Ministerial Advisory Committee Research Articles

‘Following the science’: the role of an independent advisory structure in the COVID-19 pandemic response and beyond

Background As the COVID-19 pandemic spread in 2020, many governments across the globe put structures in place to access rapid independent scientific evidence. The South African Minister of Health established an advisory committee in March 2020 to provide high-level strategic advice. This technical guidance, developed as topic-specific ‘advisories’, was expected to be context-specific and based on the best available evidence, locally and internationally. The authors developing the advisories could draw on systems-wide, multidisciplinary experience. Approach This chapter provides a reflective experience of the process of preparing advisories, the development of rapid evidence syntheses and their use in decision-making, the outputs and the lessons learned from that process, and the structural and operational changes over the course of the pandemic. As South Africa has moved out of the acute phase of the pandemic, the lessons learned must be embraced and best practices adopted to inform future pandemic preparedness. Advisories needed to use the best available evidence rather than wait for the best possible evidence. Some advisories were therefore revised multiple times, as new evidence emerged. Advisories were submitted to the Minister of Health for consideration prior to public release. However, in some cases, delays in such release led to confusion as to the scientific basis of policy decisions. The confidentiality of the committee debates also needed to be balanced against the need for engagement with the public. In order to promote accountability and build public trust, from March 2022 all advisories were published on a dedicated website within seven days of receipt by the Minister. The public were thus informed of the scientific basis of the advice, providing important context for subsequent executive decisions. Consistent feedback to the committee from decision-makers was also important, as their advice was only one of many inputs considered by a complex array of government bodies, across different departments. Conclusions The world faces a significant risk of further pandemics and other public health emergencies and is engaged in high-level negotiations on strengthening global capacity to respond. Whether that involves a global pandemic accord, strengthened International Health Regulations, or a strengthened global approach to medical countermeasures, rapid, credible, independent and country-specific scientific advice will remain essential. The lessons learned during COVID-19 should not be lost. Submitted on behalf of the Ministerial Advisory Committee on COVID-19.

Pūao-te-Ata-tū and dissenting voices of change at New Zealand’s oldest school of social work

INTRODUCTION: The Ministerial Advisory Committee Report on a Māori Perspective for the New Zealand Department of Social Welfare (1986) offers an historic reference point from which to examine education and training reforms initiated at Aotearoa New Zealand’s oldest school of social work and designed to better address the needs and aspirations of Māori and those working with Māori. Pūao-te-Ata-tū is an internationally unique example of social research facilitated by distinguished Māori leaders and senior government officials using indigenous methods. The Vice Chancellor of Victoria University was approached in 1986 along with its new Professor of Social Work about becoming drivers of Pūao-te-Ata-tū Recommendation 10(c) to “assess the extent to which tertiary social work courses are meeting cultural needs for those public servants seconded as students to the courses”. The early passing of alumnus- Elder John Rangihau, shortly after Pūao-te-Ata-tū was published, left a legacy—acknowledged posthumously by the Council of Victoria University in 1989—when a senior Te Rangihau Scholar teaching and research position was established with Ngāi Tūhoe. A decade of reform in social work education and research at Victoria University saw important movement towards supporting and promoting Māori perspectives in the delivery of community social services in three New Zealand regions. IMPLICATIONS: Five lessons learned about partnerships from the Victoria University experience are highlighted as issues that promote cultural responsiveness in support of Māori whānau, tamariki and rangatahi. The Wellington programme closed at the start of the new millennium without addressing the VUW Council relationship with Ngāi Tūhoe, highlighting broken promises.

The future of Māori health is here – The 2022 Aotearoa New Zealand health reforms

The formal launch of Te Aka Whai Ora, the new Māori Health Authority, on 1 July 2022 marks one of the most significant health system changes in Aotearoa's recent history. The new authority joins a suite of newly created central government institutions including Te Whatu Ora (Health NZ), and Whaikaha (Ministry of Disabled People). The Hauora Māori Ministerial Advisory Committee was also created to be positioned alongside a slimmed down Manatū Hauora (Ministry of Health) focused on stewardship and incorporating a re-established Public Health Agency.

Risk communication and community engagement – unlocking the key to South Africa’s response to SARS-CoV-2

Background. COVID-19 has changed the way that governments communicate and engage with citizens. In emergencies, effective communication must be immediate, grounded in science, transparent, easy to understand and in language-appropriate messaging delivered through multiple and varied platforms. For the South African (SA) COVID-19 response, the intent was to design an agile, locally relevant Risk Communication and Community Engagement (RCCE) strategy as the pandemic was unfolding and to constantly evaluate its implementation. Early involvement of communities in the formulation and direction of a risk communication plan is essential to its success. Objective. To outline the significance of the RCCE’s robust communication strategy during the COVID-19 response and the lessons learnt in executing the strategy. Methods. This is a qualitative review of documents and reports generated and utilised by the RCCE Technical Working Group (TWG) and reflects the lessons learnt from discussions and multiple engagements at district, provincial and national levels. The review incorporates lessons learnt from international practice, resource documents from the World Health Organization (WHO), RCCE readiness and response to coronavirus disease, feedback from the Behavioural Science Ministerial Advisory Committee, input from the call centre, website and various established social media platforms. Results. Communication and building trust with multiple stakeholders begin before an outbreak and is a prerequisite to facilitate the timeous flow of information, particularly in the context of a rapidly evolving outbreak of a new disease, where the scientific community does not immediately have all the answers. Initial COVID-19 messages were therefore filled with challenges that ranged from the lack of scientific and epidemiological information to rumours, conspiracy theories and misinformation. The findings validate that empowering communities to act, strengthening public trust and community participation using multiple channels as well as timely responses to rumours and misinformation are important drivers of COVID-19 communication efforts in SA. Communication efforts must be accelerated to translate science into locally relevant languages and the impact of interventions must be measured to appropriately direct limited resources. Conclusion. The risk communication strategy incorporated several key lessons that could be used to improve communication and inform future emergency response communication that is immediate, science-based, transparent, inclusive and encourages community participation.

SAHR 2021 Health sector responses to Covid-19: Chapters at a glance

When it comes to service delivery and access in both the public and private health sectors, COVID-19 has put everything to the test. It has demonstrated how central public health security is to health and livelihoods, and how pandemic health emergencies expose the weaknesses and vulnerabilities of health systems, costing lives and causing immeasurable damage to economies. Few could have imagined the impact of COVID-19 when this pandemic reached our shores in March 2020. But it has also created opportunities for rapid innovation, and out of sheer necessity, has increased and enabled cross-sectoral collaboration, and public−private partnership initiatives. It is against this backdrop that Health Systems Trust (HST) in collaboration with the Health Economics and AIDS Research Division (HEARD) − a research unit based at the University of KwaZulu-Natal − launches its special edition of the South African Health Review. This edition considers the government’s and broader health sector’s response to COVID-19, explores the current challenges facing the health system at this unprecedented time, and reflects on lessons learnt for future for public health emergencies. The chapters offer information on, inter alia, the challenges of balancing lives with livelihoods, and the impact of COVID-19 on different cadres of healthcare workers, especially Community Health Workers who found themselves at the forefront of our COVID-19 response. Other areas covered include the impact of COVID-19 on vulnerable populations like children, persons with disabilities, farmworkers, migrants, and the poorest in our society. We thank HEARD, as well as members of the Editorial Advisory Committee, for their contribution in guiding the content of the Review towards featuring these multiple perspectives, thereby adding to the publication’s richness and diversity. We also extend our thanks to the Ministerial Advisory Committee on COVID-19 for their contribution to this edition, and to the Johnson & Johnson Foundation for their generous support for its production. Developing this edition in the midst of loss and uncertainty has been difficult, and its completion is due in large part to the tenacity and dedication of all those who contributed to its delivery. On behalf of the Board of Health Systems Trust, I thank the authors, reviewers, Editorial Advisory Committee members, editorial team, and administrative personnel who worked tirelessly to produce this Review. Your commitment and expertise have collectively ensured another excellent edition of the South African Health Review − a valuable resource for the health sector and the country. We thank you for your contribution.

Sisonke: reaching several goals together

Sisonke: reaching several goals together

Informing Anti-Racism Health Policy in Aotearoa New Zealand

Racism is firmly established as a determinant of health and an underlying cause of ethnic health inequities. As an organised system, racism operates at multiple levels (including structurally and interpersonally). Racism and its many manifestations are breaches of international human rights obligations and, in the Aotearoa New Zealand context, te Tiriti o Waitangi. This article considers approaches to anti-racism in health and disability policy in the 30 years following the foundational publication Pūao-te-Ata-Tū (Ministerial Advisory Committee on a Māori Perspective for the Department of Social Welfare, 1988), which was one of the first government publications to name and call out the harmful impacts of institutional racism. The article then examines the ways in which government health and disability sector organisations have talked about and responded to racism at a national level since 1980. The results of this research urge a stronger organisational-level approach to antiracism in the health and disability system for more tangible results, requiring multi-level solutions, and transforming what is considered ‘business as usual’ in health and disability sector institutions.

A cross-sectional analysis of out-of-pocket expenses for people living with a cancer in rural and outer metropolitan Western Australia.

Objective To determine the extent of medical and non-medical out-of-pocket expenses (OOPE) among regional/rural and outer metropolitan Western Australian patients diagnosed with cancer, and the factors associated with higher costs. Methods Cross-sectional data were collected from adult patients living in four regional/rural areas and two outer metropolitan regions in Western Australia who had been diagnosed with breast, prostate, colorectal or lung cancer. Consenting participants were mailed demographic and financial questionnaires, and requested to report all OOPE related to their cancer treatment. Results The median total OOPE reported by 308 regional/rural participants and 119 outer metropolitan participants were A$1518 (interquartile range (IQR): A$581-A$3769) and A$2855 (IQR: A$958-A$7142) respectively. Participants most likely to experience higher total OOPE were younger than 65 years of age, male, resided in the outer metropolitan area, worked prior to diagnosis, had private health insurance, were in a relationship, and underwent surgery. Multivariate analysis of regional/rural participants revealed that receiving care at a rural cancer centre was associated with significantly lower non-medical OOPE (estimated mean A$805, 95% confidence interval (CI): A$735-A$875, P=0.038; compared with other rural participants (A$1347, 95% CI: A$743-A$1951, P<0.001)). Conclusion The cancer patients who participated in this study experienced variation in OOPE, with outer metropolitan participants reporting higher OOPE compared with their regional/rural counterparts. There is a need for cost transparency and access to care close to home, so that patients can make informed choices about where to receive their care. What is known about the topic? In recent years, OOPE for health care in general and cancer in particular have been widely debated by consumers and not-for-profit organisations; the topic has attracted much political attention because it affects both equity and access to care and has wider financial implications for the community. Research studies and reports from both consumer organisations and a Ministerial Advisory Committee found that cancer patients can face exorbitant out-of-pocket costs, and that individuals with private health insurance and those with prostate and breast cancer reported higher costs. In Western Australia, a cancer centre providing comprehensive cancer care was established in the second most populous region to ameliorate the high costs for travel and accommodation that regional cancer patients are known to experience. What does this paper add? This study is unique because it collected detailed cost information from patients and reports on the OOPE of regional/rural and outer metropolitan Western Australian patients receiving care for one of the four most common cancers; it therefore offers novel insight into the experiences of these groups. This study demonstrates that outer metropolitan cancer patients are experiencing much higher OOPE compared with regional/rural cancer patients. Additionally, regional/rural study participants who accessed a Regional Cancer Centre experienced significantly lower non-medical OOPE, compared with regional/rural study participants receiving care elsewhere. What are the implications for practitioners? First, there is a need for improved communication of OOPE to minimise costs to the patient, for example, by facilitating access to local cancer care. Health service providers and insurance companies can improve cost transparency for cancer patients by making this information more readily available, allowing patients to make informed financial choices about where to seek care. Second, the needs of working patients deserve specific attention. These patients face significant work uncertainty and additional distress following a cancer diagnosis.

How South Africa's Ministerial Advisory Committee on COVID-19 can be optimised

How South Africa's Ministerial Advisory Committee on COVID-19 can be optimised

The new IAA in Canada: From revolutionary thoughts to reality

Federally, Canada entered a new chapter of review and revision of its impact assessment law in 2015. On the path to reform, the Federal government undertook a number of activities that spanned almost two years before introducing legislation. Efforts included striking an ‘expert panel’ to consult Canadians and establishing a multi-stakeholder Ministerial advisory committee. A new impact assessment Bill was eventually introduced to the House of Commons in early 2018. Key provisions of the Bill include a sustainability orientation, an early planning stage, a climate test, and a gender-based assessment requirement. Despite these positive changes, the IAA draws heavily on the flawed existing federal process (CEAA 2012) for its basic structure and approach and falls well short of what Canadians told the Expert Panel should be reflected in a new bill (and what the Panel itself recommended). The new Act falls even further short of what the literature suggests are the key elements of IA legislation.

Editorial - ‘Seeds of illumination in a sometimes dry landscape

Editorial for issue 24(3-4).

An overview of cancer research in South African academic and research institutions, 2013 - 2014.

Cancer is emerging as a critical public health problem in South Africa (SA). Recognising the importance of research in addressing the cancer burden, the Ministerial Advisory Committee on the Prevention and Control of Cancer (MACC) research working group undertook a review of the current cancer research landscape in SA and related this to the cancer burden. Academic and research institutions in SA were contacted to provide information on the titles of all current and recently completed (2013/2014) cancer research projects. Three MACC research working group members used the project titles to independently classify the projects by type of research (basic, clinical and public health - projects could be classified in more than one category) and disease site. A more detailed classification of projects addressing the five most common cancers diagnosed in males and females in SA was conducted using an adapted Common Scientific Outline (CSO) categorisation. Information was available on 556 cancer research projects. Overall, 301 projects were classified as clinical, 254 as basic science and 71 as public health research. The most common cancers being researched were cancers of the breast (n=95 projects) and cervix (n=43), leukaemia (n=36), non-Hodgkin's lymphoma (n=35) and lung cancer (n=23). Classification of the five most common cancers in males and females in SA, using the adapted CSO categories, showed that the majority of projects related to treatment, with relatively few projects on prevention, survivorship and patient perspectives. Our findings established that there is a dearth of public health cancer research in SA.

Welcoming and celebrating diversity: The Uniting journey of learning on inclusive practice

Welcoming and celebrating diversity: The Uniting journey of learning on inclusive practice

Responding to child deaths: the work of Australia's Victorian Child Death Review Committee

The Victorian Child Death Review Committee (VCDRC) in Australia is a multidisciplinary Ministerial Advisory Committee established to review the deaths of children either currently child protection clients or known to the statutory child protection system. The Committee provides advice about each child death as well as insights into what are the surrounding patterns and issues. Key to this role is examining the contribution of the service sectors to the protection of children and the routine practices that are in place to respond to children and vulnerability. This paper provides a snapshot of the cases referred to the VCDRC and the key messages for practice drawn from them. What emerges is that often the threshold for when statutory child protection services must be involved in child and family matters can be ambiguous and that agreement about intervention, the level and nature of need or risk, and when cumulative harm and neglect require statutory responses are not always shared between agencies. It is clear that the lack of common frameworks about what constitutes child protection intervention challenges services. It is recommended that there be and used agreed definitions and frameworks to ensure shared understandings and collaborative responses across the service and legal systems.

Family Group Conference: A Bridge between Lifeworld and System

Family Group Conferencing (FGC) has been used in New Zealand since 1989. This new approach to care and protection for children and adolescents was triggered by an accusation of ‘institutional racism’ (Ministerial Advisory Committee, 1988, p. 25) which denied Maori families their own ways of problem solving and decision making, thereby prolonging the process of colonisation as ‘institutional decisions were being made for, rather than by, Maori people’ (Ministerial Advisory Committee, 1988, p.18). FGC has been adopted in European countries for non-racist issues in response to the unwanted side effects of care and protection work. This article examines the hypothesis: what makes FGC necessary is not the issue of racism, but a more fundamental phenomenon of administration, law, professionalism and modern government. We will argue that FGC is a legal and professional procedure, needed to cure the unhelpful side effects

NHI will drive costs down - Shisana.

The National Health Insurance Plan, (NHI), due for legislation in June next year, will be phased in one facility at a time over the next five years, costing higher income earners more (via a payroll tax) but in no way limiting their choice of provider. That was the assurance given by the chair of the NHI Ministerial Advisory Committee, Dr Olive Shisana, who said the incremental accreditation of healthcare facilities was to ensure the delivery of quality health care based on agreed standards. “If this quality improvement plan was done by district or province, I’d be worried, but we’re building capacity, facility by facility. When each facility (public or private) is ready and meets standards of accreditation, it gets declared NHI-ready and changes its modus operandi,’ she explained. The Ministerial Advisory Committee of 24 experts drawn from the entire healthcare spectrum, is required to deliver draft proposals on NHI legislation to Health Minister Dr Aaron Motsoaledi by March next year. Public input will happen as soon as cabinet approves the policy proposals, probably this November so that the ensuing and legally required three month consultation process can be completed in time for Motsoaledi’s review. That would leave just enough time for legal crafting for presentation to parliament by June. Shisana was responding to claims that the ANC government was ‘overcompensating for apartheid health inequities in the form of a grand gesture,’ that was doomed to failure because of the woeful current state of public healthcare.

Policy and strategic implications of Australia's divergent HIV epidemic among gay men

The importance of this issue of Sexual Health has technical, strategic and policy dimensions. Overall Australia continues to have a relatively well-controlled HIV epidemic, contained by and large to gay men. The lack of significant transmission affecting intravenous drug users continues to bear testament to sound public health policies, for which we continue to be the envy of countries that took a different route. There has, however, been an increasing rate of notifications among gay men in Victoria, Queensland, South Australia and Western Australia and the numbers of such transmissions for Australia as a whole has also increased as a result. This gives rise to the first impetus for this issue of the journal. It provides a timely basis for considering adjustments to our to-date successful prevention strategies. In New SouthWales (NSW), the state hardest hit by the HIV epidemic since its arrival in Australia, the trend has been different, with notifications among gay men falling since a spike in 2001 and flat overall since 1998. Grulich and his colleagues point out that this may make NSW unique among countries where reliable records are kept. This difference gives rise to the second impetus for this issue. What lessons are there to learn from the different trend in NSW? There is not cause for a panicked knee jerk reconsideration of strategy, although there is reason for immediate analysis and for careful response. The trend increases in notifications among gay men in several states do not mean that we have lost control of the Australian epidemic. On several key indicators, other states could be said simply to have increased from lower rates up to those of NSW, which on some measures have come down. Nonetheless a country with Australia’s successful record, resources and epidemic infrastructure should aspire to do better and to be able quickly to act to prevent any more alarming development. Otherwise Australia may be in danger of a different, less-controlled epidemic. Australia is blessed with internationally envied capacity, in four national HIV research centres and in an HIV community sector, non-government organisations providing services to and advocating for both people with HIV and those from affected communities. The community sectors have been led in each state by AIDS Councils, membership-based non-government organisations set up by the gay community in collaboration with other affected communities. For the most part Australia has also been advantaged by the strength of relationships between both these sectors, the clinical sector and governments. It is significant that the work reported in this issue started under the auspice of the intersectoral NSW Ministerial Advisory Committee on HIV/AIDS Strategy and draws heavily on collaboration between the national centres, the community sector and a couple of other key groups. The NSW Ministerial Advisory Committee wanted to know whether the apparent difference between NSW and other states’ apparent trends in notifications among gay men was real and what they needed to do to secure that record and avoid an increase in infections. This issue of the journal follows a workshop where much of this data was presented, focusing on the difference between NSW, Queensland and Victoria. It shows that the difference is real. NSW is experiencing a different trend and there are lessons to be drawn, not just for the three states examined in the NSW Think Tank but for our national response. The analysis of the NSW rates among gay men does not point to a single explanation for a lower notification rate, nor a magic bullet to stem the trend elsewhere. It does, however, point to a combination of several factors that need to be understood by policy makers and those active in the epidemic response. Important facets of an explanation lie in surveillance data, in clinical and behavioural trends and in policy, investment and relationship dynamics. One immediate advance would be the uniform adoption of new ‘detuned’ testing technology that could be applied nationally at very low cost to all positive HIV tests and allow us to move from a reliance on notification rates to being able to count new infections in our surveillance. This is an immediate priority issue for consideration by the Commonwealth Department of Health and Ageing and would give us much more sensitive and real-time data. There are several factors that limit increases in infections among gay men. In each of these the trend in NSW is either stable or decreasing whereas in other states some are increasing or stable. Within the surveillance data the effect appears to be cumulative. Facets of an explanation include, for example, the high HIV testing rate among gaymen and the high proportion of

PINUS Association Symposium: ‘Medicine and the New Paradigms of Science’

PINUS Association Symposium: ‘Medicine and the New Paradigms of Science’

Creating a soccer Strategy for Northern Ireland: Reflections on football governance in small European countries

This article examines attempts in Northern Ireland to deal with the crisis in local soccer. Its main immediate focus is on the conclusions of a ministerial advisory committee, of which the author was a member, which sat from October 2000 until its findings were published in December 2001, but the article also reflects on earlier reports on the state of domestic soccer in Northern Ireland. Far from being wholly insular in its concerns, the authors of the 2001 report drew upon the experiences of other small European nations, including Norway and Sweden, particularly in relation to the issue of national governance. This broader perspective is reflected in the article, which challenges the assumption that national football associations, especially smaller ones, have little power to initiate change. It is also argued, however, that not only global but also local factors can limit the capacity for change of individual governing bodies and that this is particularly apparent in the Northern Irish case.

The South Australian Nurse Practitioner Project: A Midwife'S Perspective On A New Initiative

Midwifery education in Australia is currently the focus of intense debate both within and outside the field of midwifery. Proposed changes arsing from these debates centre principally around the issue of midwifery as a separate profession from nursing. This paper describes a case in point as to how changes in attitude and practice are occurring. As a midwife representing the Australian College of Midwives Inc.- SA Branch (ACMI-SA) on the Advisory Committee of the South Australian Nurse Practitioner Project, I provide an insight into some of the debates around midwifery and its relationship with this project. ACMI was a member of the Ministerial Advisory Committee established following the initiative of the Executive of the Department of Human Services (DHS) (formerly the South Australian Health Commission) in forming the Nurse Practitioner Project. The Terms of Reference for this committee included the development of an operational framework for the development and implementation of the Nurse Practitioner role in South Australia. A collaborative approach was seen as essential to enable nurses to best serve their communities by functioning at an advanced level of practice. The ACMI and midwives generally fully support the Nurse Practitioner Project for nurses. By Jennifer Pauline Byrne.