The initiative is not the panacea to our healthcare and infrastructure problems, but if it is designed and used correctly, it could contribute positively to our objectives to increase access to healthcare, focused on prevention and primary health, writes Xolile Sizani.

I have been listening to the debate about the Eastern Cape scooter project, wondering whether the project makes sense or if the dignity of black people is continuing to be impaired by it. I think the answer lies in understanding the objectives behind those scooters.

We all know that the National Health Insurance (NHI) is premised on enabling access to universal healthcare. In a country where 16% of the population consumes 50% of the healthcare spend and the other 84% goes to the other half, the dignity of the majority of South Africans is already compromised.

The government is currently rolling out initiatives such as Centralised Chronic Medicines Dispensing and Distribution (CCMDD) to deliver medicines to patients at their homes or at local clinics or community centres, such as shops and churches, etc.

In 2017, when I was involved in the CCMDD programme, one million patients with chronic conditions in KwaZulu-Natal were registered. We delivered about 600 000 medicine parcels to them every month through this programme. In the Western Cape, about 700 000 patients were benefitting from the CCMDD programme.

Not only did we improve health outcomes for these patients, but we also saved them money as they went to the clinic only once they had received an SMS notification, informing them that their medicines were ready for collection. We also saved them time because they no longer had to stand in long queues waiting for their medicines; and this time could be used productively in other ways.

Community Healthcare Workers (CHW) were deployed to visit children at schools to screen them for health-related conditions, like eye screening, etc.

These are commendable attempts by our government to bring healthcare and access closer to our people and it’s my view that the provision of these scooters continues the government’s efforts to work hard to take healthcare services into our communities. Primary healthcare and preventative medicines should always remain a cornerstone of South Africa’s healthcare strategy.

Risk management should assist the government in making informed decisions in determining any solution to our healthcare challenges, all the time. But, more importantly, no single solution can address all our healthcare challenges.

Multiple solutions and multi-departmental interventions should be considered. For example, building and/or renovating or maintaining roads, clinics, hospitals, mobile clinics, training more doctors, nurses and CHW, providing scooters and police infrastructure to protect these assets from being vandalised, etc all need to be integrated when looking at long-term sustainable solutions to our healthcare challenges.

The government needs to take a holistic view of these solutions.

The scooter project recognises and mitigates risk in the following ways:

If we accept that universal access to healthcare is a human right and that prevention and provision of primary healthcare is a critical strategy, we need to ensure that community healthcare workers are empowered to visit more patients at home – to deliver their medicines and to check on their vital healthcare needs.

These healthcare workers should have the tools they need, such as mobile clinics that bring healthcare provisions to those patients who cannot access brick and mortar infrastructure.

But there are also cases where, for health reasons, some patients may not be able to come to the mobile clinic centres – what about them? Don’t they deserve to be attended to individually? This is a healthcare risk that needs mitigation – and the scooter project could address the challenge of access by those who are not able to go to the clinics.

This is the scenario I envisage: A trained and qualified CHW in the OR Tambo District in the Eastern Cape is trained and licenced to ride these motor bikes, while other CHWs are licenced to drive mobile clinics. On certain days, they visit patients at home as part of regular check-ups, while other patients are healthy enough to go to mobile clinic centres or clinics themselves for their regular check-ups.

These CHW on scooters carry with them the bare necessities, such as oxygen cylinders, first aid kits and the necessary requirements to stabilise a patient’s condition. On arrival at the patient’s home, and based on the health condition of the patient, the triage, and assessment of the patient’s weight, the conditions of the roads, the weather conditions etc, they decide whether the patient can be safely transported on a scooter to a nearby mobile centre or clinic.

In instances where the CHW finds the risk too high, they can then contact their supervisor to arrange for an ambulance to pick up the patient instead of using the scooter.

If, however, the assessment concludes that the risks are low, the CHW can then transport the patient to either the clinic (or a mobile clinic) to be attended to. In this scenario, it is clear that the scooter is not an isolated solution, but an integral part of an arsenal of solutions that the government can use to continue to improve access to healthcare.

It is not the panacea to our healthcare and infrastructure problems, but if it is designed and used correctly, it could contribute positively to our objectives to increase access to healthcare, focused on prevention and primary health.

I would like to highlight that the jury is out regarding the design of the scooters for the objectives they are intended to achieve. There is a need to ensure that these scooters comply with the World Health Organisation’s (WHO) design specifications and healthcare standards for mobile transportation of patients.

The South African Bureau of Standards (SABS) and the national Department of Health should do everything to make sure that these mobile units fully comply with the standards for mobile transportation.

The Department of Transport also has a critical role to play, and they need to make sure that there are strict protocols and licencing regimes for CHWs to be licenced to ride these vehicles and to transport patients on them. Importantly, the National Treasury should assure us that the price paid for these units is competitive.

My view remains that the NHI is a critical strategy to improve access to healthcare.

There remains a need for the government to continue focusing on the provision of primary healthcare and preventative healthcare, and to develop integrated solutions to address our healthcare.

While the introduction of these mobile scooters makes strategic sense, an integrated and risk-based approach should be taken. Where gaps remain, they must be bridged to ensure that we don’t compromise on the safety of patients – and all hands need to be on deck in providing solutions and ensuring continuous improvement.

Throwing the baby out with the bath water would certainly be regressive in this instance.

–  Xolile Sizani is the CEO of Servest – A facilities management company.

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