By Marcus Low – the post Health in 2025: Spotlight’s top 4 questions for the year ahead appeared first on Spotlight.

INTRODUCTION:
Healthcare in 2025 faces big challenges globally and in South Africa. Key issues include debates over South Africa’s NHI, with little chance of compromise on medical schemes. In the U.S., Trump’s policies may cut HIV funding, research, and WHO support, hurting developing countries. New HIV prevention injections show promise but aren’t widely available yet. South Africa’s public healthcare struggles with staff shortages due to shrinking budgets. Urgent action and strong leadership are needed to address these pressing problems.

From the ongoing political and legal battles over NHI, to the far-reaching health impacts of political change in the United States, it is set to be another tumultuous year for healthcare in South Africa and around the globe. Here’s Spotlight’s top four healthcare questions for 2025.

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The post Proposed Health Professions Act Amendment a double-edged sword appeared first on Spotlight.

The Democratic Alliance intends to propose legislation that would allow healthcare professionals to do community service and internships in private hospitals. Such a legislative change risks exacerbating some of South Africa’s healthcare inequalities, argues Bulela Vava.

The unemployment crisis in South Africa has become increasingly untenable. It not only effects young people in general, but also graduates. This problem of graduate unemployment is sending a message that even education is no longer the safety net it used to be.

Among the casualties, unemployed healthcare workers are not spared. Time and time again, hundreds of early career healthcare workers find themselves helpless, either struggling to secure community service or internship placements or to join the healthcare workforce after they complete compulsory community service.

This has led to a crisis with far-ranging impacts, in particular for rural and township economies that often have the highest burden of healthcare needs but with a disproportionately low allocation of the required human resources.

Wrong solution

In a move to address this problem, Michéle Clark, DA member of parliament who also sits on the portfolio committee for health, intends to introduce an Amendment Bill to the Health Professions Act.

At its core, the draft bill aims to introduce measures allowing the private sector to employ community service and intern health professionals, a move aimed at tackling the rising unemployment rates among healthcare graduates. While this initiative appears progressive on the surface, a deeper dive into its implications reveals a complex scenario that may not yield the intended benefits, particularly for marginalised communities in rural and township areas.

Concerns with the draft bill

The draft bill deserves reserved support, but also raises some real concerns.

On the one hand, the idea of harnessing the private sector’s resources to create employment opportunities for community service and intern healthcare workers is commendable. The public health system, already burdened by budget constraints, would benefit from the additional workforce without bearing the full financial responsibility. Moreover, unemployed healthcare workers – many of whom are left disillusioned after years of rigorous training—would finally have a chance to gain much-needed experience and earn a livelihood.

On the other hand, the proposed bill’s implementation without a careful appreciation of both the context and complexity of the problem it seeks to solve raises some red flags.

The most pressing concern lies in its potential impact on healthcare equity. By allowing the private sector to employ these young professionals, there is a risk that the focus will skew towards profit-driven goals, leaving rural and under-resourced communities underserved. A significant majority of people living in rural and township communities cannot afford the often-exorbitant costs associated with accessing private healthcare, and this makes for a bad business investment case for the private sector.

Historically, the private healthcare sector in South Africa has been concentrated in urban and affluent areas where patient populations can afford care. The rural and township communities, where healthcare access is already severely limited, may continue to see little to no substantial investment from private entities. This geographical maldistribution of healthcare services only serves to widen the gap in health outcomes between the rich and the poor.

Moreover, the introduction of private employment for internship and community service professionals could lead to a two-tier system where the private sector attracts the best talent due to better working conditions and remuneration, leaving the public sector with fewer resources. This would widen the disparity between public and private healthcare services, which is already a major barrier to achieving equitable health outcomes in the country.

The way forward

Government is not without blame in this unfolding crisis, and its role cannot be overlooked. For years, there has been a failure to adequately plan and invest in the healthcare workforce, resulting in many newly qualified healthcare professionals being unemployed. The public sector’s inability to absorb these graduates has created a bottleneck that leaves many young professionals idle despite the country’s dire need for healthcare services. With its inability or lack of urgency to resolve the problem, the passing of this proposed amendment by the government could appear to be a move to outsource its responsibility to the private sector, a move that might provide short-term relief but does little to resolve the underlying problems.

To truly address the unemployment of healthcare workers and the access to healthcare crisis in South Africa, a more comprehensive approach is needed. One that looks beyond mere employment and instead focuses on equitable distribution of healthcare services. The amendment bill should include clear provisions and incentives for the private sector to deploy community service and intern professionals in underserved areas. It should also enforce legally binding accountability measures to ensure that private sector involvement does not come at the expense of the greater public good.

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Additionally, government must prioritise leadership and governance reforms in the public health sector in the interest of the public, focus on addressing push factors such as dilapidated infrastructure and poor working conditions and build on decentralised training for improved healthcare coverage. While this proposed amendment may not readily address this, a review of the current community service policy is needed, facilitated by an inclusive and comprehensive consultative process.

Ultimately, strengthening the public healthcare system is crucial to counterbalancing the influence of a profit-driven private sector and ensuring that marginalised communities receive the quality care they deserve.

*Vava is an Atlantic Fellow for Health Equity in South Africa and President of the Public Oral Health Forum, a network of oral health professionals committed to improving oral health outcomes in South Africa through strategic advocacy, education, research, and collaboration.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

The post Proposed Health Professions Act Amendment a double-edged sword appeared first on Vuka News.

The post How healthcare workers are being trained to meet the needs of rural communities appeared first on Spotlight.

The post How healthcare workers are being trained to meet the needs of rural communities appeared first on Vuka News.

The post Critics raise alarm over leadership issues at Gauteng health department appeared first on Spotlight.

The post Critics raise alarm over leadership issues at Gauteng health department appeared first on Vuka News.

the post Why the fuss about long-acting antiretrovirals for HIV? appeared first on Spotlight.

By Francois Venter

HIV prevention injections that can provide two, or even six, months of protection per shot have arguably been the biggest HIV story of the year. Ahead of World AIDS Day, Professor Francois Venter assesses the state of play and the critical next steps with these potentially game-changing new tools in the fight against HIV.

The post Why the fuss about long-acting antiretrovirals for HIV? appeared first on Vuka News.

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The post The high cost of having too few pharmacists in SA appeared first on Vuka News.

By Marcus Low – the post #InTheSpotlight | SA has started a TB revolution – can we see it through? appeared first on © Spotlight.

Summary by Vuka.news:

1. TB Rates in South Africa: TB cases have declined from 500,000 (2005) to 330,000 (2023), but the pace is too slow. South Africa remains a high TB burden country with 427 cases per 100,000 people.

2. HIV and TB Link: HIV compromises immune systems, making people more vulnerable to TB. Rising antiretroviral therapy use since 2008 has helped reduce TB cases by improving immunity. TB diagnoses are hindered by late detection, leading to widespread transmission before treatment. “Earlier identification of people in early stages of TB disease is really critical if we hope to control TB,” says Professor Thomas Scriba.

3. Advances in TB Understanding: TB is no longer just classified as latent or active; an intermediate stage, sub-clinical TB, exists. Sub-clinical TB patients can be infectious without symptoms, complicating control efforts. Early treatment of sub-clinical TB could prevent lung damage and reduce transmission.

4. TB Testing Revolution: Molecular tests now give results in hours versus weeks and are widely used in public healthcare. Portable X-ray machines enable community testing but need follow-up molecular tests. New saliva, stool, and blood-based tests are being developed.

5. Targeted Universal Testing (TUT): TUT tests high-risk groups, like those with HIV or recent TB exposure, even without symptoms. Early results show TUT increases TB detection significantly.

6. Challenges in Sustaining TB Control: TB programs depend heavily on international funding, posing sustainability risks. Political support and public awareness campaigns, akin to those for HIV, are vital.

7. Research and Local Innovation: South African universities are leaders in TB research, focusing on early detection and treatments. Investing in local TB solutions could reduce reliance on international donors. “The outcome is very much still in doubt…TB claimed 56,000 lives in the country last year.”

The post #InTheSpotlight | SA has started a TB revolution – can we see it through? appeared first on Vuka News.

the post Signed and stalled: Critical healthcare deal in Gauteng teetering on the brink appeared first on © Spotlight.

An extended impasse over a vital agreement for training and improved hospital management between the Gauteng Department of Health and Wits University remains derailed, despite behind the scenes efforts to get it back on track, reports Ufrieda Ho.

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BY Elri Voigt – the post Women in SA could have access to a three-monthly HIV prevention ring by 2026 appeared first on Spotlight

SUMMARY by Vuka.News:

New Three-Month HIV Prevention Ring: A new three-month vaginal ring containing dapivirine (100mg) is being developed as an HIV prevention tool, aiming for fewer insertions and clinic visits compared to the current monthly ring (25mg). Early studies show it achieves effective drug levels and is safe, meeting both non-inferiority and superiority benchmarks in comparison to the monthly ring.

Study Results and Safety: In a phase one trial, the three-month ring showed equivalent or higher drug levels in blood and vaginal fluid than the monthly ring, especially in the first month. Both rings were well-tolerated with similar minor side effects like vaginal discharge; no HIV infections were reported among participants.

Potential Approval and Benefits: Researchers hope the three-month ring will be approved for use in South Africa and other countries, providing an alternative to daily PrEP pills, particularly for women who prefer discreet methods.
Approval may also include safety data for pregnant and breastfeeding women based on data from the monthly ring, which could expand the ring’s accessibility.

Cost and Manufacturing: Manufacturing costs aim to cap at $16 per three-month ring, presenting an annual cost-saving compared to the monthly ring.
South African pharmaceutical company Kiara Health is positioned to manufacture and distribute the ring, marking a shift towards African-based production.

Pilot Studies and Uptake in South Africa: Implementation studies in South Africa are exploring PrEP options, including the monthly ring and long-acting injections (CAB-LA). Preliminary data shows women aged 25+ prefer the ring over pills, while younger women lean towards daily pills due to familiarity and perceived ease.

DREAMS PrEP Choice Study Findings: This study observed that women prefer options matching their lifestyle needs, with 27% choosing the monthly ring mainly due to its discreetness and reduced need for daily pills. Challenges included fear of inserting the ring and discomfort with foreign objects, particularly among younger women.

Future Steps: The Population Council plans to submit the three-month ring for regulatory approval in 2024, aiming for market availability by 2026.

The post Women in SA could have access to a three-monthly HIV prevention ring by 2026 appeared first on Vuka News.

The post Why including pregnant women in a TB study in SA was a big deal appeared first on Spotlight.

Pregnant women are typically excluded from clinical trials of new TB medicines. This has led to a lack of solid scientific evidence on how best to treat women who fall ill with TB while they are expecting. Tiyese Jeranji asked local TB experts about the problem and puts the spotlight on a recent study that broke the mould by opening its doors to pregnant women.

The post Why including pregnant women in a TB study in SA was a big deal appeared first on Vuka News.

South Africa has the third highest suicide rate in Africa and Africa has higher rates of suicide than any other continent. In the wake of World Suicide Prevention Day on September 10th, clinical psychologist Vincenzo Sinisi asks what can be done to bring down suicide rates.

The post SA has the third highest suicide rate in Africa – there are steps we can take to tackle it appeared first on Spotlight.

The post SA has the third highest suicide rate in Africa – there are steps we can take to tackle it appeared first on Vuka News.

The post Nursing in SA is changing, but is it enough to avert an anticipated crisis? appeared first on Spotlight.

The post Nursing in SA is changing, but is it enough to avert an anticipated crisis? appeared first on Vuka News.

The post Mandatory health insurance for SA is an ‘upgrade’ on NHI, proponents say appeared first on Spotlight.

The post Mandatory health insurance for SA is an ‘upgrade’ on NHI, proponents say appeared first on Vuka News.

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The post #InTheSpotlight | Beyond the hype, what might AI actually mean for healthcare in SA? appeared first on Spotlight.

BY Jesse Copelyn – IN SUMMARY:

• AI in Healthcare: Artificial intelligence (AI) is being tested and used in healthcare to assist with diagnostics, research, and even therapy, with varying levels of success. AI can perform tasks traditionally done by doctors, such as detecting tumors in x-rays and diagnosing illnesses.
• AI in Diagnostics: AI has shown potential in diagnosing diseases. For example, Google tested an AI model that provided more accurate diagnoses than doctors using the same patient information.
• AI as a Therapist: AI-powered Chatbots are being used for tasks like answering medical questions, booking appointments, and even providing therapy via apps. However, it’s unclear if AI therapy is truly effective due to limited studies.
• AI in Medical Research: AI is helping with medical research, such as Google DeepMind’s AlphaFold, which predicts protein structures. This has helped researchers working on vaccines like malaria.
• Challenges of AI in Healthcare: AI still faces challenges, such as generating incorrect information (“hallucinations”). The impact of AI in low-resource areas (like rural clinics) is also unclear.
• AI in TB Screening in South Africa: AI is making a big impact in screening for tuberculosis (TB) in South Africa, where mobile x-ray units use AI to detect abnormal lung images. AI-based tools called CAD (computer-aided detection) can identify TB and, or better than, human radiologists.
• AI Performance in TB Detection: In a 2021 study, the AI tool qXR captured 90% of TB cases at a specific threshold score, outperforming human radiologists. The tool analyzes x-ray images and assigns a score indicating the likelihood of TB.
• AI in Silicosis Screening: AI is also being used to screen for silicosis, a lung disease affecting miners. The National Department of Health is adopting CAD systems for both TB and silicosis to improve diagnostic accuracy and patient outcomes.
• Regulatory Challenges: Regulations for AI in medical devices are outdated. The South African Health Products Regulatory Authority (SAHPRA) hasn’t yet registered AI-based devices, and there’s concern that AI systems’ evolving nature complicates regulatory oversight.
• Data and AI Training: AI is sometimes trained on outdated data. For example, AI tools might miss subclinical TB (cases without symptoms) because they were trained on data from symptomatic patients.
• International Support: International agencies like Global Fund and USAID are funding AI-assisted x-ray machines for TB screening in South Africa, deployed in mobile clinics and hotspot areas.
• AI and Public Health Systems: South Africa’s health data systems are fragmented, which could hinder AI deployment. Building internal AI expertise and ensuring interoperability in digital systems will be critical for success in using AI.
• Vision for the Future: AI holds promise for improving South Africa’s healthcare, especially in tackling diseases like TB and silicosis. However, the transition will be challenging without proper infrastructure and technical expertise.

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The post Childhood vaccine coverage in SA declined in 2023, finds WHO report appeared first on Spotlight.

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The post Eye health services in the public sector are critically impaired – it is high time the health department responds appeared first on Vuka News.