Update on National Health Insurance

Health Minister Dr Aaron Motsoaledi has urged citizens who are concerned about the establishment of the National Health Insurance (NHI) to be patient as government is working around the clock on this issue.

"The problem is that many believe that NHI is just the release of a document. For us in health, we know that it also involves an extensive preparation of the health care system, while at the same time preparing a policy document and in this case, the reengineering of the Health Care System is very vital," Motsoaledi said.

Motsoaledi, who was presenting the department's R25.7-billion for 2011/12 on Tuesday, announced that additional earmarked funding has been allocated at provincial level for preparatory work for the NHI, which amounts to R16.1-billion over a three-year period.

He, however, pointed out that under the present health care system, whether public or private, no NHI can ever survive.

"I know that at face value, problems in the health system are said to be existing only in the public sector and the private sector must be left alone to some wayward phenomena called market forces, even though these market forces dismally failed to stop or more appropriately caused the most recent global economic collapse," Motsoaledi said.

He said while it is true that the public health care system is bedevilled by very poor management leading to poor quality care, adding to the very low resources available in the public health sector, the current overall health care system, both public and private, will be completely re-engineered.

"The present health care system is characterised by four very clearly identified negatives. It is unsustainable, very destructive, extremely costly and very hospicentric or curative in nature. For any intervention dealing with the cost of health care, like the NHI, to make any sense, a complete re-engineering is essential and it is an obligation placed upon our shoulders," Motsoaledi said.

Elaborating on the re-engineering of the health care system, Motsoaledi said it will be according to three main streams, with the first being a district based model, where a team of five specialist or clinicians shall be deployed in each district.

The team will consist of a principal obstetrician, a paediatrician, a family physician and an advanced midwife, while a senior primary care nurse will specifically focus on maternal and child mortality.

Motsoaledi said he has consulted all the deans of the eight medical schools in the country, the professional associations of paediatricians, obstetricians, family physicians, the Colleges of Medicines of South Africa responsible for specialist training and the nursing fraternity during the recent nursing summit, who supported the initiative.

He said his intention is that by the end of this calendar year, they should be far ahead in implementing this initiative, which will include the creation of the posts at district level, something that has never existed before and will be completely new in the public service.

"We are absolutely determined to make sure that this model is implemented. Once appointed, these teams will deal with guidelines and protocols at our antenatal care clinics, labour wards, post natal health care, and paediatrics and child health clinics.

"They will follow up on every case of mortality to make sure that ...meetings are held for every single incident, to deal with the cause at hospital level immediately rather than waiting for research studies and results later.

"The specialist teams will deal with training of interns, as well as community service doctors and medical officers. They will also focus on midwives and their practice in helping to bring down maternal mortality.

They will also assist primary health care nurses on following up on patients in their communities, especially for post natal care," said an optimistic Motsoaledi.

The second stream includes a school health programme, which will be launched with the Ministers of Basic Education and Social Development.

Mostoaledi said a task team established about two weeks ago is working around the clock to deal with these issues.

"This stream of Public Health Care (PHC) will deal with basic health issues like eye care problems, dental problems, hearing problems, as well as immunisation programmes in our schools ... It will move further on to deal with more complex problems like contraceptive health rights, which will include issues such as teenage pregnancy and abortions ... and HIV and Aids programmes among learners. Added to this will be [information on] drugs and  alcohol abuse in schools," Motsoaledi explained.

He noted that the task team consisted of all relevant stakeholders from the three departments, nongovernmental organisations (NGOs) dealing with children, universities and individual experts.

"When the team has completed its work, we will start implementation in the poorest schools ... which are also far from the nearest health centres."

The third stream will be a ward based PHC model, which will deploy at least 10 well trained PHC workers per ward.

"This method is being put to good use in Brazil, where 30 000 ... community health care agents have been deployed to various communities. I was also highly encouraged when the Minister of Health in India announced during the Moscow gathering last month that in his country, they are deploying 800 000 such cadres and they call them health care activists.

"A total of 251 teams have already been deployed and in just three months, have reached 41 000 families and, in the process, discovered that 18% of the screened people had TB," Motsoaledi said, pointing out that in the past they would never have picked up the cases and would have waited for them to show up in healthcare institutions when it was already too late.

He emphasised that the re-engineering of PHC system into three streams will consolidate PHC as the country's primary mode of health care delivery.

"It will encourage prevention of disease and promotion of health in contrast to the present obsession with treatment of individual disease when it is already too late for many individuals and at great cost to the fiscus and the GDP of our country.

"It is because of this hugely curative and costly health care system that some so-called experts believe NHI is an impossible dream."

Edited by: Bua News

The validity of medical certificates

Do your employees suffer from chronic Friday or Monday flu? Are they ill every other weekend and never hand in a sick note because it was only one day? What about that “clinic note” handed in, confirming a check-up, which resulted in a claim for paid sick leave at the end of the month? What about the medical certificate which was issued a day before the employee’s return from being ill for a week. And then there is also the occasional medical certificate that is completely illegible, from a strange doctor, and from a strange area, which is not even close to the employee’s home or workplace.

What are your rights with regards to accepting or refusing medical certi ficates and requiring one for the Monday or Friday flu?

If an employee is off sick for more than 2 consecutive days, OR for one day, but on 2 or more occasions in an 8 week period, you are entitled to request a medical certificate. An employer also has the right to refuse a medical certificate if the certificate is not valid. A medical certificate is only valid if:

• It states that an employee was UNFIT TO WORK for the duration of the employee’s absence on account of SICKNESS or INJURY; and

• It is issued and signed by a medical practitioner or another person who is certified to diagnose and treat patients AND who is registered with a professional council established by an act of parliam ent.

A medical certificate stating that the employee(patient) informed the doctor of his illness or that the doctor “saw” the patient, will not suffice, as the practitioner did not declare, in his professional opinion, that the employee(patient) WAS UNFIT TO PERFORM HIS DUTY – thus, unpaid leave. Clinic notes will also only be valid, if signed by a medical practitioner authorised to make a diagnosis and not if signed by the nurse or only stamped by the clinic. Check-ups, fetching of medicine, tests and examinations will not enable the employee to claim for paid sick leave, as it does not render him UNFIT TO PERFORM HIS DUTIES DUE TO ILLNESS OR INJURY – again, unpaid leave.

Unfortunately, the last-day-of-illness medical certificate has to be accepted if the medical professional s tated that, in his opinion, the employee (patient) was unfit to fulfil his duties due to illness. In this instance, warn the employee that in future, a medical certificate has to be obtained sooner than the last day of illness.

A Medical practitioner will be a doctor, dentist, psychologist with a Master degree, registered at the HPCSA, or if the practitioner is registered in terms of the Allied Health Services Profession Act.

Altered certificates will of course be rejected from the start, as well as illegible certificates.

The Health Professions Council of South-Africa’s (HPCSA’s) guidelines for a medical certificate shortly state that:

• it has to stipulate the name, address and qualifications of the medical practitioner,

• name of the patient, date and time of the exam,

• if the diagnosis was made in his professional opinion or if the patient informed him of the illness,

• the illness itself,

• if the patient is totally or partially unfit for duty and

• the recommended period of sick leave.

The patient has to consent to the details of the illness being stated in the medical certificate, and if withheld, a simple “illness” is sufficient.

Employers must also take into consideration that if they signed a collective agreement which states that medical certificates from traditional healers will be accepted, employers will have to accept these certificates.

If an employer normally accepted medical certificates from a traditional healer, the employer will be forced to accept similar medical certificates in the future.

Fraud is common practise when it comes to medical certificates. Take the time to phone the suspicious practitioner and confirm the appointment when in doubt. You’ll be amazed how often these practitioners don’t e xist or ever heard of the employee.

How can you increase your white blood cell count?

(NaturalNews) Low white blood cell counts are indicative of a suppressed immune system and can have many causes. Emotional state and stress, an unhealthy diet and lifestyle, and nutritional intake can all cause lower immune system response and low white blood cell counts. Low immunity can also be caused by a number of health conditions, by surgical or medical treatments and by the natural aging process. Whatever the cause, low immunity and low white blood cell counts prevent the body from being able to have an optimum response to infections and illness. Here are some things which can help prevent low immunity and keep white blood cell counts high:

- Avoid sugar and keep sweet stuff to a minimum. Sugar prevents white blood cells from being their strongest

- Eliminate unhealthy fats. Polyunsaturated fats in vegetable oils such as corn, safflower, and sunflower oil are deterrents to a healthy immune system.

- If you are overweight, lose a few pounds. Being overweight is very detrimental to your immune system and studies have shown that overweight people are less able to fight off infection.

- Drink plenty of water to boost the immune system as well as flush out toxins

- Exercise is a proven immune system booster. Exercise is best in moderation, however, since too much exercise may wear the body down and create immune system problems.

- Avoid stress and try to relax. Stress is rightly called the silent killer and too much stress invariably leads to a lowered immune system.

Many food items help boost immune function and white blood cell counts. For example:

Carrots and other red, yellow, orange, and dark-green leafy vegetables contain beta carotene which helps protect the immune system, especially the thymus gland. Beta carotene and other carotenes also strengthen white blood cell production, and foods rich in beta-carotene help the body better fight off infection.

Yogurt can be very beneficial for the immune system. It helps the body produce antibodies and strengthens white blood cells.

A cup of cabbage will give you your daily requirement of vitamin A. This is an antioxidant that helps your body fight cancer cells and is essential in the formation of white blood cells. Vitamin A also increases the ability of antibodies to respond to invaders.

People who eat more garlic have more natural killer white blood cells.

Other helpful foods include chicken, cabbage, almonds, guava, crab, dark grapes and navy beans.

Supplements can play a big role in boosting immune function and white blood cell counts. Some examples:

- Oleander extract in herbal supplement form. One herbal oleander based supplement was 100% effective in a clinical trial of raising white blood cell counts in HIV/AIDS patients with extremely compromised immune systems.

- Astragalus root helps stimulate white blood cells and protects against invading organisms. It also enhances production of the important natural compound interferon to fight against viruses.

- Zinc is necessary for white blood cell function and it acts as a catalyst in the immune system's killer response to foreign bodies.

- Vitamin C is an immune enhancer that helps white blood cells perform at their peak and quickens the immune system response.

- The trace mineral selenium is vital to the development and movement of white blood cells.

- Both Siberian ginseng (eleuthero) and Asian ginseng provide support for the immune system.

- Echinacea helps stimulate the immune system in a variety of ways, including increased white blood cell production.

- Green Tea also stimulates production of white blood cells.

Always be careful where you put your condoms

Classic - had to share

Be prepared in an emergency situation

Emergency evacuation planning is an essential part of preventing injuries and ensuring the safety of your employees in emergency situations. Imagine what could happen if a fire extinguisher isn’t working when there’s a fire, or an emergency exit door is locked in an emergency.

 

It’s an employer’s duty to identify all possible emergency situations, prepare for dealing with emergencies and to make sure all employees know what to do by (OHSAct Section 8 Duty of the Employer to create and maintain a healthy and safe workplace):

• Providing clear instructions and information;
• Holding regular practice drills; and
• Conducting regular inspections of emergency equipment and escape routes.

 

Appoint competent employees to deal with emergencies

 

These appointments must include:

- An emergency controller: to take control and make sure the emergency plan is working.

 

- Evacuation wardens: to make sure everyone in the building is evacuated and moved to a safe place.

 

- First aiders: to help anyone that is injured and make sure disabled employees are evacuated and moved to a safe place.

 

- Fire fighters: to extinguish fires.

Draft Driven Machinery Regulations, 2010 promulgated in terms of the Occupational Health and Safety Act, Act 85 of 1993 ("OHSA")

Introduction

The Minister of Labour has promulgated draft revised Driven Machinery Regulations (the draft regulations'). These draft regulations seek to repeal GNR 1010 of 2003 (it is assumed that this is reference to the Driven Machinery Regulations contained in the OHSA, albeit that this reference is incorrect. GNR 1010 of 2003 in fact refer to the previous amendments to the Driven Machinery Regulations which were in fact promulgated under GNR 295 of 26 February 1988. This will be an aspect on which clarity will be sought through interaction with the Department of Labour).

We have set out below the pertinent amendments and/or additions to these draft regulations for your information. If you would like a full text copy of Government Gazette Number 9479 of 4 March 2011 with Regulation Notice 163, for your records please contact us and we will forward a copy to you.

Scope of application

The draft regulations specifically state that these regulations shall apply to the design, manufacture, operation, repair, modification, maintenance, inspection and testing of driven machinery. The current Driven Machinery Regulations are silent in this regard.

Sanding machines

The draft regulation 9(8) requires the user of machinery used for the purpose of grinding, cutting, fettling, polishing or similar applications shall ensure that the operators of such machines are duly trained.

This is an additional requirement included in respect of specific training required to be provided, over and above training required to ensure compliance with section 8 of the OHSA. Employers and users of machinery will have to ensure that a specific system is implemented in terms of which this specific training is formally provided and that the employer or user is able to demonstrate to the Department of Labour that this has been complied with.

Slitting machines

Where the current regulations require that effective guarding is provided the draft regulations provide further directions regarding the nature of this effective guarding. The user of machinery will be required to ensure, in terms of draft regulations 11(2) and 11(3) that fixed guarding or enclosures prevents access to the machine and that access points must be controlled by an interlocked safety device which device must prevent or arrest the motion of the machine when activated by unauthorised entry.

Goods hoist

The current regulations governing the use of goods' hoists in regulation 17 do not appear in the draft regulations, nor have they been replaced. The definition of lifting equipment in the draft regulations specifically excluded goods' hoists and it appears as though this equipment may no longer be regulated by the Driven Machinery Regulations.

Lifting machines and lifting tackle

A number of amendments are proposed to the regulations governing lifting machines and lifting tackle, which amendments will require the employer or user of machinery to amend current systems and/or implement additional systems to ensure compliance. In summary, the following additional requirements have been placed on employers or users of machinery in the draft regulations:

in addition to the requirement that no user shall use or permit the use of a lifting machine unless it has at all times at least three full turns of rope on the drum of each winch, which forms part of such a machine when such a winch has run to its lowest limit (as contained in the current Driven Machinery Regulation 18(1)(c),) the draft regulations require the user of machinery to ensure that the winch is controlled by an automatic cut out device. It is however noted in the draft regulations that this draft sub regulation will not apply to capstan type winches;

the user will be required to ensure that every power driven lifting machine is fitted with a limiting device that will cause the driving effort to be automatically arrested when the load condition is greater than the rated load condition of such machine. This requirement currently only applied, in driven machinery regulation 18(2)(b) to winch operated lifting machines with a lifting capacity of 5000 kg or more;

the thorough examinations to the whole installation and all working parts of every lifting machine will, under the draft regulations, also include ancillary lifting equipment. In addition, where under the current Driven Machinery Regulations this test must be carried out by a person who has knowledge and experience of the erection and maintenance of the type of lifting machine involved, the draft regulations require that this test is carried out by a registered Lifting Machinery Inspector appointed by a registered Lifting Machinery Entity who has knowledge of the erection and maintenance of the type of machine. However, the draft regulations state that mobile cranes will be excluded from the performance tests after each re-deployment;

no user of machinery shall use, or permit the use of temporary suspended access platform installations unless it complies with a safety standard with respect to its construction, installation, operation and inspection incorporated into the draft regulations for this purpose;

the current Driven Machinery Regulations, in regulation 18(8), require that no user shall use or permit any person to be moved or supported by means of a lifting machine, unless such machine is fitted with a cradle approved for that purpose by an inspector. The draft regulation amend this requirement and will require the used of machinery to ensure that any lifting machine used for the lifting of persons is fitted with a man-cage designed and fabricated according to an approved SANS standard and that a risk assessment is carried out by the user;

the requirements is respect of jib cranes, contained in current Driven Machinery Regulation 9 have been amended in the draft regulations to apply to all power driven lifting machines; and

the draft regulations require the factor of safety required for lifting tackle with respect to the maximum mass loads to comply with the SANS standard rather that the specific reference to safety factors as currently contained in Driven Machinery Regulation 18(10)(c)

Conclusion

The draft regulations provide greater clarity in respect of the obligations placed upon the employer or user of machinery. However, this in turn creates an additional onus for the employer or user of machinery to ensure that specifications in the incorporated standards are in place and that the employer or user remains abreast of the requirements as contained in the various SANS standards.

Written by Warren Beech, Partner and Kenneth Coster, Partner at Webber Wentzel

Are you ready for the Consumer Protection Act?

The Consumer Protection Act, 2008 (the CPA) is coming into force on 31 March 2011. It will have a significant effect on the supply of goods and services. The act will also regulate the relationship between suppliers and consumers in detail.

One of the most controversial provisions of the CPA relates to the liability of suppliers. If someone supplies goods, and those goods cause harm to the consumer, the supplier will be liable for the harm. This will be the case even if the supplier was not negligent. Further, all parties in the supply chain can be held liable by the consumer. This includes the manufacturer, the wholesaler and the business that sells the goods to the public.

Suppliers must also take note of the standard warranties that will apply to goods supplied to consumers. These warranties cannot be excluded. When the CPA is in force, consumers will have the right to receive goods that:

• are reasonably suitable for the purposes for which they are intended;

• are of good quality, in good working order and free of any defects;

• will be useable and durable for a reasonable period of time, having regard to certain factors; and

• comply with any applicable standards set under the Standards Act, 1993.

The CPA also deals with the marketing of goods. Consumers will have the right to restrict unwanted direct marketing (this will include promotional e-mails and telesales). Further, if a consumer bought goods as a result of direct marketing, the consumer will be entitled to cancel the sale of those goods within a specified period.

A supplier will have to ensure that its packaging and/or labelling complies with the CPA’s requirements. The Minister of Trade and Industry will prescribe certain information or descriptions that must be applied to specific goods. In addition, the CPA has strict requirements relating to the disclosure of the price of goods. If goods are displayed for sale, the supplier must also display the price of those goods at the same time.

When it comes to promotional competitions, suppliers will in future have to ensure that they follow the provisions of the CPA in this regard. For instance, the CPA contains certain requirements regarding the rules of promotional competitions. It also regulates the consideration payable by consumers for entering into competitions.

Another important aspect of the CPA relates to business names. In future, a supplier will not be able to trade under a name, unless:

• in the case of an individual, that name is displayed in his or her identity document;

• in the case of a juristic person (e.g. a company), the name is registered; or

• name is registered in terms of the process prescribed by the CPA.

These issues are just some of those that are dealt with in the CPA. It is important for all businesses to make sure that they are ready for the CPA. They will have to take steps to mitigate their risks against the CPA’s strict liability provisions. In addition, the wording of standard documentation should be checked for compliance with the act.

Written by Danie Strachan at Adams & Adams Attorneys. Contact: danie-s@adamsadams.co.za.