Gauteng needs to learn prevention strategies from Western Cape as Covid-19 peak looms - Health Forum

Western Cape Premier Alan Winde thanks nurses and health care workers during a recent visit to Ceres in the Cape Winelands. PHOTO: Twitter/Premier Alan Winde
Western Cape Premier Alan Winde thanks nurses and health care workers during a recent visit to Ceres in the Cape Winelands. PHOTO: Twitter/Premier Alan Winde
  • Gauteng needs to have a strategy on prevention of Covid-19 in order to flatten the curve in the wake of the peak, says Dr Aslam Dasoo of Progressive Health Forum.
  • Among some of the options which the province would need to look into would have to be intermittent lockdowns. 
  • PHF has put forward a proposal calling for a joint Covid-19 response between public and private healthcare sectors. 

If there is anything Gauteng needs to learn and implement from the Western Cape as the Covid-19 peak looms, it must be prevention strategies.

This is according to the Progressive Health Forum's (PHF), Dr Aslam Dasoo, who told News24 that Gauteng's trend of a spike in cases was similar to that of the Western Cape in the past two months.

He said the difference was, however, that in Gauteng, the curve seemed to be getting much steeper. 

PHF is the national advocacy network of healthcare veterans, health activists, health workers and professionals from all health disciplines.   

READ | Makhura calls on Gautengers to help weather Covid-19 storm

"In other words, the rate of infections in Gauteng is exceeding what the worst rate was in the Western Cape at the corresponding time and this is a dire signal for our services here in Gauteng in particular," he said.

Dasoo said Gauteng would now have to put in place whatever measures it can implement, adding there would be nothing untoward - with regional lockdowns in places identified as hotspots.

Intermittent lockdowns could be the only option for Gauteng

He said while Gauteng was, of course, in a much better position in terms of having more health resources both in the public and the private health sectors - unlike provinces such as the Eastern Cape, it would be able to mitigate and flatten the peak, but won't be able to manage it completely. 

He said when the Western Cape had reached a peak it began to conduct rapid prevention measures in known hotspots and was able to slow down its curve.

"Somehow we can't really do that [in Gauteng] and measures like intermittent lockdown would be the only option left. Either way, we are going to have many sick. And the system that will be the system of ultimate resort is the health system and that is unfortunately not going to withstand the onslaught," he said. 

Other reasons why Gauteng may not be able to completely manage was not only due to its state of readiness but also its failure of having preventative strategies in place, Dasoo added. 

"I know that the government has been trying its best to get people to physical distance, wear masks and so on but it has not penetrated the consciousness, I think, of most people.

And of course, it doesn't help that the lockdown has created severe economic hardship and that people are desperate to get to work, to earn something because they are close to poverty and so the combination of those things has affected prevention strategy.
Aslam Dasoo

"The health system, ideally, should have been protected from the surge by the prevention measures, but because the prevention measures have now not worked, we can expect the damage in our facilities," he said. 

A joint response from public and private healthcare systems

Dasoo said when the national lockdown was announced in March, PHF was not completely comfortable with it,  because it didn't believe the country had adequately prepared itself to do what was needed during the lockdown - to flatten the curve by ramping up testing and reduce the spread. 

"But three weeks into the lockdown, the NHLS (National Health Labatory Services) hadn't even gotten its plan together. So the first three weeks, while it stopped movement and pushed out the curve, it didn't flatten the curve. It pushed out the curve by a few weeks and those few weeks should have been used much more productively than it was." 

PHF believes there is a lot that could still be done as the peak of the virus looms - and has put forward a proposal that would allow at least 15 000 medical practioners in the private health system to be enlisted into the national efforts, Dasoo said. 

READ | Gauteng could see 'intermittent lockdown' as Covid-19 peak looms - Masuku

He said from the onset, the entire public and private health systems should have mobilised via an integrated response. 

In a statement on Sunday the major representative organisations of the medical profession along with PHF said the private health system was more than willing and ready to participate in the response, insisting that only an integrated joint effort of public and private health approach could provide the best response to Covid-19.

Professor Alex van den Heever of the Wits School of Governance and member of PHF, who helped develop the overarching framework of the PHF proposal said: "The proposal envisages private medical scheme funding for practices on a capitation basis that would guarantee sufficient income for practices for the next 18 to 24 months, while capping the risk to medical schemes." 

Key tenets of the proposal, according to the statement, include:

  • Money be advanced by medical schemes to private practitioners on a non-repayment basis, based on 2019 earnings. This will involve a guaranteed payment to medical practices of up to 70% of historical claims (using 2019 as a base year), and 30% based on activities that exceed the 70%. The guaranteed payment will be offset against actual activities as they normalise over time.
  • The global cap will be based on both medical savings account and risk benefit claims. In this way medical, dental and allied practices can also be supported with this framework.
  • Claims activities over the periods 2020 and 2021 will be capped at historical 2019 levels (the global cap), meaning that the risk for medical schemes of a surge in claims either due to Covid-19 patients or deferred treatment would also be capped at 2019 figures. In this way the reserves of medical schemes are also protected.
  • The risk of a decline/increase in numbers of medical scheme members would be balanced by a pro-rated adjustment to the global cap.
  • The only practices that could be negatively affected by participating in such an arrangement, would be those practices that would have generated income during the pandemic, in excess of 100% of their 2019 income.
  • Discussions have also been held with the banking sector to address short-term needs to access to bridging loans until such time as this framework can be implemented.

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