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INSIDER
SAMA
AUGUST 2019
Good is the enemy of great:
Cultures of leadership
COHSASA CEO elected to IAQS
PUBLISHED AS A SERVICE TO ALL MEMBERS OF SOUTH AFRICAN
THE SOUTH AFRICAN MEDICAL ASSOCIATION (SAMA) MEDICAL ASSOCIATION
CONTENTS
AUGUST 2019
Source: Shutterstock: ImageFlow
3 EDITOR’S NOTE 11 Introducing the KMRED
Leadership and quality healthcare Dr Selaelo Mametja
Diane de Kock
13 A South African doctor in
4 FROM THE PRESIDENT'S DESK South Sudan
Lessons for SA from an unusual Dr Carissa Saunderson
source
Prof. Hoosen Coovadia 14 2020 CCSA products launched
Rendani Tendane
5 FEATURES
COHSASA CEO elected to IAQS 14 They walk among us – the workplace
SAMA Communications Department psychopath
SAMA Communications Department
5 Advertising professional services
and products – legal and ethical 16 Worker burnout: Too much work and
requirements unclear goals
Hanneke Verwey Gert Viljoen
7 Good is the enemy of great: Cultures 17 TB infection prevention and control
of leadership greatness improve in healthcare settings
employee engagement Annatjie Peters
Elaine Jacob
18 MEDICINE AND THE LAW
8 New essential medicines and Concealed sepsis
diagnostics lists published Medical Protection Society
World Health Organization
19 BRANCH NEWS
9 One in three people globally do not
have access to safe drinking water
World Health Organization
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EDITOR’S NOTE AUGUST 2019
Leadership and
quality healthcare
G
ood-quality leadership is vital in delivering good-quality healthcare. This month
we focus on leadership in the workplace, its importance, self-care and striving
for excellence.
On page 4 SAMA president Prof. Hoosen Coovadia discusses some lessons for SA, and
particularly our leaders. We congratulate Jacqui Stewart (page 5) on her election to the
International Academy of Quality and Safety (IAQS), “a recognition of the importance
of Africa”. Jacqui, CEO of the Council for Health Service Accreditation of SA, is the first
board member from an African organisation.
Elaine Jacob from the Leadership Academy of SA (page 7) warns of the perils
Diane de Kock of settling for good instead of great. “The only way to keep relevant is to strive for
Editor: SAMA INSIDER greatness.” She maintains that leadership is a skill we can all learn: “Leadership is not a
gene, and it is not a trait – it’s a set of skills, and anyone can learn new skills.”
The effects of bad leadership are highlighted in the article (page 14) on the
workplace psychopath. Dr Renata Schoeman, psychiatrist and associate professor in
leadership, says it is often leaders – who should be at the forefront of reducing the
workplace conditions that lead to stress and burnout – who contribute to the problem,
rather than the solution.
These articles serve as an introduction to the challenges of leadership in the
healthcare sphere. The theme of the SAMA conference, which takes place from 8 to 10
August, is “Leadership & Quality in Healthcare – Let’s Close the Gap”. We look forward
to reporting on the conference in the October issue of SAMA Insider.
Editor: Diane de Kock Senior Designer: Clinton Griffin
Head of Publishing: Diane Smith
Copyeditor: Kirsten Morreira Published by the South African Medical Association
Block F, Castle Walk Corporate Park, Nossob Street
Erasmuskloof Ext. 3, Pretoria
Editorial Enquiries: 083 301 8822 | dianed@hmpg.co.za
Advertising Enquiries: 012 481 2069 Email: publishing@hmpg.co.za | www.samainsider.org.za | Tel. 012 481 2069
Email: dianes@hmpg.co.za Printed by Tandym Print (Pty) Ltd
Opinions and statements, of whatever nature, are published in SAMA Insider under the authority of the submitting author, and should not be taken to present the official
policy of the South African Medical Association (SAMA) unless an express statement accompanies the item in question.
The publication of advertisements promoting materials or services does not imply an endorsement by SAMA, unless such endorsement has been granted. SAMA does not
guarantee any claims made for products by their manufacturers. SAMA accepts no responsibility for any advertisement or inserts that are published and inserted into SAMA
Insider. All advertisements and inserts are published on behalf of and paid for by advertisers.
LEGAL ADVICE
The information contained in SAMA Insider is for informational purposes and does not constitute legal advice or give rise to any legal relationship between SAMA and the receiver
of the information, and should not be acted upon until confirmed by a legal specialist.
FROM THE PRESIDENT’S DESK
Lessons for SA from an unusual source
first-time MP in India’s parliament who listed number of hate crimes in India between 2014
the “signs of early fascism” in what has been and 2019.
hailed on social media as the “speech of the She also criticised the government for its
year”. I listened to her maiden speech and “unimaginable subjugation and control of
was bowled over by the eloquence with mass media”, including the fact that India’s
which she delivered it, and by its devastating TV messages channels spend “the majority
content, which reinforces, and maybe even of airtime broadcasting propaganda for the
confirms, many widely believed accusations ruling party”.
against the new President of India, Narendra The government, she said, had an “ob -
Modi: generally held to display fascist beliefs session with national security”. An “atmos-
and represent a deviation from India’s history phere of fear” pervaded the country, with new
of democracy, secularism and inclusiveness. enemies being created every day. On top of
The main thrust of what Mahua Moitra, this, “the government and religion are now
of the opposition Trinamool Congress party intertwined. Need I remind you that we have
(TMC), said was that she had seen a list of the redefined what it means to be a citizen?” she
early warning signs of fascism on a poster in demanded, saying laws had been amended
Prof. Hoosen Coovadia, SAMA president the Holocaust Memorial Museum in the USA. to target Muslims.
She pointed out that India’s constitution was She also said that “a complete disdain for
T
he most recent elections in our country under threat, and the country was being “torn intellectuals and the arts” and “the repression
have given us a mixed bag of some apart” by the ruling party’s “lust to divide”. of all dissent” was the most dangerous sign
benefits, but also huge disadvantages. Ms Moitra acknowledged Modi’s Bharatiya of all – and it was “pushing India back to the
It is hard to know the likely outcomes in the Janata Party (BJP)’s landslide victory in the Dark Ages”.
medium to long term of the introduction recent general elections, but said that “the The last early warning sign of fascism
of a new set of legislators and their cronies, very nature of the overwhelmingness of this evident in India, Ms Moitra said, was the
under the fixed smile and leadership of mandate makes it necessary for the voices of “erosion of independence in our electoral
Cyril Ramaphosa and the disunited ANC. dissent to be heard.” system”.
In addition to all the well-recognised A former investment banker with JP Although MPs from the treasury benches
shortcomings of the country in 2019, which Morgan, Ms Moitra quit her well-paying tried to shout her down, she stood firm and
include a precarious governance system, job in London in 2009 to return to Indian called on the parliamentary Speaker to rein in
a shattered economy, a restless populace politics. She has been the TMC’s national the “professional hecklers”.
and severe basic services disarray, with spokesperson for several years, and regularly We in this country can take away many
dysfunctional health, education and welfare appears in prime-time TV debates. During lessons relevant to our situation. Ms Moitra’s
institutions, we also have a deplorable the recent elections, on the campaign trail speech is significant at a time in India when
unemployment rate – especially among the in rural Krishnanagar constituency in West one party – Mr Modi’s BJP – dominates
youth, who will need all the optimism they Bengal state, where the TMC is in power, parliament, and the opposition is struggling to
can muster to see a brighter future under the Ms Moitra took direct aim at Mr Modi. She be heard. Like the BJP, the ANC has a dominant
present setup. We are not alone: even a brief talked about the recent deadly suicide attack role in SA; indeed, the ANC has an enviable
glance around the world will show clearly that in Kashmir, and India’s subsequent air raid historical status, and can therefore marshal
the despairing effect is almost global; we see on Pakistan. She accused the BJP of trying more legitimate policies for the country on
the US under the vacillating and belligerent to divide Hindus and Muslims. She said some of the key determinants of life. But
Trump administration, the travails of a Brexit elections in the past were to change the in fact, the ANC is riddled with fissiparous
Europe, an unstable and often impoverished government, but this election was to save tendencies, which inhibit its effectiveness.
Africa, Latin America (Venezuela) desperate the constitution of India. There are, however, many examples of brave
for survival under a welter of US economic And now, in her maiden parliamentary persons who have fought for justice and
sanctions and an array of countries struggling speech, she listed the seven “danger signs of the elimination of corruption, in society and
to deal with poverty and its attendant early fascism” that she saw in Modi’s party. It within the ANC. These activities need to be
suffering. is critical that we in SA, given the right-wing given more cohesion and strength.
But I wish to discuss a lesser-known factor and raucous voices fighting for control in the Ms Moitra’s speech is especially signi-
that gives us a promise of hope. This is the African National Congress (ANC) and other ficant because politics in India is still very
rise of younger activists and community- parties, pay attention to her words. patriarchal: it is dominated by men, and
based revolutionaries who are challenging “ There is a powerful and continuing women make up only 14% of members of
the status quo, though the example given nationalism that is searing into our national the house. From this perspective, we in SA
here may be nothing more than a single fabric,” she said. “It is superficial, it is xeno- start from higher ground in our fight for
phenomenon, transient and ephemeral. It phobic and it is narrow.” She pointed to a justice and freedom, but we should take
concerns the actions of a remarkable young “resounding disdain for human rights”, which note of Ms Moitra’s intellectual criticisms,
woman in India: this is the story of a female she said had led to a 10-fold increase in the messages, courage and passion.
4 AUGUST 2019 SAMA INSIDER
FEATURES
COHSASA CEO elected to IAQS
SAMA Communications Department
M
s Jacqui Stewart, CEO of the Council manager. She was appointed interim CEO in
for Health Service Accreditation of January 2015, and CEO in April 2016.
Southern Africa (COHSASA), has Ms Stewart’s election to the academy is
been elected to the International Academy not only a personal milestone, she says, it is
of Quality & Safety (IAQS). The academy was also a recognition of the importance of Africa
established by the International Society for in this forum.
Quality in Health Care (ISQua). “I am obviously delighted to be in this
The IAQS recognises distinguished position, but what it means for SA and Africa
individuals who make a significant contri- is far more important. The recognition Africa
bution in the field of quality and safety in is getting is also evident in the fact that, for
healthcare. Ms Stewart was nominated by an the first time in 36 years, the ISQua annual
inaugural member of the academy. conference will be held in Africa, in Cape Town
“I am extremely honoured and humbled in October. This is a signal of the growing
by this appointment. My first reaction was importance of Africa’s involvement to this
‘Why me?’” explains Ms Stewart. body,” she notes.
She says being part of an international Ms Stewart says COHSASA’s bid to co-host
body such as the IAQS gives her, and the event – which attracts between 1 500
COHSASA, an opportunity to interact with and 1 700 delegates – was supported by
leaders and experts in patient safety and Jacqui Stewart other African delegates at the conference in
quality in healthcare from around the Malaysia last year, an indication of the support
world. She has worked in the public and private and unity within the African healthcare
In 2017 Ms Stewart was appointed as an healthcare sectors in SA and England. She community.
institutional member to the ISQua board. “I qualified as a registered nurse in Cape Town, “I made the presentation, but I wasn’t alone;
am the first board member from an African going on to specialise in cardio-thoracic the other African delegates all stood with me,
organisation, which is important because it nursing in London where she ran the which is encouraging and important,” she says.
means that lower-middle income countries, heart transplant unit at Harefield Hospital, Fellow members of the academy from SA
which previously didn’t have an elected Middlesex, for 5 years. She has since been are Prof. Laetitia Rispel, professor of public
voice on this body, now have someone involved in a variety of managerial roles in health at the University of the Witwaters-
representing their interests. It’s a great nursing, quality, capital and service planning rand, and Prof. Morgan Chetty, chair of
responsibility, and I am thrilled to be a part in the UK National Health Service. the Independent Practitioners Association
of it,” she says. Between 1996 and 2002, Ms Stewart was a Foundation in SA.
Ms Stewart was a member of the SA director at the Family Health Services Authority Other elected members of the academy
Lancet Commission on High Quality Health in Kent, and then the East Kent Health Authority, from Africa are Dr Gilbert Buckle, executive
Systems. An ISQua expert, Ms Stewart also responsible for primary healthcare, service director of the Africa Institute of Healthcare
serves on the accreditation council of the development and integration. She moved to Quality, Safety & Accreditation in Ghana (and
ISQua External Evaluation Association. a regional role and then became the director of also a COHSASA board member), Dr Sodzi
She holds a Master of Professional Studies career development and succession planning Sodzi-Tettey, executive director and head,
(Health) from Middlesex University, London, at the NHS Modernisation Agency Leadership Institute for Healthcare Improvement, Africa
and was recently chosen as one of the 100 Centre. Region, Ghana, and Dr Emmanuel Aiyenigba,
Most Impactful Healthcare Leaders of 2019 In 2005, Ms Stewart returned to SA improvement advisor for the Institute for
by the World Health & Wellness Congress. and joined COHSASA as chief operations Healthcare Improvement in Nigeria.
Advertising professional services and
products – legal and ethical requirements
Hanneke Verwey, legal advisor, SAMA Governance and Legal Unit
U
ntil relatively recently, doctors were professional services or products. These subsequently published, in recognition of the
limited in the manner in which they restrictions were lifted by the HPCSA in 2006. fact that marketing may be required in order
were permitted to advertise their Less restrictive guidelines and rules were to run a sustainable practice. Advertising is,
SAMA INSIDER AUGUST 2019 5
FEATURES
however, still highly regulated, and doctors consultation, or advertising the fact that free In this regard, rule 4 provides that letterheads
must comply with the ethical rules, guidelines Wi-Fi is available in the practice waiting room, may only contain the practitioner’s: (i) name;
and legislation. could be construed as touting. (ii) profession; (iii) registered category;
The HPCSA’s “Guidelines on over-servicing, (iv) speciality or subspecialty, or field of
HPCSA rules and guidelines perverse incentives and related matters” practice; (v) registered qualifications or other
In terms of rule 3 of the “Ethical rules of (booklet 11) further provide that doctors may academic qualifications or honorary degrees,
conduct for practitioners registered under not advertise or endorse or encourage the in abbreviated form; (vi) registration number;
the Health Professions Act” (No. 56 of use of any health establishment or orthodox (vii) address (including email address);
1974), a doctor may advertise professional medicine, complementary medicine, medical (viii) telephone and fax numbers; (ix) practice
services, or permit, sanction or acquiesce device or scheduled substance or health- or consultation hours; (x) practice code
to such advertisement, provided that related product or service in a manner that number; and (xi) dispensing licence number
the advertisement is not unprofessional, unfairly promotes the practice of a particular (if any).
untruthful, deceptive or misleading, or causes doctor or healthcare facility for the purpose of
consumers unwarranted anxiety that they may financial gain or other valuable consideration. Consumer Protection Act
be suffering from any health condition. The “Endorse” means any action whereby a person Advertising of professional services is
HPCSA defines “advertising” as any written, or body attaches approval to or sanctions any also regulated in terms of the Consumer
pictorial, visual or other descriptive matter, health establishment or orthodox medicine, Protection Act No. 68 of 2008, as patients and
or verbal statement or reference in respect complementary medicine, medical device or doctors qualify as “consumers” and “suppliers”
thereof: (i) appearing in any newspaper, scheduled substance, or other health-related in terms of the Act. Patients are entitled to
magazine, pamphlet or other publication; product or service, with a view to encouraging fair and responsible marketing, as set out
or (ii) distributed to members of the public; or promoting the preferential use or preferential in part E of the Act. Part E contains various
or (iii) brought to the notice of members of sale thereof for the purpose of financial gain or provisions relating to fair marketing, but those
the public in any manner whatsoever, that other valuable consideration. most relevant to the medical profession are
is intended to promote the sale of orthodox sections 29, 30 and 32. In terms of section 29,
medicine, complementary medicine, medical
devices or scheduled substances or health-
Doctors must goods or services may not be marketed in
a manner that is reasonably likely to imply
related products, or to attract patients to any
particular health establishment or health-
comply with ethical a false or misleading representation, or is
misleading, fraudulent or deceptive in any
related service. Furthermore, a doctor may not rules, guidelines and way. In terms of section 30, a supplier may
canvass or tout, or allow canvassing or touting furthermore not advertise goods or services
to be done on his or her behalf. legislation as being available at a specified price in a
“Canvassing” is defined as conduct that manner that may result in consumers being
involves direct contact with prospective The precise scope of what constitutes “unfair” misled or deceived in any respect relating
clients, either verbally or by, among other promotion is not defined in the rules or to the actual availability of those goods or
things, distributing letters, pamphlets, circulars guidelines. The fairness of the promotion will services from that supplier, at that advertised
or other means of communication, including be determined on a case-by-case basis, and price. Although patients may agree to the
printed or electronic communication, in therefore a conservative approach should direct marketing of goods and services,
which attention is drawn to one’s personal be adopted for the sake of prudence. The section 32 of the Act provides that they
qualities, superior knowledge, quality of guidelines merely define “promote” as any should be informed of their right to opt out
service, professional guarantees or best action taken by a person or body, or allowed of that agreement.
practice in order to secure the prospective to be taken by such person or body, to further
clients’ custom. Doctors should therefore or to encourage the preferential use of any Medicines and Related
refrain from mentioning anything related to health establishment, health-related services Substances Act
their superior service, personal excellence, or products, or the preferential sale of these, The marketing of medicine is regulated by the
special knowledge, best prices and so forth, for the purpose of financial gain or other Medicines and Related Substances Act No. 101
as this could be construed as canvassing. valuable consideration. of 1965, and the regulations published under
“Touting” means, but is not limited to, The council’s 2001 booklet “Guidelines it. This Act defines advertising as any “written,
conduct that draws attention, either verbally for making professional services known” pictorial, visual or other descriptive matter
or by means of printed or electronic media, was discontinued in 2007, and replaced or verbal statement or reference appearing
to one’s offers, guarantees or material with booklet 11. The requirements and in any newspaper, magazine, pamphlet,
benefits that do not fall into the categories specifications for outside signs and electronic media (including radio and
of professional services or items, but are nameplates and the use of graphics television), or other publication, distributed
linked to the rendering of a professional (including anatomical structures) and colours to the public, or brought to the notice of
service, or designed to entice the public to in promotional material therefore no longer the public in any manner whatsoever” that is
the professional practice. Touting thus entails apply. Outside signs may, however, not be intended to promote the sale of any medicine,
enticing members of the public on the basis indecent, deceptive or misleading, or bring the scheduled substances, medical devices or in
of benefits that fall outside of the boundaries profession into disrepute. The rules relating to vitro diagnostics (IVDs).
of the doctor’s professional service. By way information on professional stationery were, In terms of section 18 of the Act, no person
of example, offering a free gift with every however, retained following the amendments. may advertise any medicine or scheduled
6 AUGUST 2019 SAMA INSIDER
FEATURES
substance, medical device or IVD for sale than that stated by the CEO. In terms of of the Health Professions Act. In the event of a
unless such advertisement complies with the general regulations under the Act, only finding of unprofessional conduct, any of the
the prescribed requirements. Section 20 medicines that do not contain a scheduled sanctions listed in this Act may be imposed,
furthermore provides that no person may substance, and medicines that only contain a including a caution or reprimand, suspension,
publish any false or misleading advertisement substance appearing in schedule 0 or 1, may removal from the register or a prescribed fine.
concerning any medicine, medical device or be advertised to the public – that is, off-the- Furthermore, any person convicted of an
IVD, or make any claim to the therapeutic shelf and over-the-counter medication. offence in terms of the Consumer Protection
effect and efficacy of any medicine, device Doctors are encouraged to read the Act or the Medicines Act may be liable to a
or IVD, other than that stated by the CEO of relevant legislation in conjunction with fine or imprisonment, or both.
the South African Health Products Regulatory the HPCSA’s guidelines, in order to ensure Should members be unsure as to whether
Authority. Section 20 also prohibits stating compliance with both the ethical and the or not their marketing material complies with
or suggesting that any medicine, medical legal requirements. Doctors whose conduct the ethical and legislative provisions, they
device or IVD should be used for any purpose falls foul of the HPCSA’s rules and guidelines are encouraged to approach SAMA’s legal
or under circumstances or manner other may be subject to disciplinary steps in terms department for it to be reviewed.
Good is the enemy of great: Cultures of leadership
greatness improve employee engagement
Elaine Jacob, Leadership Academy of SA
J
im Collins opened his book Good to Great The only way to keep relevant is to strive for called a leader is only half the battle; learning
with the statement “Good is the enemy of greatness. We need every person within our to lead is the other half.” Dr. Maxwell explains
great.” He explained that when we have organisation to strive for greatness. We need that transforming yourself and those around
good schools, good businesses and good our performance to match our potential. We you into leaders who successfully lead in the
government, we are prone to accept that level need to step up and go to the next level. We real world is the key to success or failure for
of quality as sufficient. Collins observed: “Few need to aspire to greatness! any organisation.
people attain great lives, in large part because People working with leaders who under-
it is so easy to settle for a good life.” State of the global workforce stand and live out their leadership ability
Many people have bold aspirations and Globally, according to Gallup’s State of the are significantly more satisfied with those
dreams, but unfortunately, they end up Global Workplace 2017 report, only 13% of leaders’ actions and strategies. They also
settling for good instead of great. Good adults who work full time for an employer feel more committed, excited, energised,
gives us a false sense of security. We feel okay across 142 countries worldwide are engaged influential and powerful. There is no hard
because, while we may not have reached our in their jobs: 63% are disengaged, and 24% evidence to support the assertion that
potential, at least we’re not bad. are actively disengaged. The low percentages leadership is imprinted in the DNA of only
We can do good work on autopilot, but of engaged employees represent a barrier some individuals. Leadership is not a gene,
great work takes initiative, creativity, passion to creating high-performing work cultures and it is not a trait – it’s a set of skills, and
and courage. That sounds like a lot of effort around the world. anyone can learn new skills.
when there’s no burning need to change. What is the correlation between em-
That is why good is the enemy of great. It’s ployee engagement and business out- Create a leadership culture
because it lulls us, deadens us and seduces comes? According to Gallup’s employee By creating a leadership culture at every
us into thinking that we don’t really need to engagement survey, engaged employees level of the organisation, you’re also creating
try. You’re not that bad, so why bother? produce better business outcomes (based on a culture of accountability, boosting overall
Too many times, we think that as long a composite of financial, customer, retention, productivity and raising organisational
as we aren’t the worst, as long as we’re safety, quality, shrinkage and absenteeism outcomes. How can you get started? Here
competent, if the person in the next cubicle metrics) than other employees, across are four methods.
isn’t performing as well as we are, then that’s industries, company sizes and nationalities,
good enough. It’s not, anymore. The world, and in good economic times and bad. Provide the right foundation:
as we know, has changed, and continues • Clarify: Leadership development is a highly
to change: we are living in VUCA (volatile, Improve employee mis understood factor. Often people and
uncertain, complex and ambiguous) times. engagement organisations use the words “management”
There are many external pressures, and We believe leadership is the answer. and “leadership” interchangeably. Under-
besides these, we have internal pressures “Everything rises and falls on leadership,” stand the difference between the two.
that tell us that business as usual is not going states Dr John C Maxwell. “Most people like • Gain buy-in: Buy-in from all levels of the
to cut it any longer. being leaders by title and position, but being organisation is key to instilling a leadership
SAMA INSIDER AUGUST 2019 7
FEATURES
culture. Peter Drucker stated: “Culture eats and greater earnings per share for businesses. we need to be extremely relevant to our
strategy for breakfast.” A culture of apathy Helping people play to their strengths is the people. When we look at our return on
and disengagement is sometimes evident most time-effective way to improve their investment, we not only focus on our return
from board level, and runs rife into the performance and engagement at work. to shareholders or return to reinvest back
lower levels of organisations. Therefore into our business – but also on the return
a culture of leadership demonstrated at Promote great leadership practices: Culture to our people. Putting our people at the
board level improves the culture of the wins. Culture is made up of the behaviours and centre and helping them to achieve their
entire organisation. practices of the leaders of the organisation. best is part of our talent-led DNA.” Business
• Develop: Develop a recruitment strategy to Most leaders want leadership culture, but and political leaders must recognise
attract leaders, and develop new and junior- the problem is that in many companies, they when traditional patterns in management
level staff by giving them skills to increase merely talk the talk and don’t walk the walk. practices, education or gender roles, for
focus, improve efficiency, and maximise their Often the leadership culture becomes just a example, become roadblocks to workers’
individual impact within a team. reflection of the leader, which may be created motivation and productivity, and when
subconsciously rather than consciously. selectively disrupting tradition will help clear
Leadership is not a Our leadership practices fall into five
broad categories: (i) challenging the process;
a path to greater prosperity and transformed
company cultures. Employers who focus on
gene, and it’s not a (ii) inspiring a shared vision; (iii) enabling
others to act; (iv) modelling the way; and (v)
replacing outdated management processes
with ones that enhance workplace cultures
trait – it’s a set encouraging the heart. and support engagement can drive their
percentage of engaged workers high above
of skills Develop growth plans with leadership average. This is the journey from good to
strengths and practices in mind: Leading great!
Develop strengths: All employees have companies such as Google, Microsoft,
strengths – the unique combination of Accenture and Deloitte understand that the
talents, knowledge, skills and practice that people-development continuum needs to be
help them do what they do best every day. revolutionised to help people be their best at The Leadership Academy SA
These strengths provide employees and work and in life. We suggest that performance The Leadership Academy SA is an organi-
employers with their greatest opportunities for appraisals include a leadership growth plan. The sation of leadership and performance
success. What leaders do, or fail to do, with this approach includes real-time, frequent, forward- coaches that aims at optimising workplaces
workforce potential has enormous implications looking coaching discussions that help people: for economic and human development,
for a company’s future. Gallup’s data show • understand expectations by providing tools that create cultures of
that simply learning their strengths makes • build on their strengths leadership greatness.
employees 7.8% more productive, and teams • understand areas for growth They are a partnership with international
that focus on strengths every day have 12.5% • achieve their career aspirations. leadership author and authority on
greater productivity. Investing in and focusing leadership Dr John C Maxwell, and the
on employees’ talents boosts employee Conclusion coaching authorities: the International
and customer engagement, according to The Google CEO explains that “with two- Coach Federation (ICF) and Harvard
Gallup’s research, leading to higher levels of thirds of the workforce being millennials Institute of Coaching.
performance, profitability and productivity, and Generation Z just around the corner,
New essential medicines and diagnostics lists published
World Health Organization
T
he WHO recently updated their global Published on 9 July 2019, the two updated inclusion in this list of some of the newest
guidance on medicines and diagnostic lists focus on cancer and other global health and most advanced cancer drugs is a strong
tests to address health challenges, challenges, with an emphasis on effective statement that everyone deserves access to
prioritise highly effective therapeutics and solutions, smart prioritisation and optimal these life-saving medicines, not just those
improve affordable access. The Essential access for patients. who can afford them.”
Medicines List (EML) and List of Essential “Around the world, more than 150
(in vitro) Diagnostics are core guidance countries use the WHO’s EML to guide Essential Medicines List 2019
documents that help countries prioritise decisions about which medicines represent Cancer treatments: While several new cancer
critical health products that should be widely the best value for money, based on evidence treatments have been marketed in recent
available and affordable throughout health and health impact,” said WHO director-general years, only a few deliver sufficient therapeutic
systems. Dr Tedros Adhanom Ghebreyesus. “ The benefits to be considered essential. The 12
8 AUGUST 2019 SAMA INSIDERFEATURES
medicines that the WHO has added to the the current standard therapy, but offers testing was added – this service must be
new EML for 5 cancer therapies are regarded advantages for tropical countries, as it does made available in specialised laboratories.
as the best in terms of survival rates to treat not require refrigeration. Infectious diseases: The list focuses on
melanoma, lung, prostate, multiple myeloma additional infectious diseases prevalent in
and leukaemia cancers. Not all submissions to the EML committee are low- and middle-income countries, such
For example, two recently developed included in the list. For example, medicines as cholera, and neglected diseases such as
immunotherapies (nivolumab and pembro- for multiple sclerosis that were submitted leishmaniasis, schistosomiasis, dengue and
lizumab) have delivered up to 50% survival for inclusion were not listed. The committee zika.
rates for advanced melanoma, a cancer that noted that some relevant therapeutic options In addition, a new section for influenza
until recently was incurable. currently marketed in many countries were testing was added for community health
Antibiotics: The Essential Medicines not included in the submissions; it will settings where no laboratories are available.
Committee strengthened advice on antibiotic welcome a revised application with all relevant General tests: The list was also expanded
use by updating the Access, Watch, and available options. The committee also did not to include additional general tests that address
Reserve (AWaRE) categories, which indicate recommend including methylphenidate, a a range of different diseases and conditions,
which antibiotics to use for the most common medicine for attention deficit hyperactivity such as iron tests (for anaemia), and tests to
and serious infections to achieve better disorder (ADHD), as the committee found diagnose thyroid malfunction and sickle cell
treatment outcomes and reduce the risk uncertainties in the estimates of benefit. anaemia (an inherited form of anaemia very
of antimicrobial resistance. The committee widely present in sub-Saharan Africa).
recommended that three new antibiotics for List of Essential (in vitro) Another notable update is a new section
the treatment of multidrug resistant infections Diagnostics specific to tests intended for screening of
be added as essential. The first List of Essential Diagnostics was blood donations. This is part of a WHO-wide
published in 2018, concentrating on a strategy to make blood transfusions safer.
Other updates to the medicines list include: limited number of priority diseases – HIV, “The List of Essential Diagnostics was
• new oral anticoagulants to prevent malaria, tuberculosis and hepatitis. This year’s introduced in 2018 to guide the supply of
stroke as an alternative to warfarin for list has expanded to include more non- tests and improve treatment outcomes,” said
atrial fibrillation and treatment of deep communicable and communicable diseases. Mariângela Simão, WHO assistant director-
vein thrombosis. These are particularly Cancers: Given how critical it is to secure general for medicines and health products.
advantageous for low-income countries as, an early cancer diagnosis (70% of cancer “As countries move towards universal
unlike warfarin, they do not require regular deaths occur in low- and middle-income health coverage and medicines become
monitoring. countries largely because most patients more available, it will be crucial to have the
• biologics and their respective biosimilars are diagnosed too late), the WHO added 12 right diagnostic tools to ensure appropriate
for chronic inflammatory conditions such tests to the diagnostics list to detect a wide treatment.”
as rheumatoid arthritis and inflammatory range of solid tumours, such as colorectal, The lists are available at: https://apps.who.
bowel diseases. liver, cervical, prostate, breast and germ cell int/iris/handle/10665/325771 and https://
• heat-stable carbetocin for the prevention cancers, as well as leukaemia and lymphomas. www.who.int/medical_devices/publications/
of postpartum haemorrhage. This new To support appropriate cancer diagnosis, a Second_WHO_Model_List_of_Essential_In_
formulation has similar effects to oxytocin, new section covering anatomical pathology Vitro_Diagnostics/en/.
One in three people globally do not
have access to safe drinking water
World Health Organization
B
illions of people around the world and hygiene: 2000 - 2017: Special focus of water, sanitation and hygiene, UNICEF.
continue to suffer from poor access on inequalities”, finds that while significant “Children and their families in poor and rural
to water, sanitation and hygiene, progress has been made toward achieving communities are most at risk of being left
according to a new report by UNICEF and universal access to basic water, sanitation and behind. Governments must invest in their
the WHO. Some 2.2 billion people around the hygiene, there are huge gaps in the quality of communities if we are going to bridge these
world do not have safely managed drinking services provided. economic and geographic divides and deliver
water services, 4.2 billion people do not “Mere access is not enough. If the water this essential human right.”
have safely managed sanitation services and isn’t clean, isn’t safe to drink or is far away, The report reveals that 1.8 billion people
3 billion lack basic handwashing facilities. and if toilet access is unsafe or limited, then have gained access to basic drinking water
The Joint Monitoring Programme report, we’re not delivering for the world’s children,” services since 2000, but there are vast
“Progress on drinking water, sanitation said Kelly Ann Naylor, associate director inequalities in the accessibility, availability
SAMA INSIDER AUGUST 2019 9FEATURES and quality of these services. It is estimated since 2000, but in many parts of the world the water, sanitation and hygiene. Poor sanitation that 1 in 10 people (785 million) still lack wastes produced are not safely managed. It and contaminated water are also linked to basic services, including the 144 million also reveals that 2 billion people still lack basic transmission of diseases such as cholera, who drink untreated surface water. The data sanitation, of whom 7 out of 10 live in rural dysentery, hepatitis A and typhoid. shows that 8 in 10 people living in rural areas areas and one-third live in the least developed “Closing inequality gaps in the accessibility, lack access to these services and in 1 in 4 countries (LDCs). quality and availability of water, sanitation and countries with estimates for different wealth Since 2000, the proportion of the popu- hygiene should be at the heart of government groups, coverage of basic services among the lation practising open defecation has been funding and planning strategies. To relent richest was at least twice as high as among halved, from 21% to 9%, and 23 countries on investment plans for universal coverage the poorest. have achieved near-elimination, meaning is to undermine decades of progress at the “Countries must double their efforts on that less than 1% of the population practises expense of coming generations,” said Kelly sanitation or we will not reach universal open defecation. Yet 673 million people Ann Naylor. access by 2030,” said Dr Maria Neira, WHO still practise open defecation, and they are director of the Department of Public Health, increasingly concentrated in ‘high burden’ Environment and Social Determinants of countries. Worse, in 39 countries, the number About the JMP Health. “If countries fail to step up efforts on of people practising open defecation has The WHO/UNICEF Joint Monitoring sanitation, safe water and hygiene, we will actually increased, the majority of whom are Programme (JMP) for Water Supply, continue to live with diseases that should in sub-Saharan Africa, where many countries Sanitation and Hygiene is the official UN have been long ago consigned to the have experienced strong population growth mechanism tasked with monitoring country, history books: diarrhoea, cholera, typhoid, over this period. regional and global progress, especially hepatitis A and neglected tropical diseases Finally, the report highlights new data toward the Sustainable Development Goal including trachoma, intestinal worms and showing that 3 billion people lack basic targets relating to universal and equitable schistosomiasis. Investing in water, sanitation handwashing facilities with soap and water access to safe drinking water, sanitation and and hygiene is cost-effective and good for at home in 2017. It also showed that nearly hygiene. The JMP is an authoritative source society in so many ways. It is an essential three-quarters of the population of the LDCs of internationally comparable estimates foundation for good health.” did not have basic handwashing facilities. to inform policy decisions and resource The report also says that 2.1 billion people Every year, 297 000 children under 5 years allocation, especially at the international level. have gained access to basic sanitation services old die due to diarrhoea linked to inadequate 10 AUGUST 2019 SAMA INSIDER
FEATURES
Introducing the KMRED
Dr Selaelo Mametja, head of department, KMRED
T
his article is long overdue, but as they
say, better late than never. I am happy
to introduce to our SAMA family and
members the Knowledge Management,
Research and Ethics Department (KMRED),
fondly called KIMRED. We take pride in serving
the members, and can only hope that our
work and efforts continue to have impact.
Our department consists of eight people:
• HOD: Dr Selaelo Mametja (SelaeloM@
Samedical.org)
• Two health policy analysts: Shelley McGee
(ShelleyM@Samedical.org) and Katlego
Mothlaoleng (KatlegoM@Samedical.org) Dr Selaelo Mametja Shelley McGee Katlego Mothlaoleng Brandon Ferlito
• Bioethics researcher: Brandon Ferlito
(BrandonF@Samedical.org)
• Research assistant and administrator:
Jolene Hattingh (JoleneH@Samedical.org)
• Intern: Thabiso Nchabeleng (ThabisoN@
Samedical.org)
• CPD officer: Lisa Reid (LisaR@Samedical.
org)
• SAMAREC officer: Adri van der Walt (AdriV@
Samedical.org).
The overall function of the department
includes health policy, ethics, research and
CPD accreditation and offering.
Jolene Hattingh Thabiso Nchabeleng Lisa Reid Adri van der Walt
Health policy research,
monitoring and evaluation existing inequities in health and improve and some of our issues were addressed in the
This responsibility includes scanning efficiencies. draft report, for example: the fact that doctors
for health policy discussions, making We found that if the pooling of finances, and are often the price-takers; the need to protect
submissions regarding relevant health cross-subsidies, does not occur at a fund level, and promote evidence-based medicine; the
policy and legal documents, and advocacy doctors find themselves in a moral dilemma, need to regulate the employment of doctors
for health policy matters relevant to the between patients with fewer needs but excess- in profit-making institutes, to promote
department. The motive behind this is that ive benefits, and those with serious health and protect doctors’ autonomy; and the
health policy influences the environment needs, but no access to health benefits. LCBOs need to monitor outcomes to ensure that
within which medical doctors work, and were retracted in 2015, subsequent to SAMA’s doctors and schemes are able to provide
as a member organisation it is imperative intervention, as the package did not provide any an account of quality healthcare. We have
that we engage with policy development, guaranteed and meaningful health benefits to made a submission regarding the manner
implementation and review. Over the last address the burden of disease. The Council for in which HMI has concluded that there is
4 years, our submissions on health policy Medical Schemes (CMS) has published a call supplier-induced demand, as we believe
included healthcare financing policies, mainly for comments regarding LCBOs, and we are the methodology was flawed (reports are
responding to the NHI White Paper and Bill, again concerned that these packages will not available for our members on request). One
Medical Schemes Amendment Bill, low-cost adequately provide for the needs of the covered of the craziest examples of this is the fact that
benefit options (LCBOs) and the consolidation population unless there are meaningful cross- admissions in paediatrics and psychiatry are
of medical schemes, among others. subsidies. One of our doctors nailed it on the all called discretionary, and the statement
SAMA’s view is that everybody deserves head when she said: “Doctors are essentially that there is an oversupply of circumcision in
universal access to healthcare. Pooling must being asked to treat their patients with their KZN. It makes perfect sense that KZN doctors’
occur at a population level, with sufficient hands tied behind their backs.” circumcision levels are higher than those
health and wealth cross-subsidies. Users Our department has been key in making in other provinces, since due to a lack of
must access healthcare based on need, not submissions to the health market inquiry traditional circumcision, men are more likely
only on the ability to pay, in order to reduce (HMI). The HMI panel has heard our concerns, to take up medical circumcision.
SAMA INSIDER AUGUST 2019 11FEATURES
We also continue to engage the CMS on on the ethical concerns of the International available. We offer value for money compared
benefit definitions, and one of our key Association of Athletics Federations (IAAF) with other research committees.
successes has been the inclusion of laparo- guidelines. While our own effort did not get
scopic appendicectomy as a prescribed much media attention, the WMA statement CPD accreditation, knowledge
minimum benefit (PMB). We support and was influential to the extent that it elicited management and research
advocate for PMB review to include primary, an IAAF response, which shows that to deal Our research includes providing forecasts on
secondary and tertiary healthcare. We have with international matters, it is imperative issues that may affect doctors in the future,
made numerous requests for the National for SAMA to affiliate with international and addressing them in order to maximise
Department of Health (NDoH) to revise the organisation. We identified the key ethical opportunities and mitigate risk. In the last
pharmacy-based diagnosis and treatment issues around the case in the July issue of 4 years, we have done research on electronic
(PCDT ) guidelines, as although they claim SAMA Insider. health records, telemedicine and cannabis.
to have reviewed the document, the latest Our work also includes promoting This year and next year, we will focus on the
list remains scary, as we believe some awareness of medical ethics, especially to our fourth industrial revolution and the profession.
of the diagnoses require on- and offsite stakeholders who may want to partner with Our knowledge management function
investigations, and pharmacists do not have doctors in a manner that violates medical includes management of knowledge that is
the ability to do these. We are continuously ethics. Our recent stakeholder engagements generated within SAMA.
engaging the NDoH on the matter. included schemes and some telephone We also offer CPD accreditation. We will
marketing companies. We found that help you with all your CPD accreditation; our
Bioethics and research engaging with businesses protects our service is speedy and efficient.
ethics committee members from dealing with these issues at At KMRED our work comes directly from
Bioethics research includes research on the implementation level. members, delegation from the boards and
professional and medical ethics. Our Part of our work also includes providing committees and from scanning the policy and
research on the ethics of electronic health administrative support to the SAMA Research ethics debates. Should you need us to address
records and telemedicine is currently being Ethics Committee (SAMAREC). SAMAREC or advise on a policy or ethical issue, you can
disseminated via CPD events. Our recent is an independent committee specifically contact the department: queries can be sent
medical ethics work includes our support appointed for the purpose of research ethics to Jolene Hattingh at JoleneH@samedical.
for Caster Semenya. SAMA issued a media approval. Should you need ethics approval for org or Thabiso Nchabeleng at ThabisoN@
statement, and urged the WMA to speak out research in the private sector, this service is samedical.org.
30 YEARS ON… Hosmed remains committed to
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still embodying the vision to Care for Life!
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10381 Hosmed Sama Half Page Advert.indd 1 2019/07/03 08:11FEATURES
A South African doctor in South Sudan
Dr Carissa Saunderson
Dr Carissa Saunderson, an emergency doctor from Cape Town, shares her experiences while working with Doctors Without Borders (Médecins Sans
Frontières; MSF) in a primary health centre in rural Mayom, South Sudan.
How to become part of MSF
Doctors work in MSF projects around the world where they are responsible for patient
consultations, examinations, diagnosis and treatment. They are required to be able to use
ultrasound equipment and perform minor surgeries. In MSF projects, they will be responsible
for some management and administration, as well as health education and supporting and
liaising with other healthcare professionals and hospitals.
What are the requirements? A Bachelor’s medical degree and at least 2 years’ professional
experience. Commitment to MSF’s humanitarian work and principles, and willingness to work
in different contexts worldwide, including unstable areas. Being a strong team player able to
work well in a multicultural team. Flexibility and adaptability. Capacity to manage stress. Being
self-driven with a solution-oriented approach. Abilities to train staff and colleagues. Fluency in
English and/or French – other languages are an asset, especially Spanish, Portuguese, Arabic
or Russian.
Benefits:
• Volunteer stipend
I
f you had asked me in the first weeks • All expenses covered (accommodation, daily expenses, travel, etc.)
after landing in Mayom, South Sudan, • Professional liability cover, medical insurance and repatriation cover.
if I would return for another MSF
assignment, I would have replied with an Applicants must be able to work with MSF for a minimum of 6 months.
eye-roll and a “hell, no.” I would have selfishly To apply, visit the MSF stand (stand 23) at the SAMA conference from 8 to 10 August
pointed out how I missed simple things like 2019, or go to www.msf.org.za/work-with-us.
hot showers and flushing toilets. There’s an
English proverb that goes: “A smooth sea
never made a skilled sailor.” In this story, I’m At the beginning, it was stressful. But not
not the sailor. I’m the person who got to instantly resorting to special investigation
work and live next to the sailor. And watch taught me to be more critical from a clinical
the resilience of the sailor blossom daily point of view. By making us think a bit more,
in a very muddy clay-like environment. I and really weigh our options and discuss a
learnt about resilience and the strength of case, in the end this makes us better clinicians.
humanity. I’m immensely grateful to the I remember one particular patient – a
souls I worked with for allowing me to do feverish, malnourished baby who had severe
so. The longer I stayed, the more the reason diarrhoea, was very dehydrated and nearly in
I initially joined MSF rang true: that it’s only shock. His mother had been struggling, alone
ever about the patient. and in vain, for a week before bringing him
In Mayom, I worked in MSF’s primary to the facility.
healthcare centre. The next medical facility The team was able to help by giving him IV
was in Agok, a town a 120 km away where fluids and medicine, and monitoring his progress,
we would refer acutely unwell patients or doing sponging and providing supportive
surgical cases. Unfortunately, due to the care. Eventually this tiny person improved. The
difficult road conditions, the trip could take gratitude on this mother’s face spoke volumes.
anything from eight to 10 hours. It was unlike anything I had ever seen.
Working in a primary clinic was different Without me being able to speak her
to what I was used to doing back home in an language nor her to speak mine, she called Dr Carissa Saunderson at work in Mayom
emergency room in Cape Town where, for me over. She reached behind her neck and
example, you could request a chest X-ray, do took off her necklace, and insisted I have it. If you asked me today whether I would return
some simple bloodwork – or refer a patient I realised that it was her most prized posses- for another MSF assignment in South Sudan,
to an appropriate department or different sion and she wanted to show her gratitude. I would smile and tell you that an army of
facility altogether. Not in Mayom. There we Refusing it would have been an insult. elephants couldn’t keep me away! Although
had to think more, to use clinical judgement, With much protest, I accepted. I wore it I went there to help, I feel like I received so
our stethoscopes and our hands. immediately and for days after. much more out of it.
SAMA INSIDER AUGUST 2019 13
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