1. SUSTAINING HEALTHCARE THROUGH REGIONAL INTEGRATION

2. Shylet Sanyanga SADC Committee Chairman and CEO: AHFoZ

3. Presentation Outline BHF - SADC members SADC Protocol on Health Strategic objectives of the BHF-SADC Committee Regional integration opportunities Challenges Where to?

4. BHF Membership [1] The map on the next slide highlights the 15 current members of SADC The goal of BHF is one of regional inclusivity of all SADC member states. It is hoped that the rest of the countries in the region will join this grouping for us to achieve collective growth as a region. Current members of BHF are:- – Botswana – Lesotho – Namibia – Moçambique – Swaziland – Zimbabwe – South Africa

5. BHF Membership [2] SADC member countries

6. SADC Protocol on Health - Agreement Signed by 14 Heads of State on 18 August, 1999, in Maputo Mozambique. “State Parties shall co-operate in addressing health challenges facing them through effective regional collaboration and mutual support under this protocol for the purposes of achieving the following objectives”:

7. SADC Protocol on Health- Objectives to identify, promote, co-ordinate and support those activities that have the potential to improve the health of the population within the Region; to co-ordinate regional efforts on epidemic preparedness, mapping, prevention, control and where possible the eradication of communicable and non-communicable diseases; to promote and co-ordinate the development, education, training and effective utilisation of health personnel and facilities; to facilitate the establishment of a mechanism for the referral of patients for tertiary care;

8. SADC Protocol on Health Objectives[2] to foster co-operation and co-ordination in the area of health with international organisations and co-operating partners; to promote and co-ordinate laboratory services in the area of health; to develop common strategies to address the health needs of women, children and other vulnerable groups; to progressively achieve equivalence, harmonisation and standardisation in the provision of health services in the Region; and to collaborate and co-operate with other relevant SADC Sectors.

9. Strategic Objectives BHF-SADC Committee

10. Strategic objectives [1] Recognition of regional stakeholders and medical schemes To provide an enabling environment for all stakeholders in the region. To promote the common interests of health funders in the SADC region. To promote regional cooperation in development of regional healthcare policies and programmes. To promote sustainable, affordable and quality healthcare in the SADC region.

11. Strategic objectives [2] To achieve these objectives BHF has formed a Working Group tasked with specific duties to undertake on behalf of all members. The Working Group will be responsible for the following areas that will all support the strategic objectives outlined above:- – Lobbying and advocacy initiatives – Marketing initiatives; and – Healthcare developmental initiatives

12. Strategic objectives [3] The BHF Working Group

13. Regional integration opportunities

14. Regional integration opportunities [1] Concentrate on maximising our use of ICT to enable our product to become borderless throughout SADC. Review the issue of study permits and need for separate medical aid coverage in the country of study despite the student having existing coverage in the country of domicile. Country recognition through an accreditation process to facilitate acceptance of member funders from the SADC region.

15. Regional integration opportunities [2] Continue to assess the impact of any National Health Insurance Schemes, in South Africa and other countries within the region, on levels of access to public hospitals and levels of service provision for the poor. Harmonising of tariffs with the aim of a regional tariff structure As a region, we must reverse the impact of lower costs charged by countries such as India by becoming more competitive in terms of price and quality of service. – Consider the following graph which shows that the cost of treatment in India is almost half that of costs in the region!

16. Regional integration opportunities [3] Comparison of medical costs for certain procedures (extracted from AHFoZ study)

17. Regional integration opportunities [4] If we, as members, can work towards reducing this cost disparity there will be regional health care opportunities for all member countries through:- – Reduced number of patients opting for treatment and procedures outside the region and who in turn will be supporting local hospitals and practitioners; and – An opportunity to boost medical tourism into the region by becoming a global centre of excellence known worldwide. A SADC help desk or website with access to a regional online database with details of, inter alia, tariffs, costs, location of hospitals, and other service providers for ease of reference by patients from the region.

18. Regional integration opportunities [5] Adoption of WHO ICD-10 methodologies by all members states working with and learning from the early adopters such as South Africa. – This will improve the collection of statistics, harmonise tariffs and provide limitless data analytic opportunities to healthcare funders to identify trends and opportunities. This is important for policy formulation at country or regional level. Becoming innovative in creating new products for older members of our community.

19. Challenges

20. Challenges [1] The mobility of people within Africa and the SADC region for many reasons. – BHF needs to recognise this fact and address it by designing innovative medical aid packages to cater for foreign nationals, asylum seekers and illegal immigrants that often are denied medical care in their new host country or are required to pay for services in advance. – We need to create a borderless region, in a medical aid sense, to provide support to migrant populations through regional medical aid packages payable electronically from anywhere in the world.

21. Challenges [2] Harmonise barriers to entry in the sector – Regional health care funders need access to the region’s larger markets which are presently closed to them through protectionist legislation. Other markets cannot be penetrated at all whilst some players from other countries have had to enter some markets through local firms in those countries. – Competition should be based on service and not regulation.

22. Challenges [3] The disease burden within the SADC countries in particular HIV/AIDS and its impact on funders – Work with global researchers to improve the affordability of drugs. – Consider any relevant interventions that member countries can take to further reduce the risks of HIV/AIDS that are not currently in place.

23. Where to?

24. Where to? [1] Keep moving forward – To achieve and sustain any of the objectives and opportunities discussed today it is essential for us to:- Keep moving forward by consulting regularly with all our stakeholders; Have the explicit support of the Board to empower the members of the Working Group to ensure these strategic objectives are achieved; and To actively pursue the opportunities and the challenges listed in this presentation to create a conducive environment and promote a sustainable healthcare system in the region.

25. Where to? [2] Seek the support of all the SADC Ministers of Health – Some challenges involve issues of sovereignty and regulatory frameworks and Ministerial support will be vital in solving these matters Access the variety of strengths that each country in the region is endowed with in order to improve our own local products through knowledge transfer. Attract new members from the SADC region by proving the value of being part of BHF to the existing members. This requires support and commitment by existing members.

26. Where to [3] On the political front there is talk about introduction of a common Visa for the region, similar to the Schengen Visa for European countries. Whilst we are from the private sector; we operate in political environments and we cannot dissociate ourselves from developments on the political front. Medical schemes’ authorities should therefore be proactive to avoid being taken by surprise by the “winds of change” as the world fast becomes a global village with no borders!.

27. THANK YOU