N.T. Molai23/02/11

HEALTH TECHNOLOGY STRATEGY

Briefing To The Portfolio Committee On Health

02 March 2011

N.T. Molai23/02/11

PURPOSE

α To brief the Portfolio Committee on the Health Technology Strategy

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HT STRATEGY IN BRIEF

α The main purpose of the strategy is to ensure that: β Appropriate Health Technologies are available;β Fully functional; β Pose minimal risk to patients;β While reducing the systematic inefficiencies and associated wastage

α Has 5 Strategic Objectives (SO1 – SO5)β SO1: Promoting Equity In Access & Distribution Of HT (HT

Planning)β SO2: Reduction Of The Unnecessarily High Cost Of HT (HT

Acquisition)β SO3: Ensure Safety and Efficacy of HT (HT Asset Management)β SO4: Ensure Appropriate Introduction, Adoption and Continued

Use Of HT (HT Assessment, Evidence Based)β SO5: Development of Relevant Legislation (HT Regulations)

α Underpinned by a vigorous capacity building drive and review of governance structures

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HT DEFINITION

Health Technology (HT) includes devices, drugs, medical and surgical procedures and the knowledge associated with these in the prevention, diagnosis and treatment of diseases, as well as in rehabilitation, including the organisational and supportive systems within which health care is provided

THIS STRATEGY HOWEVER FOCUSES ON MEDICAL DEVICES

N.T. Molai23/02/11

HT PLANNING

Challenge Intervention

-Poor planning-Disjointed & chaotic eqpnt infrastructure

Develop and Implement HT Planning strategy - Norms & Stds- HT distribution )

No rational basis & mechanisms for HT replacement & procurement (sales people driven)

Comprehensive HT Audit - HT Asset register - Asset Mngt System- HT Functionality- Eqpnt age analysis- HT distribution pattern etc)

High tech equipment purchased, unused (skills shortage)

Build planning capacity

- health planners

- HT economists)

Mismatch b/n the need and available technologies

Multidisciplinary HT Planning Committees to be established at all levels

Strategic Goals Develop a Technology Planning

mechanism (Norms & Stds) Develop a National HT Plan (HT

distrib for Pub & Priv) Build planning capacity (Health

Planners & HT econmst) Establish national HT inventory

(HT distributions patterns) Develop relevant HT packages

(EHTP, EELs etc)

N.T. Molai23/02/11

Current Challenges Being Addressed in the Planning

New Radiological/ Fluoroscopic Unit unused for 2YrsWorth US$78’000Age: 2 years

Oxygen Tent Made from an old aquarium

No Sharps Containers/Waste-Disposal Units. Each Cost US$ 28Hospital requires 300 NB: US$78’000 => 2785 containers

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HT ACQUISITION

Challenge Intervention

Inability to determine HT cost drivers

HT value chain analysis

Fragmented medical device acquisition & poor controls

Strategic sourcing incl-central procurement,-bulk procurement-HTs, Standardization)

Possible price variation b/n provs & between Public & Private Sectors

Challenges related to BEE

HT pricing review & transparent HT pricing

Creation of HT budget item in SCOA

BEE reviewing

Strategic Goals cost reduction strategies, incl

bulk buying discounts restructuring of the

procurement process Strategic sourcing partnerships SA to become a Regional HT Acquisition

CoE Develop a mutually beneficial

relationship with HT industry Strengthen BEE Analysis of HT pricing issues Develop local manufacturing capability

liaise with DTI,DST, Treasury Nurture HT industry through local

acquisition

N.T. Molai23/02/11

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HT MANAGEMENT

Challenge Intervention

- Low maintenance rates incl budget vs high purchase

- Outsourcing costs @ 8% higher than inhouse) rates-High equipment downtime at +/-25%

Optimize maintenance (outsourcing vs inhouse)

Review HT Structure & strengthen CE

Low HT management baseline

Deteriorating clinical engineering

Strengthen national CE infrastructure

(CE workshops; Maintenance budget)

Dearth of CE skill (high vacancy rates, no investment in HT -HR development

Nation wide capacity building drive (Electr Engineers/Techs CE)

Strategic Goals Strengthen clinical engineering infrastructure Establish standards of usage including maintenance Set and enforce training standards Develop and adopt an optimal mix of in-house & outsourced maintenance Build technical capacity

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0

20

40

60

80

100

120

140

160

EC

FS

GP

KZ

N

LP MP

NC

NW

WC

REQUIRED

VACANT

FILLED

Critical shortage of

technical capacityPublic Sector Statistics

Private Sector equally challenged

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HT ASSESMENT

Challenge Intervention

Rapid rate of technology influx incl - +/-28000 new devices registered p.a.by FDA-Leads to HT cost escalation

Adopt a national HTA Model

Establish HTA Agency (funding)

Establish HTA structure in NDoH

Over servicing and perverse incentives in the use of technology,

Lack of comprehensive HT Scanning mechanisms (risk of obsolete technology dumping)

Strategic Goals Development of HTA Mechanisms Development of relevant

structures Institutionalizing of HTA Foster International HTA

collaboration Develop HT forecasting and HT

Scanning mechanism

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12

1,400 Capital Equipment products

2,000 Surgical Instruments

450 Implantable devices

Single Use Disposables

The Universe of Medical Devices

•5,000 generic entities•More than 1,000,000 brands, models & sizes•More than 10,000 manufacturers•RSA info however not available

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Resultant effect of -Poor maintenance-Poor user training-Poor equipment selection

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Pad site burn

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Regulation in three areas

Needs Assessment

Health Technology Assessment (HTA)

Qualified userSafe/Effective use

Good Management Practice (GMtP)

I II IIIMARKET SELECTION UTILISATION

Market AvailabilityClassification

Safety & PerformanceGHTF Guidelines

Post Market Obligations

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Three Levels of Medical Device Regulations

Needs Assessment

Health Technology Assessment (HTA)

Qualified userSafe/Effective use

Good Management Practice (GMtP)

I II IIIMARKET SELECTION UTILISATION

Market AvailabilityClassification

Safety & PerformanceGHTF Guidelines

Post Market Obligations

Current Focus on Safety

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THANK YOU