide oxygen to 55 hospitals. Motsoaledi said Tuesday's release of the findings of the forensic report ordered by Public Works Minister Dean Macpherson clears his department of any wrongdoing in the more than R800 million tender. The investigation found the CEO of the Independent Development Trust, Tebogo Malaka, failed to exercise the necessary oversight over ballooning costs. ALSO READ: Macpherson on irregular oxygen plant tender after R13m spend: 'We have effectively lost' Minister Aaron Motsoaledi says the finalisation of this investigation removes the dark cloud that's been hanging over the health department. Motsoaledi said those who've been implicated in wrongdoing - not only committed financial corruption - but deprived patients of urgent life-support in the form of oxygen. Motsoaledi's spokesperson Foster Mohale, said: 'Minister Motsoaledi is pleased that the Department of Health lost nothing and all the money that has been donated by the Global Fund is safe. It would have been a sad day if donor funds' money was to disappear under our watch.' The tender has since been removed from the IDT and is now under the management of the development bank. Motsoaledi said that with the finalisation of the forensic investigation, the remaining work will be expedited to conclude the project.
