HASA Pulse #3

Member Feature: Arwyp Medical Centre Member Feature: Capital Super Speciality Hospitals Member Feature: Lenmed Climate change and microbial resistance Designing for Life: How urban and spatial design matters for health, wellness and productivity THE SUSTAINABILITY ISSUE Climate change and mental illness A world of new diseases, extreme heat, and cyclones

2 HASA PULSE #3 THE SUSTAINABILITY ISSUE Netcare is spearheading climate change solutions in the SA healthcare sector It has been estimated that the ecological footprint of healthcare providers worldwide is equivalent to 4.4% of global net emissions. If the health sector globally were a country, it would be the fifth largest emitter on the planet. The Netcare Group’s environmental sustainability investment represents Africa’s largest healthcare environmental sustainability programme. Since 2013, we have emphasised improving energy efficiency at our facilities throughout South Africa, implementing more than 204 environmental sustainability projects. “By the end of FY2022, we achieved a 35% energy intensity reduction per hospital bed, surpassing the original target of 22-25% set for 2023. Netcare has eliminated R1.204bn in energy, water, and waste costs since 2013 to date,” says Jacques du Plessis, managing director of Netcare’s hospital division. Last year, for the third consecutive year, Netcare was awarded gold medals in all four categories of the prestigious 2022 Global Health Care Climate Challenge Awards. The gold medals for greenhouse gas reduction, renewable energy, climate resilience, and climate leadership were awarded by Global Green and Healthy Hospitals, a Health Care Without Harm initiative. “Looking to the future, we have set ambitious targets which include purchasing 100% of our energy from renewable energy sources, zero waste to landfill and a 20% reduction in our water utilisation by 2030, striving to first do no harm [as per the Hippocratic oath committed to by healthcare workers] while continuing to find ways to become part of the solution the urgent climate crisis demands.” Operational savings Netcare’s environmental sustainability initiatives achieved cumulative operational savings of just over R1 billion by the end of the 2022 financial year, yielding an internal rate of return of more than 25%. Had Netcare not embarked on this environmental sustainability programme, its electricity cost over this past financial year alone would have been some R598 million, compared with the R386 million that was incurred.

HASA PULSE #3 THE SUSTAINABILITY ISSUE 3 4 WELCOME 4 Chief Executive Officer 4 HASA Board of Directors 6 MEMBERS 6 Lenmed: Embracing every day to make a positive impact in healthcare 8 Capital: Super Speciality Hospitals 10 Comprehensive neurovascular surgery at Arwyp Medical Centre 14 PRESS ROOM 14 HASA statement on Parliament’s approval of the NHI Bill 16 CURRENT AFFAIRS 16 South Africa needs to invest in nurses to avoid a healthcare catastrophe 18 SPECIAL FEATURES 18 Climate change could sink NHI’s goal of an equal healthcare system 20 Climate change Is set to drive up incidents of mental illness as temperatures rise 22 Hospitals will need to evolve to deal with extreme weather, heat and sicker people 24 How the climate affects antimicrobial resistance 27 A world of new diseases, extreme heat and cyclones 28 VOICES 28 Designing for Life: How urban and spatial design matters for health, wellness and productivity 30 DIRECTORIES WRITERS. Shaun Smillie, Elsabé Brits and Anya Smith EDITOR. Mark Peach COPY EDITOR. Mandy Collins DESIGNER. Janice De Angeli, See Janice Jump CONTENTS

4 HASA PULSE #3 THE SUSTAINABILITY ISSUE CHIEF EXECUTIVE OFFICER, DR DUMISANI BOMELA Throughout this year, our message has been that if we are collectively able to see the possibilities that exist despite the diffi culties that seem to surround us, and if we are prepared to work collaboratively, then we will fi nd ways to prevail. The message was core to our media campaign during the fi rst half of the year and will comprise the theme of our annual conference in Cape Town in September. We passionately believe this. And history is replete with examples of unlikely collaborators who changed the course of events by recognising common challenges and devising ways to mutually benefi t in overcoming them. At its root, though, overcoming common challenges involves a willingness to act. It is a deliberate step to act in concert with others after willingly identifying the contours of what faces us. We must individually and jointly grasp the nettle or live in regret and blame when unwanted consequences follow. In the healthcare system, the stakes are high – lives are at risk, and the health of our compatriots is what we must collaborate to fi ght to achieve. It will be diffi cult in a troubled and challenging world facing many destabilising factors. But we South Africans have shown how we can rise to the challenge. The second Presidential Health Summit was a harbinger of what we can do, as is the initiative where more than a hundred heads of businesses have extended a collaborative hand to the State to jointly address key economic drivers facing steep challenges, including logistics and transport and corruption. We must seek opportunities to collaborate, willingly choose to work together to our mutual benefi t and ensure that our collaborative eff orts are sustained through a genuine sense of partnership. The consequences of failure cannot be countenanced. FROM THE CEO • Dr Biren Valodia (Mediclinic) Chair • Andre Joseph (Life Healthcare) • Gale Shabangu (Mediclinic) • Melanie Da Costa (Netcare) • Dr Biancha Mentoor (Netcare) • Dr Nceba Ndzwayiba (Netcare) • Bob Govender (Mediclinic) • Tanya Lowth (Life Healthcare) • Ansuyiah Padayachee (Life Healthcare) • Amrita Raniga (Life Healthcare) • Dr Stefan Smuts (Mediclinic • Dr Dumisani Bomela (HASA CEO) • Mark Peach (HASA Public Aff airs) The Public Relations Committee provides oversight for this publication. The views of writers and commentators are their own. THE HASA PUBLIC RELATIONS COMMITTEE H O SPITA A L H O SPI TA L

HASA PULSE #3 THE SUSTAINABILITY ISSUE 5 Ascot Park Hospital (87 Beds) Ascot Breast Clinic GP Practice and Allergy Clinic 7 Hospitals 1100 Employees 500+ Specialists and Dr’s City Hospital (250 Beds) Cardiac Clinic Ultra-Kidney Care Newly Revamped Paediatric Unit Durdoc Hospital (139 Beds) Pulmonology Clinic Isipingo Hospital (171 Beds) Ultra-Kidney Care Mental Health Ward Occupational Health and Travel Medicine Richards Bay Medical Institute (65 Beds) Pain Clinic Radiotherapy Varian Truebeam Linear Accelerator Ribumed Day Hospital, Glenwood (36 Beds) 4 Operating Theatres with Laminar Flow Dedicated Paediatric Ward Ribumed Medical Care, Ballito (72 Beds) 4 Operating Theatres with Laminar Flow Behavioural Centre Renal Care Unit [email protected] www.jmh.co.za Follow us on Citi-Med Ambulance Service 0800333911 Most Medical Aids Accepted City Hospital and Isipingo Hospital now part of the Discovery Health Joint Arthroplasty Network Competitive Cash Rates and Financing Options All Hospitals on the GEMS Emerald Value Network To learn more about the JMH Group please visit our website www.jmh.co.za SPECIAL FEATURES

6 HASA PULSE #3 THE SUSTAINABILITY ISSUE With its sights set on expanding as a brand while carrying out its mission to bring quality care to more people, the Lenmed Group was formalised in 2007, growing its footprint in South Africa (Gauteng, Northern Cape, KwaZulu-Natal and the North West), Botswana, Mozambique and Ghana. Being in existence for over three decades, the hospital group has grown from strength to strength and is driven by the goal of providing exceptional industry-leading qualityof-care, patient experience, and making a tangible difference in the communities in which it operates. One of the economic and social rights guaranteed by the South African Constitution is access to high-quality healthcare services. This premise is one of the core drivers of Lenmed, founded in 1984, by a group of doctors gathering the required funds to open the first Lenmed facility in Lenasia, South of Johannesburg, to serve the then marginalised communities of Lenasia, Soweto and surrounds. The Group has always endeavoured to create places of healing and provide affordable quality healthcare in the communities it serves. FROM HUMBLE BEGINNINGS TO BECOMING AN INDUSTRY LEADER Lenmed is forging ahead with its goal to become a leading healthcare provider in Africa. From humble beginnings in Lenasia, south of Johannesburg, the hospital Group knows that growth and sustainability are critical issues in the healthcare space, as they directly affect the ability of healthcare systems to meet the needs of patients and communities alike. Over the years, Lenmed has balanced the need for growth and expansion with the requirement to support the United Nations Sustainable Development Goals (SDGs) 3 and 9, which promote good health and well-being and industry, innovation and infrastructure respectively. One way to achieve growth and sustainability in healthcare is to focus on improving the quality of care while enhancing efficiency. This can be done through various initiatives that improve effectiveness and reduce waste while improving patient outcomes. In addition, research and development to adopt new technologies and approaches to care allow organisations to be at the forefront of medical innovation, attract new patients, and maintain financial stability over the long term. Through its environmental, social and governance framework, Lenmed has implemented a number of projects that have empowered it to carry out its work and support LENMED: EMBRACING EVERY DAY TO MAKE A POSITIVE IMPACT IN HEALTHCARE FEATURED MEMBER

HASA PULSE #3 THE SUSTAINABILITY ISSUE 7 the aforementioned SDGs. Some of these include the switch to efficient and environmentally friendly energy sources through the installation of solar-powered systems, as well as the installation of water restrictors and aerators to limit the flow of water and curb wastage at its hospitals. These are quintessential to solving the challenges linked to the scarcity of electricity and clean water in some parts of the regions Lenmed hospitals operate. Through the guidance of its Environmental Committee, the projects are implemented with the intent of ensuring that patient and community needs are met without compromising on quality, efficiency, prevention, and innovation. CELEBRATING EXCELLENCE IN PATIENT CARE AT LENMED Over the years, many of the hospitals that are under the Lenmed Group house centres of excellence and have received internationally recognised awards and accreditations. Recently, Lenmed’s Ahmed Kathrada Private Hospital, Howick Private Hospital, Randfontein Private Hospital, Shifa Private Hospital and Wilmed Park Private Hospital received ‘better than expected’ (the highest possible rating) awards in the Discovery Hospital Care rating. The Hospital Care rating is a transparent measure of how private general hospitals perform on a range of quality-of-care measures and how they compare to other private hospitals in the country, aimed at allowing patients to make betterinformed decisions. This recognition underscores the tireless work and immense contribution made by all stakeholders in providing exceptional care to our patients in their time of need. In alignment with the importance of providing quality treatment and appropriate management at centres of care promoted by the Trauma Society of South Africa, Randfontein Private Hospital was accredited as a Trauma Centre – making it the first hospital in the group to receive this certification and one of few in the country. Of great importance is the implementation and adherence to best practices and industry standards. One such example is noted in the work that has been done at the Ethekwini Hospital & Heart Centre, situated in KwaZuluNatal. The digitally integrated hospital boasts an extensive and leading adult and paediatric cardiac and cardiothoracic service offering and is the first in Africa to be awarded Chest Pain Centre Accreditation with Primary Percutaneous Coronary Intervention (PCI) by The American College of Cardiology (ACC). This is based on Ethekwini Hospital & Heart Centre’s demonstrated expertise and commitment to treating patients with heart attacks. In addition to this, the Ethekwini Heart & Hospital Centre became the first South African private facility to win a World Stroke Organisation (WSO) Award in 2022. The hospital received a gold award for its work in quality stroke care and for establishing cultures and systems to support continuous improvement. The journey for Lenmed is one that has been filled with a number of notable milestones, with over 38 years of work behind it, the vision is very clear – to carve out its path as a thought leader in healthcare, creating places of healing for our communities and attracting the best expertise by building steadfast and devoted teams, while always contributing to the creation of healthier and prosperous communities.

8 HASA PULSE #3 THE SUSTAINABILITY ISSUE The Capital Hospital Group is strongly positioned to offer easily accessible, low-cost, high-quality services, and it is our intention to work with the stakeholders to improve on our current performance through a long-term partnership that will add value to all stakeholders. Capital Hospital has been providing healthcare services for the past 10 years to a large segment of the population in the Durban and surrounding areas as well as patients from the North and South of Durban. The hospital currently consists of 83 beds, with 26 high care isolation units and 12 ICU beds. These single rooms are used at no additional charge with an added advantage of patients upgrading or downgrading within the same entity from admission to discharge. All isolation rooms are installed with the capacity for positive and negative pressure configuration, for Isolation units. This is a distinct advantage in terms of Infection control, producing superior clinical outcomes. Recently DOH has approved a name change to Capital Super Speciality Hospitals. Capital hospital is a member of the National Hospital Network group (NHN). Capital Heart Hospital boasts a state-of-the-art Heart Centre, Cardiac Catheterization lab, Endovascular lab and a Cardiac Operating theatre – opened in 2018. We at Capital Heart and Endovascular have positioned our unit as a centre of excellence for cardiology. We have recently introduced to our range of procedures TAVI and EP procedures – heart studies. The Cardiac Cath Lab enables Coronary Angiogram and Stenting procedures of a blocked artery to be done as an emergency procedure saving damage to the patient’s heart muscle and valuable time which can make the difference between life and death. CAPITAL: SUPER SPECIALITY HOSPITALS We at Capital Heart and Endovascular have positioned our unit as a centre of excellence for cardiology. FEATURED MEMBER

HASA PULSE #3 THE SUSTAINABILITY ISSUE 9 The doctors are also well trained to perform implantation of devices for Cardiac Rhythm management, including pacemakers, intracoronary defi brillators, and bi-ventricular intracoronary defi brillators. WHAT IS CARDIAC ELECTROPHYSIOLOGY? Electrophysiology is the branch of cardiology that deals with the electrical activities of the heart. It involves the study and diagnosis of arrhythmias, or irregular heartbeats, as well as the development and implementation of treatments to correct these abnormalities. Electrophysiologists use a variety of tools and techniques to monitor the electrical signals of the heart and diagnose arrhythmias, including electrocardiograms (ECGs), electrophysiology studies (EPS), and cardiac mapping. One common treatment for arrhythmias, particularly atrial fi brillation (AFib), is catheter ablation. This procedure involves the insertion of a thin, fl exible catheter into the heart through a blood vessel, typically in the groin area. The catheter is guided to the area of the heart responsible for the irregular heartbeat, using mapping tools and imaging technologies. Once in place, the catheter delivers radiofrequency energy, which creates scar tissue in the heart tissue, blocking the abnormal electrical impulses that are causing the arrhythmia. We can also use a freezing technique called Cryoablation which greatly reduces the procedure time. There are newer technologies such as pulsed fi eld ablation which are also improving the success rates for atrial fi brillation ablation. Atrial fi brillation ablation may be an option for patients who have not had success with medications or other non-invasive therapies. The procedure can help restore a regular heart rhythm and reduce symptoms such as chest pain, shortness of breath, and fatigue. In conclusion, electrophysiology plays a critical role in the diagnosis and treatment of arrhythmias, particularly Atrial Fibrillation. Catheter ablation is a common procedure used to correct these abnormalities, helping restore normal heart function and improve quality of life for those living with arrhythmias. We have a state-of-the-art electrophysiology laboratory at Capital Hospital which off ers the latest technology to achieve these ablations as well as for other arrhythmias. BY DR KEVIN MICHAEL, CARDIAC ELECTROPHYSIOLOGIST Hybrid Cathlab

10 HASA PULSE #3 THE SUSTAINABILITY ISSUE Neurovascular surgery, a subspecialty of neurosurgery, involves comprehensive management of blood vessel and associated conditions and disorders of the brain and spinal cord. This includes both surgical and endovascular treatment of patients with stroke, aneurysms, vascular malformations and carotid disease as well as management of complex vascular tumours. The word endovascular means “inside a blood vessel.” Endovascular neurosurgery is also known as neuro-interventional surgery. It is performed with the use of catheters and other small devices. Endovascular intervention is an alternative treatment to standard open surgery, which is more invasive. “The benefit of such therapy is that the lesion is treated less invasively, which frequently results in quicker recovery times and more successful treatment,” says Dr G Horton, a leading Endovascular Neurosurgeon at Arwyp Medical Centre. He treats cerebral aneurysms, stroke, carotid disease, arteriovenous malformations and other vascular malformations using minimally invasive neuroendovascular procedures as well as surgery involving microsurgical techniques. NEUROENDOVASCULAR PROCEDURES The following neuroendovascular procedures are performed at Arwyp Medical Centre: • Thrombolytic Therapy (Intravenous and Intra-Arterial) This uses medicine to dissolve a clot in a blood vessel in the brain. • Endovascular Mechanical Thrombectomy This uses a small catheter to remove a blood clot that is blocking the blood flow in a brain artery. • Endovascular Coiling This is done to treat a brain aneurysm. A brain aneurysm is a bulge in a weak spot in the wall of an artery in the brain that fills with blood. The bulge is at risk of a tear (rupture). This would cause bleeding on the brain. To prevent this, a surgeon puts a very thin metal coil inside the aneurysm. It blocks blood flow into the bulging area. It may also be closed with a clip. • Cerebral Angiography (DSA) This is a diagnostic radiological procedure. It demonstrates the circulation of blood in the brain. FEATURED MEMBER COMPREHENSIVE NEUROVASCULAR SURGERY AT ARWYP MEDICAL CENTRE Neurosurgery is a type of surgery that treats disorders of the brain, spine, spinal cord, and peripheral nerves.

HASA PULSE #3 THE SUSTAINABILITY ISSUE 11 Dr Horton holds the following qualifi cations: • M.D. (Doctor of Medicine): University of Miami (USA) • General Surgery Internship: University of Minnesota/Hennepin County Medical Center (USA) • Neurosurgery Residency: Penn State University (USA) • Endovascular Neurosurgery Fellowship: Penn State University (USA) • Neurovascular Surgery Fellowship (micro neurovascular surgery and skull base surgery): University of Michigan (USA) • Carotid Artery Angioplasty and Stenting (CAS) The carotid arteries send blood and oxygen to the brain. This procedure uses a small balloon to open a carotid artery that has become too narrow. A tiny mesh stent is then put in place to keep the artery open. SURGICAL MANAGEMENT Surgical management of neurovascular disorders involves brain and spinal surgery to directly address the patient’s condition. The following surgical neurovascular procedures are performed at Arwyp Medical Centre: • Intracranial Aneurysm Microsurgical Clip Ligation A titanium clip(s) is placed at the base of the brain aneurysm to permanently exclude the aneurysm from the normal circulation and prevent future bleeding from the aneurysm. The surgery is performed using a high-powered microscope and microsurgical techniques. • Microsurgical Resection of Brain and Spinal Cord Arteriovenous Malformation (AVM) A blood vessel malformation in the brain or spinal cord is removed surgically using high-powered microscope visualisation and microsurgical techniques. • Microsurgical Ligation of Brain and Spinal Dural Arteriovenous Fistulas (DAVF) Abnormal connections of blood vessels in the brain or spine are surgically eliminated using high-powered microscope visualisation and microsurgical techniques. • Carotid Endarterectomy (CEA) An incision is made in the carotid artery to remove plaques and restore normal circulation to the brain. When possible, this surgery is performed without the need for general anaesthesia. A local/regional anaesthetic is given, allowing safer surgery as well as eliminating the risk of general anaesthesia. ‘Awake’ CEA also allows for shorter hospital stay and recovery time after surgery. • Microsurgical Resection of Brain and Spinal Cord Cavernous Malformation. Blood vessel-type lesions located within the brain or spinal cord are surgically removed using highpowered microscope visualisation and microsurgical techniques.

12 HASA PULSE #3 THE SUSTAINABILITY ISSUE 22 HOSPITALS l Issue 2 l 2023 NEUROSURGERY Neurosurgery is a type of surgery that treats d i s o r d e r s o f t h e brain, spine, spinal cord, and peripheral nerves. N e u r o v a s c u l a r s u r g e r y , a subspecialty of neurosurgery, involves comprehensive management of blood vessel and associated conditions and disorders of the brain and spinal cord. This includes both surgical and endovascular treatment of patients with stroke, aneurysms, vascular malformations and carotid disease as well as management of complex vascular tumours. The word endovascular means “inside a blood vessel.” Endovascular neurosurgery is also known as neuro-interventional surgery. It is performed with the use of catheters and other small devices. Endovascular intervention is an alternative treatment to standard open surgery, which is more invasive. “The benefit of such therapy is that the lesion is treated less invasively, which frequently results in quicker recovery times and more successful treatment,” says Dr G Horton a leading Endovascular Neurosurgeon at Arwyp Medical Centre. He treats cerebral aneurysms, stroke, carotid disease, arteriovenous malformations and other vascular malformations u s i n g m i n i m a l l y i n v a s i v e neuroendovascular procedures as well as surgery involving microsurgical techniques. Neuroendovascular procedures The following neuroendovascular procedures are performed at Arwyp Medical Centre: • Thrombolytic therapy (intravenous and intraarterial). This uses medicine to dissolve a clot in a blood vessel in the brain. • Endovascular mechanical thrombectomy. This uses a small catheter to remove a blood clot that is blocking the blood flow in a brain artery. • Endovascular coiling. This is done to treat a brain aneurysm. A brain aneurysm is a bulge in a weak spot in the wall of an artery in the brain that fills with blood. The bulge is at risk of a tear (rupture). This would cause bleeding on the brain. To prevent this, a surgeon puts a very thin metal coil inside the aneurysm. It blocks blood flow into the bulging area. It may also be closed with a clip. • C e r e b r a l a n g i o g r a p h y (DSA). This is a diagnostic r a d i o l o g i c a l p r o c e d u r e . I t demonstrates the circulation of blood in the brain. • Carotid artery angioplasty and stenting (CAS). The carotid arteries send blood and oxygen to the brain. This procedure uses a small balloon to open a carotid artery that has become too narrow. A tiny mesh stent is then put in place to keep the artery open. Surgical management S u r g i c a l m a n a g e m e n t o f neurovascular disorders involves brain and spinal surgery to directly address the patient’s condition. The following surgical neurovascular procedures are performed at Arwyp Medical Centre: • I n t r a c r a n i a l a n e u r y s m microsurgical clip ligation. A titanium clip(s) is placed at the base of the brain aneurysm to permanently exclude the aneurysm from the normal circulation and prevent future bleeding from the aneurysm. The surgery is performed using a high-powered microscope and microsurgical techniques. • M i c r o s u r g i c a l r e s e c t i o n of brain and spinal cord arteriovenous malformation (AVM). A b l o o d v e s s e l malformation in the brain or spinal cord is removed surgically using high-powered microscope visualisation and microsurgical techniques. • Microsurgical ligation of b r a i n a n d s p i n a l d u r a l a r t e r i o v e n o u s f i s t u l a s (DAVF). Abnormal connections of blood vessels in the brain or spine are surgically eliminated using high-powered microscope visualisation and microsurgical techniques. • C a r o t i d e n d a r t e r e c t o m y (CEA). An incision is made in the carotid artery to remove plaques and restore normal circulation to the brain. When possible, this surgery is performed without the need for general anaesthesia. A local/regional anaesthetic is given, allowing safer surgery as well as eliminating the risk of general anaesthesia. ‘Awake’ CEA also allows for shorter hospital stay and recovery time after surgery. • M i c r o s u r g i c a l r e s e c t i o n of brain and spinal cord cavernous malformation. Blood vessel-type lesions located within the brain or spinal cord are surgically removed using highpowered microscope visualisation and microsurgical techniques. Doctor Horton holds the following qualifications: M.D. (Doctor of Medicine): University of Miami (USA); General Surgery Internship: University of Minnesota/Hennepin County Medical Center (USA); Neurosurgery Residency: Penn State University (USA); Endovascular Neurosurgery Fellowship: Penn State University (USA); Neurovascular Surgery Fellowship (micro neurovascular surgery and skull base surgery): University of Michigan (USA). Comprehensive Neurovascular Surgery at Arwyp Medical Centre FOR MORE INFORMATION CONTACT THE MARKETING DEPARTMENT ON 011 922 1124 Arwyp Medical Centre Private Hospital, situated in Kempton Park, recently celebrated 36 years in the hospital business. From humble beginnings in 1986, occupying only two floors of a high-rise building in Kempton Park, the hospital now comprises an entire block of building in the CBD with over 26 specialist disciplines represented and 343 hospital beds. Over the many years milestones have been achieved at the Hospital including a number of ground-breaking operations. Arwyp Medical Centre Private Hospital has often led the way procuring and using the latest medical technology. The Hospital has completed several renovation projects designed to upgrade all the hospital’s facilities to state of the art, and to augment patient experience. The impressive renovations have added a further dimension of ease and convenience to the hospital. The hospital is now entered via a spacious open plan area. This area, which includes the new Admissions Department and Pre-Admission Department has been designed with comfort and convenience in mind to make it easier for patients to complete the admissions process. The Acclaimed Coffee Bean is conveniently located alongside the Admissions Department at the main entrance and will be open to patients and visitors alike. A carvery, light snacks, take-aways, cakes and beverages are served. Arwyp Medical Centre Private Hospital is accredited with the Council for Health Service Accreditation of South Africa (COHSASA) that is accredited worldwide by the International Society for Quality in Health Care (ISQua). The company accredits medical facilities which enter the program to improve the quality and safety of their healthcare. Each facility is judged by a set of international standards and each department of the facility complied with these standards to complete the audit. Arwyp Medical Centre Private Hospital was awarded another 3-year accreditation. Our facility is very proud to have achieved accreditation and grateful to our team who worked diligently to achieve this high level of accreditation. The people of Kempton Park and Ekurhuleni have come to rely on Arwyp Medical Centre Private Hospital as a vital and integral part of the community through its continual excellence in services. CELEBRATING FOUR DECADES OF CARE MEDICLINIC REMAINS TRUE TO OUR PURPOSE OF ENHANCING THE QUALITY OF LIFE. Proudly founded in South Africa in 1983, Mediclinic brings advanced care to local communities. Today, Mediclinic is an international healthcare brand with hospitals throughout South Africa, as well as Namibia, Switzerland and the Middle East. For more information on our signifi cant journey, scan this QR code. SOUTH AFRICA • SWITZERLAND • UAE • NAMIBIA www.mediclinic.com A4 Advert.indd 1 2023/07/13 13:29

HASA PULSE #3 THE SUSTAINABILITY ISSUE 13 CELEBRATING FOUR DECADES OF CARE MEDICLINIC REMAINS TRUE TO OUR PURPOSE OF ENHANCING THE QUALITY OF LIFE. Proudly founded in South Africa in 1983, Mediclinic brings advanced care to local communities. Today, Mediclinic is an international healthcare brand with hospitals throughout South Africa, as well as Namibia, Switzerland and the Middle East. For more information on our signifi cant journey, scan this QR code. SOUTH AFRICA • SWITZERLAND • UAE • NAMIBIA www.mediclinic.com A4 Advert.indd 1 2023/07/13 13:29

PRESS ROOM HASA STATEMENT ON PARLIAMENT’S APPROVAL OF THE NHI BILL The Hospital Association of South Africa notes that the Parliamentary Portfolio Committee for Health has approved the National Health Insurance Bill. We also note the media statements regarding the concerns and positions against the Bill in its current form from two representative organisations of doctors, the South African Medical Association and the South African Private Practitioners Forum. We believe that approving the Bill without substantive consideration of the many valid and signifi cant recommendations and contributions made by many participants during the Parliamentary hearing is deeply regrettable and a missed opportunity by the Committee. As the hearings demonstrated, there is broad support for universal access to quality healthcare. There is a willingness to collectively engage with the Government to craft the best possible legislation. To summarily ignore the many who voiced their concerns regarding governance structures and operational effi ciency concerns, the concentration of risk in a singlepayer system in an unstable economy featuring endemic corruption, and the many other concerns raised by State attorneys, is short-sighted and highly unwise. Passing such vast, complicated, risky, and consequential legislation requires confi dence, trust, and stakeholder collaboration. The approach taken undermines confi dence and poses a threat to trust. We urge the National Assembly and the National Council of Provinces in their deliberations on the Bill to insist on a multi-payer model to mitigate against the concentration of risk, an iterative rollout based on milestones rather than dates and to pay heed to the nation’s concerns that the proposed National Health Insurance Fund is susceptible to theft and corruption by proposing and approving alternate and appropriate governance structures. The healthcare reform decisions taken now will impact the sustainability of South Africa’s health system and will be deeply felt for generations to come. The healthcare reform decisions taken now will impact the sustainability of South Africa’s health system and will be deeply felt for generations to come. 14 HASA PULSE #3 THE SUSTAINABILITY ISSUE

HASA PULSE #3 THE SUSTAINABILITY ISSUE 15

At a time when South Africa is facing a critical shortage of nurses, not enough is being done to address the crisis – despite the private sector being willing and able to train up the deficit, writes Peter Wharton-Hood, Group Chief Executive at Life Healthcare. From the rising costs of diesel used to offset loadshedding, to difficult working conditions, and the increasing impact of inflation, South Africa’s healthcare sector is facing a multitude of challenges. But one of the biggest issues is undoubtedly the lack of critical human resources, specifically healthcare workers, that keep hospitals and facilities functioning. Today in South Africa, there is just one doctor for every 3 200 people, translating to 0.3 doctors per thousand. In contrast, countries like Australia and the United Kingdom have ten times as many with more than three doctors for every thousand people. On the ground, there is just one nurse per 213 people. Of these, less than a third are under the age of 40, and within 15 years, 47% of all nurses will have retired. The nursing shortage has been estimated currently at more than 26 000 professionals, but we expect this number to reach more than 100 000 by 2030. SKILLS SHORTAGE The numbers clearly show that we are dealing with a dire shortage of skilled professionals. At the very top of the list are nurses. They are the backbone of the healthcare sector, playing a crucial role in patient recovery and safety. What’s more, today’s investment in these critical skills does not stack up against the growth of our population – meaning if no immediate action is taken, or we cannot develop a sustainable pipeline of nursing talent, the problem is going to become noticeably worse. As a leading provider of quality healthcare, we have the facilities and the capacity to contribute to the national pool of skills, especially in the field of nursing, by training as many as 3 000 more nurses every year. We are however being denied the opportunity to invest in the next generation of nurses. The bureaucrats will simply not listen. New regulations enacted by the South African Nursing Council (SANC) and the Council for Higher Education are turning off the taps of training. While we’re ready and able to invest, from a private healthcare perspective, out-of-touch regulations permit us to train just 800 nurses per annum – which is in no way enough to reduce the impact of the shortage. CURRENT AFFAIRS SOUTH AFRICA NEEDS TO INVEST IN NURSES TO AVOID A HEALTHCARE CATASTROPHE Today in South Africa, there is just one doctor for every 3 200 people, translating to 0.3 doctors per thousand. BY PETER WHARTON-HOOD 16 HASA PULSE #3 THE SUSTAINABILITY ISSUE

ABOUT LIFE HEALTHCARE Life Healthcare is a global people-centred, diversified healthcare organisation listed on the Johannesburg Stock Exchange. Life Healthcare has over 38 years’ experience in the South African private healthcare sector, and currently operates 66 healthcare facilities in southern Africa. Services include acute hospital care, acute physical rehabilitation, acute mental healthcare, renal dialysis, oncology, imaging and occupational health and wellness services. The Group owns Alliance Medical Group, the leading independent provider of medical imaging services (MRI, CT and PETCT scans) within the UK and Europe. VISIT: www.lifehealthcare.co.za or www.alliancemedical.info/ BORDERLESS SKILLS Beyond our inability to train these skills to meet future healthcare needs, the regulations risk the sector losing even more talented and skilled nurses by limiting career advancement – prompting nurses to consider their options overseas. According to the World Health Organization (WHO), the Covid-19 pandemic has caused a rapid acceleration in the international recruitment of health workers, including nurses. Wealthier countries around the world are looking to supplement their own shortage of skilled professionals by enticing talent into these more developed environments. For countries, like South Africa, that are losing their healthcare professionals to overseas opportunities which offer better pay and prospects, the threat is that our already under-resourced healthcare sector will face an even greater shortage of skilled and experienced workers. COLLABORATE FOR SUCCESS We cannot spend more time debating the numbers – the problem is blindingly obvious to everyone. It is now time for public stakeholders to recognise that there is a significant bureaucratic problem at play which if not addressed quickly will have catastrophic long-term implications for all of us. If our Government’s goal is to forge ahead with the National Health Insurance (NHI) – which is aimed at making healthcare more accessible, giving more people the opportunity to receive treatment – then more nurses and more doctors need to be trained to realise this vision. From a private healthcare provider perspective, we are willing to extend a trusted hand of friendship to the public sector, so that we can work to overcome this critical skills shortage together. It is our intention to have constructive conversations around the practical roles that both the public and private sectors can play in addressing this crisis – before it becomes a catastrophe where people’s lives are at stake. Through our accredited, innovative, quality education and training programmes, Life Healthcare has the potential to bridge the skills gap, to invest in nursing and South Africa’s overall healthcare workforce – but we need the Government to come on board and collaborate to address the regulatory shortcomings, or risk South Africa’s pipeline of talent running dry. VISION FOR THE FUTURE The adage “the best time to plant a tree was 20 years ago, the secondbest time is now” has never been truer. If we don’t get busy solving the shortage now, I am deeply concerned that South Africa will not have the skills it needs to address future healthcare demands. That’s why we will not rest until we have permission to train more nurses, who in turn deliver high-quality care to our patients. Today, Life Healthcare has the potential and the willingness to invest in a sustainable pipeline of nurses. We need the public sector to work collaboratively to safeguard the ones already on the frontline while allowing us to train the next generation. HASA PULSE #3 THE SUSTAINABILITY ISSUE 17

18 HASA PULSE #3 THE SUSTAINABILITY ISSUE But the concern is that while the goal of NHI is to eliminate inequality when it comes to accessing primary healthcare, there is no provision for dealing with the impact of climate change. Academics Dr Caradee Wright and professors Matthew Chersich and Angela Mathee, writing for the South African Journal of Science, believe that the effects of climate change should be factored in. They point out that by the end of the century climate change is predicted to raise the temperature by, on average, four degrees in South Africa. This will, in turn, create new public health challenges that could add to an already high burden of disease, that will in turn increase hospital admissions and strain a system that is already under pressure. South Africa’s healthcare will endure heat waves that could affect the cold chain supply line, making it difficult to store and transport medicines and vaccines. There will be costs involved to improve infrastructure to ensure the thermal comfort of staff and patients, while flooding could affect water and power supplies. In turn, the academics write in their paper, this could place access to and the safe-keeping of systems that maintain patient records in jeopardy. The World Health Organization has estimated that 250,000 additional deaths will occur globally each year due to direct and indirect Parliament’s portfolio committee on health recently adopted its amendments to the National Health Insurance Bill, a step that moves South Africa closer to universal health coverage. But while this new legislation, when fully implemented, will change South Africa’s healthcare landscape, the concern for some is that the Bill doesn’t take into account the looming threat of climate change. The National Health Insurance Bill (NHI) sets out to provide all South Africans with quality health services through a single fund, and also aims to strengthen the already straining public health sector. The National Department of Health gazetted the White Paper on the NHI to be implemented next year, although the Covid-19 pandemic is likely to push this date forward. The cost, according to a Socio-Economic Impact Assessment done in 2019, is projected to be R256 billion. SPECIAL FEATURE South Africa’s healthcare will endure heat waves that could affect the cold chain supply line, making it difficult to store and transport medicines and vaccines.

HASA PULSE #3 THE SUSTAINABILITY ISSUE 19 climate change impacts. “If South Africa is going to brave the storm of climate change, as well as threats to morbidity and mortality posed by extreme weather events, our primary healthcare system needs to be robust, resilient, of high quality, and accessible,” they write. “We need to look at how climate change needs are considered within the NHI,” stresses Wright, who is the lead author on the paper. The researchers believe that if South Africans are to benefit from universal health coverage provided by the NHI, then one fundamental NHI policy of prevention of disease has to take centre stage. Dr Joni Wishnia, a public health researcher and consultant, explains that the NHI bill’s purpose is purely set up as a mechanism for funding pooling. “For better or for worse, the Bill is setting out the legislation for us to have a funding mechanism for the national health insurance. Its primary purpose is to enable the government to pool funding and purchase healthcare across all the sectors,” she explains. “It’s not to determine the burden of disease, now or in the future. It’s really quite focused.” Wishnia has been involved in research for and on the NHI Bill and its previous White Paper since 2014 and knows the difficulty of trying to put a price tag on NHI. “It is difficult without good data to really estimate what the health needs of the population will be,” she adds. “Then you have to work out how the burden of disease is going to change and how much healthcare services are going to cost. It becomes tricky.” Wishnia suggests that perhaps the NHI Bill should have started out with a package of care with climate change included and its anticipated impact on health needs. “Then the last step would be arranging the financing system to support this.” Doing it this way would have enabled an easier passage through Parliament, without different interest groups fighting over the cost of the NHI instead of the principle of universal health coverage. Other policies and bills do address climate change. The National Climate Change Response Policy was designed to respond to the urgency of climate change and push South Africa towards a green economy. The wide-ranging document does address healthcare. According to the National Climate Change Response Policy’s White Paper, the aim would be to reduce respiratory diseases through improving air quality. The policy also makes provision for improving water quality to reduce water-borne diseases and public awareness programmes to mitigate the effects of heat waves. However, the policy is not tied to, nor refers to the NHI. The Climate Change Bill was formally introduced to Parliament on 18 February 2022 by the Department of Forestry, Fisheries and the Environment, which also doesn’t address NHI. The Bill does, however, address health when the minister of the Department of Forestry, Fisheries and Environment is tasked to develop a National Adaptation Strategy and Plan through consulting with other ministers who are responsible for energy, health, public enterprises, science, transport, water affairs and sanitation within two years of the Act coming into being. To make a more effective NHI, climate change ultimately needs to be an integral part of the planning, say the three academics. This will in turn reduce inequalities that emerge as temperatures rise in the coming decades. “If we are going ahead with NHI we should really be thinking about how climate change is considered in that,” says Wright. BY SHAUN SMILLIE CLIMATE CHANGE COULD SINK NHI’S GOAL OF AN EQUAL HEALTHCARE SYSTEM

20 HASA PULSE #3 THE SUSTAINABILITY ISSUE Those most at risk will be people with pre-existing mental health and health conditions. But as with so much of climate change, the full extent of what we will face is still yet unknown. “There isn’t much robust research in the area,” explains Professor Monika dos Santos, professor of psychology, University of South Africa, who The prediction is that in the future South Africa will experience the worst of climate change as temperatures rise at twice the global average. This will leave South Africans vulnerable not only to new diseases and extreme weather events, but also to mental health challenges. SPECIAL FEATURE CLIMATE CHANGE IS SET TO DRIVE UP INCIDENTS OF MENTAL ILLNESS AS TEMPERATURES RISE

HASA PULSE #3 THE SUSTAINABILITY ISSUE 21 has studied the effect that climate change will have on mental illness. What is known through research, is that high temperatures do have an impact on mental health, and are known particularly to heighten aggression. The prevalence of mood disorders such as anxiety and depression are also expected to increase in a world dealing with climate change. “So when there is concern about food security, water shortages and habitat destruction, that clearly will increase the risk of such things as anxiety and other mood disorders in individuals,” explains Dr Indhrin Chetty, psychiatrist, and lecturer, University of the Witwatersrand. Research has shown that incidents of anti-social behaviour and violence are likely to increase too. A study that was published in 2019, in Environmental Health, a BMC journal, found that in South Africa, a 1°C rise in temperature is associated with a 1.5% increase in murder. The researchers warned that: “This temperature-health relationship may be of particular concern in the context of climate change.” With exposure to extreme weather events, which are expected to increase with climate change, will come numerous psychological illnesses including depression, anxiety, post-traumatic stress disorder and paranoia. The stresses brought on by extreme weather events and scarcity of resources could also lead to substance use and self-harm behaviour, with added burdens of childhood developmental delays, accelerated neurocognitive decline, dementia, cognitive impairment and general trauma, dos Santos points out. What this is likely to result in, is more hospital admissions and added pressure on an already overstretched healthcare system. “Clearly, from a treatment point of view, it would need to be multidisciplinary,” says Chetty. “So we’re talking not just about seeing psychiatrists in getting medication, but also involving therapy and then lots of other interventions that we can make use of in the healthcare setting to try and assist patients.” Another way of elevating the strain on care systems, suggests Chetty, is to help people by enabling them to develop coping strategies. To help professionals deal with this influx of cases caused by global warming, dos Santos suggests that healthcare facilities should take advantage of fourth industrial revolution technologies, which include artificial intelligence, robotics, drones, telemedicine and the Internet of Things (IoT). Through mining big data, more detailed information can be gleaned about the effects of climate change on populations. A technology that could prove helpful in dealing with mental health illnesses in a world where care systems are overstretched and possibly difficult to get to, is psychiatric telemedicine. This is the use of communication technology to diagnose and treat patients. Telemedicine proved its worth when it took off during the Covid-19 lockdowns. “Where you have infrastructures that are not properly capacitated, it does help play a significant role for people who cannot physically drive to the clinic,” says dos Santos, who advocated telemedicine in a study conducted in Mpumalanga. A skills shortage of professional carers, says dos Santos, can be dealt with by task-shifting, where mental healthcare delivery is moved from more highly trained providers to individuals with less training. This under the eye of those higher trained providers. The problem though is that it is impossible to plan for a future that is still so uncertain. “There is only so much planning and resource allocation you can do in a resource limited environment, so we need to rise to the challenges after they occur or when they present themselves,” says Chetty. BY SHAUN SMILLIE The prevalence of mood disorders such as anxiety and depression are also expected to increase in a world dealing with climate change.

The WHO’s fifth element is the provision of sustainably grown local food for staff and patients, and the sixth is the use of alternatives for waste incineration. The final element is to conserve water while safe alternatives exist. South Africa has already embraced some design features that are characteristic of green hospitals, in particular where energy efficiency and temperature control are emphasised. The Netcare Christiaan Barnard Memorial Hospital, for instance, which was opened in December 2016, showcased an array of green design features and green technology. The external glass skin of the building, which is separated from the internal glass windows by a void in-between, provides insulation. In Beaufort West in the Western Cape, a public health facility is seen as a future reference design for providing energy efficiency in an extreme climate setting. The Hillside Clinic was completed by the Western Cape Government in 2017. The clinic sits in an arid desert, which will see the worst of climate change in the years to come, scientists predict. If temperatures rise by two degrees Celsius as forecast as a possible scenario, Beaufort West could see a warming of 16%. Like so many clinics in South Africa the designers were concerned that high occupancy would expose patients and staff to airborne infections. To counter this, they moved to provide better ventilation and thermal comfort. In a drier, hotter world plagued by extreme weather, South Africa’s health infrastructure will be tested as we battle the effects of climate change. Climate models predict that in the next two decades South Africa will experience Day Zero droughts, killer heat waves and cyclones. And on the back of this will come disease and food insecurity. In this world, hospitals and other health facilities will have to be designed to deal with a multitude of challenges. Globally governments and organisations are looking at how health systems will have to evolve to handle the pressures caused by global warming. The World Health Organization (WHO) has issued guidelines on how hospitals can be made climate friendly in the face of climate change. They list seven elements that make up a climate friendly hospital. The first of these is energy efficiency, where efforts are made to “reduce hospital energy consumption and costs through efficiency and conservation measures.” Green building designs is the second element, where hospitals are constructed to be optimised to local climatic conditions. The third is the use of alternative energy generation, while the fourth is transportation. The WHO advocates for the use of alternative fuels while staff are encouraged to cycle or use public transport to get to work. They used a hybrid system that utilises both passive and mechanical strategies. The building was orientated to take advantage of solar heat gain in winter, while roof overhangs were designed to prevent heat gain in summer. In addition, rock bed thermal stores beneath the building are used to pre-cool the air supply in summer. The loose rocks, which hold heat, work in reverse in winter, when they are warmed by outside air passing over them. While passive ventilation or natural ventilation was favoured, mechanically driven air in the form of air conditioning and fans was still needed, particularly where 100% ducted fresh air supply is recommended. Studies found that in summer temperatures in areas of the clinic without air conditioning were eight to 10 degrees cooler. But, while health facilities can be hardened and built robustly enough to deal with climate change, the problem is the surrounding infrastructure. Last year’s floods in Kwazulu-Natal gave authorities a peek into what South Africans might face in the near future when an extreme weather event hits. Opinions differ over whether the floods that left 448 people dead and displaced over 40,000 people were caused by climate change but when the floods washed roads and bridges away, several clinics and hospitals became inaccessible to both staff and patients. SPECIAL FEATURE 22 HASA PULSE #3 THE SUSTAINABILITY ISSUE

“You can have the smartest health facility, but if the roads and other things are not sorted, then there is no use having a climate smart healthcare facility,” says Azeeza Rangunwala, the Global Green and Healthy Hospital (GGHH) Coordinator. The GGHH is an international network of health facilities and systems that aims at reducing their environmental footprint while promoting public and environmental health. Temperature control within hospitals and clinics will become increasingly important in the future, as recent research has already shown. In 2017, Dr Caradee Wright, chief scientist at the South African Medical Research Council leading the Climate and Health Research Programme, measured the indoor temperatures in patient waiting rooms in eight rural primary healthcare centres in Limpopo. “There were temperatures of over 45ºC during the afternoon. You had mums sitting there waiting for hours with their babies, bundled in blankets. In fact there’s one situation where a mom said that the heat killed her baby,” says Wright. Cooling down waiting rooms requires air conditioning that can be expensive and requires an energy source. But supplying uninterrupted energy could become a challenge in a climate change world. The suggestion is that hospitals of the future will produce their own electricity. Peta de Jager, an architect who leads the Infrastructure Innovation research group at the CSIR, believes that decentralised power could grow the divide between the haves and the have nots. “There is a lot of merit in centralised systems of utility provision: it’s more democratic in a sense,” she explains. The problem, she adds, is that authorities are not looking at a 2050 horizon. “There is a lack of appreciation of what it takes to put infrastructure in place,” she says. Still, there are positives when it comes to South African building infrastructure, which promises to hold up well in the future, says de Jager. South Africans make good use of natural ventilation and the local construction technologies are robust. “In general, we have to respond to the needs of people and we have to do it in a way that actually respects the fact that investments in infrastructure are difficult, expensive and take time,” she says. BY SHAUN SMILLIE HOSPITALS WILL NEED TO EVOLVE TO DEAL WITH EXTREME WEATHER, HEAT AND SICKER PEOPLE South Africa has already embraced some design features that are characteristic of green hospitals, in particular where energy efficiency and temperature control are emphasised. HASA PULSE #3 THE SUSTAINABILITY ISSUE 23

24 HASA PULSE #3 THE SUSTAINABILITY ISSUE The climate crisis and antimicrobial resistance (AMR) are two of the greatest and most complex threats the world currently faces. There is an intricate and close link between the climate and microbial world, just as all life on earth is interconnected. The World Health Organization (WHO) lists AMR among the top 10 threats for global health. Without effective antimicrobials, modern medicine would struggle to treat even mild infections among humans, animals, and plants. In 2019, it was estimated that 1.27 million deaths were directly attributed to drug-resistant infections globally, and 4.95 million deaths worldwide were associated with bacterial AMR, including those directly attributable to AMR. Estimates suggest that by 2050 up to 10 million additional direct deaths could occur annually. That is on par with the 2020 rate of global deaths from cancer. In the United Nations report: Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance, evidence is provided that the environment plays a key role in the development, transmission and spread of AMR. Higher temperatures can be associated with increases in AMR infections, and extreme weather patterns can contribute to the emergence and spread of AMR. Extreme weather is not only about higher temperatures, but includes droughts, floods, wildfires, and storms. The Wellcome Fund explains that the climate crisis worsens the threat of drug-resistant infections in several ways. Temperature is intimately linked with bacterial processes and infections. As temperatures warm with climate change, bacterial infection rates may increase and diseases can spread to higher altitudes and latitudes where they were not previously found. Bacteria can also grow and reproduce faster and swap genes with one another. This is known as horizontal gene transfer. The faster this occurs; the more likely bacteria are to become resistant. These extreme conditions, fuelled by climate change, will also put increasing pressure on farmers and livestock producers. Antibiotics are often used in food production and with mounting crop failures, the overuse of antibiotics increases the spread of drug resistant infections. In 2022 the The Lancet Countdown on health and climate change: SPECIAL FEATURE HOW THE CLIMATE AFFECTS ANTIMICROBIAL RESISTANCE This takes multiple forms: fuelled by population growth, urbanisation and growing demand for food and healthcare, an increase both in the use of antimicrobials and in pollutants released into the environment, are expected.

HASA PULSE #3 THE SUSTAINABILITY ISSUE 25 health at the mercy of fossil fuels was published. It pointed out how the climate has become more suitable for disease transmission. It showed, for instance, how increased rainfall, heat and humidity are increasing the spread of malaria. The report also finds that bacteria linked with mild cases of cholera – a diarrhoeal infection transmitted through ingesting contaminated food or water – is becoming more prevalent as the climate crisis shrinks and contaminates the Earth’s freshwater supply. Between 1982 and 1989 and between 2014 and 2021, for example, changes in salt levels in the sea and temperature made more coastline areas suitable for pathogens to survive and spread. According to the United Nation’s report, AMR challenges cannot be understood or addressed separately from the triple planetary crisis of climate change, biodiversity loss and pollution and waste, because they are all driven by unsustainable consumption and production patterns. This takes multiple forms: fuelled by population growth, urbanisation and growing demand for food and healthcare, an increase both in the use of antimicrobials and in pollutants released into the environment, are expected. The frequency, composition and amounts of pollution containing biotic and abiotic agents may be increasing due to the climate crisis. Temperature, oxygen and carbon dioxide concentrations in the environment can also influence the survival and proliferation of bacteria, and the rate at which they acquire resistance. Human activity and climate change have altered soil microbial diversity in recent decades, which may also promote the circulation of antibiotic resistance genes in the environment. Even treating cattle with certain antibiotics changes dung beetle microflora, which can interrupt the essential ecosystem service that dung beetles provide. One Health is an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems. It recognises the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent. The call to action from the United Nation’s report, with the One Health approach in mind, is that the environment has received limited attention in tackling AMR, but evidence shows that it plays a key role in the development, transmission and spread of AMR. Now, while its contribution and significance are determined, further and more co-ordinated action, with a focus on prevention, needs to be taken to limit the role of the environment in mediating, driving and causing AMR. All life on earth is interconnected. It is one large, vibrant body that has evolved over hundreds of millions of years – both powerful and fragile. Humans are just one, though dangerous, thread in this web, utterly dependent on all other life around us. WE NEED TO TAKE CARE. BY ELSABÉ BRITS

26 HASA PULSE #3 THE SUSTAINABILITY ISSUE OUR NURSE S. INVESTING IN OUR NURSES OUR FUTURE. WE ARE PLAYING OUR PART TO SECURE OUR NURSES' FUTURE. Life at Life Healthcare. More than a job. It’s making life better. For more information on a nursing career at Life Healthcare or our nursing college visit: www.lifehealthcare.co.za Our nurses make an invaluable contribution to quality patient care. They are at the heart of making life better. We’re committed to our nurses through an integrated employee value proposition including recognition, career development and continuous learning and training.

HASA PULSE #3 THE SUSTAINABILITY ISSUE 27 A WORLD OF NEW DISEASES, EXTREME HEAT AND CYCLONES In the near future, Johannesburg is set to become a malaria area, as the cold winters that once protected the city from anopheles mosquitoes warm as climate change takes hold. Malaria is already on a deadly march across the continent as temperatures rise. Research from the journal, Biology Letters, has shown that populations of anopheles mosquito that carry the malaria parasite, are gaining an average of 6.5m of elevation a year in Africa, and are increasing their ranges south of the equator by 4.7km a year. Rising temperatures across South Africa will mean the arrival of new diseases and illnesses that the health fraternity will have to deal with, and to do it successfully will require creativity, planning and building robust systems. “With climate change we are likely to see a lot of vector-borne diseases like malaria and dengue fever. This is brought on by changes in rainfall patterns,” explains PhD candidate and epidemiologist Malebo Makunyane. South Africa might also see the arrival of yellow fever, while habitat destruction could force some species to fi nd refuge in new habitats, increasing contact between humans and animals and causing the spread of zoonotic diseases such as rabies and anthrax. As a document compiled by the Department of Forestry, Fisheries and Environmental Aff airs described, system needs to begin now. This will mean the allocation of resources and developing the skills needed to deal with the challenges created by climate change. Besides the burden of illness, South Africa’s healthcare system of the future will likely be burdened by mega disasters never before experienced. Climate modelling done by the Global Change Institute at the University of the Witwatersrand has predicted the possibility of a category four cyclone making landfall as far south as Richard’s Bay in KwaZulu-Natal. Such an event could result in tens of thousands of casualties. “Surveillance and early warning systems need to be implemented,” says Makunyane. Systems need to be more robust and hardened to deal with such calamities. Another important component, she adds, is the use of multidisciplinary teams and strengthening public awareness through education programmes. While the coming threat of climate change may seem daunting, the Covid-19 pandemic has shown that healthcare services in the country can handle a crisis. For one, detailed surveillance systems were put in place that enabled detailed tracking of the virus. But what was shown during the pandemic was the need for clear channels of communication. “As a researcher, if I can’t share this knowledge with the relevant shareholders then it is as good as useless,” says Makunyane. the health impact of climate change will fall into two categories. It will come from either direct exposure to temperature and weather-related incidents, or indirect eff ects from the likes of air pollution and pollen production. “Air pollution is likely to be driven by weather variability, which will see not only periods of heat but also cold. With cold weather comes more burning of fi res in homes to keep warm,” explains Dr Caradee Wright, a chief scientist at the South African Medical Research Council leading the Climate and Health Research Programme. Air pollution will cause an increase in respiratory diseases. The warmer conditions are also expected to increase the development of certain pollutants like ozone, adding to air pollution. “Unfortunately those that will suff er the most will be those with inadequate resources,” says Makunyane. Food insecurity, hunger and malnutrition are expected to increase. Those suff ering from HIV and TB will be vulnerable. The prevalence of cardiovascular diseases is also expected to rise. The problem is that South Africa is heading into an unknown future. “The burden of disease, related to climate change, hasn’t been worked out as yet, but we are working on it to see how many people are going to be suff ering from induced illnesses,” says Wright. To prepare for this future Makunyane believes that the process of capacity building within the healthcare OUR NURSE S. INVESTING IN OUR NURSES OUR FUTURE. WE ARE PLAYING OUR PART TO SECURE OUR NURSES' FUTURE. Life at Life Healthcare. More than a job. It’s making life better. For more information on a nursing career at Life Healthcare or our nursing college visit: www.lifehealthcare.co.za Our nurses make an invaluable contribution to quality patient care. They are at the heart of making life better. We’re committed to our nurses through an integrated employee value proposition including recognition, career development and continuous learning and training. SPECIAL FEATURE BY SHAUN SMILLIE

I recently moved from a city to a town, and it has made a big difference in the way I experience life. Suddenly I’m driving shorter distances, seeing more green landscapes around me, not getting stuck in traffic that much, and hearing more joy-inspiring birdsong and frogs. Not everyone in South Africa lives in a city. But the majority of South Africans commute, work, sleep, exercise, eat, work, breathe and basically do all things life-related, in cities. Increasingly, the impact of the design of our living environments on our overall health and wellbeing is being recognised. This insight is slowly finding its way into architecture discussions, health research, public health system design, and even economics. Part of the rise of wellness design can be attributed to the Covid-19 pandemic and greater awareness about how the design of buildings can affect our health (think ventilation). But there is also an increasing emphasis on mental health and wellbeing. And the spaces we live in matter for how we feel: physically and mentally. The theme for World Architecture Day in 2022 was “Architecture for well-being.” 2022 was also identified as the International Union of Architects’ Year of Design for Health in Buildings and Cities. (Gattupalli, 2022). In the same year, the World Health Organization issued its Urban Design for Health guidance document, with the recognition that “the urban environment shapes human health and well-being throughout the life-cycle” (WHO, 2022). In essence, they all came to a similar conclusion: that smart design and planning of urban spaces can have a direct influence on public health and human behaviour by enabling individuals to engage in more (or less) physical activity and facilitating access to healthier food options. It is not only the details of the internal design and placement of amenities in cities (such as parks and food stores) that matter, but also overall compactness. In 2022, Mariaflavia Harari published an article considering the economic consequences of city shapes in India that was published in the American Economic Review – considered the foremost academic economics journal. It is a rarity (and one of truly few) of an academic article in the broader economics literature, as it considers the impacts of the spatial layout of cities on the way people live and work. City shapes and urban design have thus far not enjoyed much consideration in economics. Harari examined cities’ geometric characteristics over time by constructing a dataset from satellite imagery and historical maps. She found that compact city shape is associated with higher population growth and lower real wages. Lower wages are interpreted as a willingness to pay for shorter commute times. Harari argues that households explicitly consider compactness of cities in their choice of location. Compact cities may be preferred because they offer greater accessibility, lower transport time and costs (and therefore less time spent commuting and more time for other things). These types of cities promote quality of life and should therefore become a favoured location when people decide where to work and live. Compactness of cities can be promoted by city-level regulations on urban development. But these regulations are not always developed or implemented, thereby missing a golden opportunity to improve the lives of city residents. DESIGNING FOR LIFE: HOW URBAN AND SPATIAL DESIGN MATTERS FOR HEALTH, WELLNESS AND PRODUCTIVITY VOICES 28 HASA PULSE #3 THE SUSTAINABILITY ISSUE

Apart from compactness and guidance on the positioning of certain types of amenities (think healthy food options), biophilic design is being explicitly brought into architectural design to promote health. This design approach entails the purposeful linking of human-designed spaces to nature or natural elements. It emphasises the connection between indoor built environments and nature. More specifically, as a 2022 paper by Gattupalli puts it, it uses nature to “alleviate stress, improve air quality and support cognitive function[ing].” In practice, biophilic design brings natural elements into built environments through indooroutdoor connections, natural ventilation and materials, natural light, views of outside natural landscapes, water features and interior designs that mimic shapes and forms found in nature. It captures both direct and indirect experiences of nature. Early evidence from a longitudinal study in Australia, implemented in 2014, in which office spaces were filled with plants, researchers Gray and Birrel noted, pointed towards “enhanced collaboration amongst staff, including across teams, improved morale, and mitigation against stress.” If work spaces like this meant that workers are willing to spend more productive time collaborating, it is likely to promote greater productivity, staff wellbeing and even staff retention over time. There is also a growing body of evidence linking biophilic design and the incorporation of natural elements to improved health outcomes, albeit indirectly at times. Walking through forest atmospheres (compared to urban areas) has been found to reduce salivary cortisol by 13.4-15.8%, pulse rates by 3.9-6% and lower systolic blood pressure of those walking through forests (compared to people walking through urban areas). Being able to view nature scenes from a hospital bed shortens hospital stays and supports other good physiological outcomes needed for healing and recovery. Many of the studies looking at the impacts of biophilic design use small samples, are of a qualitative nature and report subjective data. However, Covid-19 has forever changed our thinking on how health can and should be promoted in indoor spaces. And with climate change, there is already a focus on creating greener, more self-regulating built spaces in urban environments. As our attention shifts away from considering only basic resources for life to our lived experiences and quality of life, there will be a greater pursuit of understanding on how different spaces shape our lives. The body of evidence on what constitutes a well-designed city shape and how nature elements can improve our health is likely to grow, becoming larger and more quantitatively focused. Cities tend to develop based on historical patterns. However, as urbanisation continues, decisions need to be made on the placement of accommodation, transport hubs, spaces to relax and breathe (green lungs), shopping locations, and spaces for relaxations and social interaction too. There is now a growing body of evidence that how cities are designed matter for life and health outcomes. Ignoring this comes at society’s peril. SOURCES: Gattupalli, A. 2022. Healthy spaces: the rise of wellness design in 2022. Archdaily. Available at: https:// www.archdaily.com/994250/ healthy-spaces-the-rise-ofwellness-design-in-2022 (accessed 30 May 2023). Browning, WD.., Kallianpurkar, N., O. Ryan, C., and Labruto, L. The Economics of Biophilia. 2012. New York: Terrapin Bright Green, LLC, 2015. Print. Available at: https://www. terrapinbrightgreen.com/wpcontent/uploads/2012/06/ Economics-of-Biophilia_ Terrapin_2015p.pdf (accessed 30 May 2023). Gray T, Birrell C. Are biophilic-designed site office buildings linked to health benefits and high performing occupants? 2014. International Journal of Environment Research and Public Health. Nov 26;11(12):12204-22. doi: 10.3390/ijerph111212204. PMID: 25431874; PMCID: PMC4276610. Harari, Mariaflavia. 2020. “Cities in Bad Shape: Urban Geometry in India.” American Economic Review, 110 (8): 2377- 2421. Jo H, Song C, Miyazaki Y. Physiological Benefits of Viewing Nature: A Systematic Review of Indoor Experiments. Int J Environ Res Public Health. 2019 Nov 27;16(23):4739. doi: 10.3390/ijerph16234739. PMID: 31783531; PMCID: PMC6926748. World Health Organization. 2022. Urban design for health: inspiration for the use of urban design to promote physical activity and healthy diets in the WHO European Region. Copenhagen: WHO Regional Office for Europe. Licence: CC BY-NC-SA 3.0 IGO. Available at: https://apps.who.int/iris/ rest/bitstreams/1461692/ retrieve (accessed 30 May 2023) (accessed 30 May 2023). BY ANYA SMITH HASA PULSE #3 THE SUSTAINABILITY ISSUE 29

DIRECTORY CONTENTS 35 MEDICAL SCHEMES 39 ACCREDITED MANAGED CARE ORGANISATIONS 42 ACCREDITED SCHEME ADMINISTRATORS 44 PUBLIC AND PRIVATE HOSPITALS 44 Eastern Cape Public Hospitals 47 Eastern Cape Private Hospitals 48 KwaZulu-Natal Public Hospitals 51 KwaZulu-Natal Private Hospitals 54 Limpopo Public Hospitals 56 Limpopo Private Hospitals 56 Mpumalanga Public Hospitals 58 Mpumalanga Private Hospitals 59 North West Public Hospitals 60 North West Private Hospitals 61 Northern Cape Public Hospitals 62 Northern Cape Private Hospitals 63 Western Cape Public Hospitals 65 Western Cape Private Hospitals 67 Gauteng Public Hospitals 69 Gauteng Private Hospitals 73 Free State Public Hospitals 75 Free State Private Hospitals 30 HASA PULSE #3 THE SUSTAINABILITY ISSUE

HASA PULSE #3 THE SUSTAINABILITY ISSUE 31 MEDICAL SCHEMES AECI MEDICAL SOCIETY Post Box 1101 Woodmead 2191 ANGLO MEDICAL SCHEME Post Box 746 Rivonia 2001 BANKMED Private Bag X 2128 Rivonia 2001 BESTMED EMPLOYEES MEDICAL AID SOCIETY Post Box 2297 Pretoria 0081 BONITAS MEDICAL FUND Post Box 3496 Melrose 2000 BUILDING AND CONSTRUCTION INDUSTRY MEDICAL AID FUND Post Box 3201 Sunninghill 2128 CHARTERED ACCOUNTANTS (SA) MEDICAL AID FUND (CAMAF) Post Box 2964 Randburg 2194 ALLIANCE-MIDMED MEDICAL SCHEME Unit 8, Four Stones Office Park 21 Dolerite Crescent Middelburg 1050 ANGLO VAAL GROUP MEDICAL SCHEME Post Box 652509 Benmore 2010 BARLOWORLD MEDICAL SCHEME Post Box 1101 Florida Glen 1709 BMW EMPLOYEES MEDICAL AID SOCIETY Post Box 84262 Sandton 0196 BP MEDICAL AID SOCIETY Post Box 6006 Roggebaai 8012 CAPE MEDICAL PLAN Post Box 6255 Parow 7500 COMPCARE WELLNESS MEDICAL SCHEME Post Box 1411 Rivonia 2196 DIRECTORY

32 HASA PULSE #3 THE SUSTAINABILITY ISSUE DE BEERS BENEFIT SOCIETY Post Box 1922 Kimberley 8301 ENGEN MEDICAL BENEFIT FUND Post Box 652509 Benmore 2010 FEDHEALTH MEDICAL SCHEME Private Bag X 3045 Randburg 2021 FOODMED MEDICAL SCHEME Post Box 1067 Parow 7500 GENESIS MEDICAL SCHEME Post Box 144 Observatory 7925 GOLDEN ARROWS EMPLOYEES MEDICAL BENEFIT FUND Post Box 15729 Vlaeberg 7490 GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS) Private Bag X1 0028 Hatfield Pretoria 0181 HORIZON MEDICAL SCHEME Post Box 1101 Florida Glen 1709 HOSMED MEDICAL AID SCHEME Post Box 16148 Doornfontein 0178 IMPERIAL AND MOTUS MEDICAL AID Post Box 2140 Houghton 2194 KEYHEALTH Post Box 14145 Lyttleton 0157 LIBCARE MEDICAL SCHEME Post Box 10499 Roodepoort 2001 LONMIN MEDICAL SCHEME Private Bag X508 Marikana 0284 MALCOR MEDICAL SCHEME Post Box 786722 Sandton 2146 DISCOVERY HEALTH MEDICAL SCHEME Post Box 786722 Sandton 2146 FISHING INDUSTRY MEDICAL SCHEME (FISH-MED) Post Box 2416 Bellville 8000 GLENCORE MEDICAL SCHEME Post Box 652509 Benmore 2010 HEALTH SQUARED MEDICAL SCHEME Post Box 1075 Woodmead 2191 IMPALA MEDICAL PLAN Private Bag X82324 Rustenburg 0300 LA HEALTH MEDICAL SCHEME Private Bag X19 Milnerton Cape Town 7530 MAKOTI MEDICAL SCHEME Private Bag X47 Rivonia 2191

HASA PULSE #3 THE SUSTAINABILITY ISSUE 33 MASSMART HEALTH PLAN Post Box 1411 Rivonia 2128 MEDIHELP Post Box 26004 Arcadia Pretoria 0083 MEDIMED MEDICAL SCHEME Post Box 1672 Gqeberha 6001 MEDSHIELD MEDICAL SCHEME Post Box 4346 Randburg 2194 MOMENTUM MEDICAL SCHEME Post Box 2338 Cornubia 4339 MULTICHOICE MEDICAL AID SCHEME Post Box 1502 Sandton 2146 NEDGROUP MEDICAL AID SCHEME Post Box 1101 Cape Town 8001 OLD MUTUAL STAFF MEDICAL AID FUND Post Box 66 7450 PARMED MEDICAL AID SCHEME Post Box 836 Florida Hills 1725 PICK N PAY MEDICAL SCHEME Post Box 15774 Vlaeberg 8000 PLATINUM HEALTH Private Bag X2081 0300 QUANTUM MEDICAL AID SOCIETY Post Box 652509 Benmore 2010 RAND WATER MEDICAL SCHEME Post Box 1127 Johannesburg 2058 RETAIL MEDICAL SCHEME Post Box 215 Brackenfell 7561 MBMED MEDICAL AID FUND Post Box 1101 Florida Glen 1709 MEDIPOS MEDICAL SCHEME Post Box 2087 Pretoria 0002 MOTO HEALTH CARE Post Box 3882 Randburg 2194 NETCARE MEDICAL SCHEME Post Box 652509 Benmore 2010 PG GROUP MEDICAL SCHEME Post Box 2329 Bedfordview 2007 PROFMED Post Box 1004 Parktown 2193 REMEDI MEDICAL AID SCHEME Post Box 652509 Benmore 2010

34 HASA PULSE #3 THE SUSTAINABILITY ISSUE RHODES UNIVERSITY MEDICAL SCHEME Post Box 1672 Gqeberha 6001 SAMWU MED Post Box 134 Athlone 7760 SASOLMED Post Box 5486 Sandton 2000 SISONKE HEALTH MEDICAL SCHEME Post Box 1672 Gqeberha 6000 SIZWE MEDICAL FUND Post Box 62345 Rosebank 2107 SOUTH AFRICAN POLICE SERVICE MEDICAL SCHEME (POLMED) Post Box 14812 Hatfield 0028 SUREMED HEALTH Post Box 1672 Gqeberha 6000 THEBEMED Post Box 4709 Sandton 2000 TIGER BRANDS MEDICAL SCHEME Private Bag X131 Rivonia 2128 TSOGO SUN GROUP MEDICAL SCHEME Post Box 652509 Benmore 2010 UMVUZO HEALTH MEDICAL SCHEME Post Box 1463 Faerie Glen 0043 WITBANK COALFIELDS MEDICAL AID SCHEME Post Box 26 Witbank 1035 WOOLTRU HEALTHCARE FUND Post Box 15403 Vlaeberg 8018 SABC MEDICAL AID SCHEME Post Box 1101 Florida Glen 1708 SEDMED Post Box 468 Bloemfontein 9300 SOUTH AFRICAN BREWERIES MEDICAL SCHEME Post Box 652509 Benmore 2010 TFG MEDICAL AID SCHEME Post Box 652509 Benmore 2010 TRANSMED MEDICAL FUND Post Box 32043 Randpark 2017 UNIVERSITY OF KWAZULU-NATAL MEDICAL SCHEME Post Box 786722 Benmore 2010

HASA PULSE #3 THE SUSTAINABILITY ISSUE 35 ACCREDITED MANAGED CARE ORGANISATIONS 3SIXTY HEALTH Post Box 10436 Johannesburg 2000 AID FOR AIDS MANAGEMENT Post Box 1101 Florida Glen 1708 BESTMED MEDICAL SCHEME Post Box 2297 Pretoria 0001 CAREWORKS Post Box 23460 Claremont 7735 CHARTERED ACCOUNTANTS (SA) MEDICAL AID FUND (CAMAF) Post Box 2964 Randburg 2125 DENTAL RISK COMPANY Postnet Suite 341 Private Bag X2 Raslouw 0190 ENABLEMED Postnet Suite 203 Private Bag X8 Elarduspark 0047 AGILITY HEALTH Private Bag X7687 Centurion 0046 ALIGND 47 Main Road Rondebosch Cape Town 7700 CAPE MEDICAL PLAN Post Box 966 Parow 7499 CENTRE FOR DIABETES AND ENDOCRINOLOGY Post Box 2900 Saxonwold 2132 DENTAL INFORMATION SYSTEMS Private Bag X1 Century City 7446 DISCOVERY HEALTH Post Box 786722 Sandton 2146 HALOCARE Post Box 8796 Centurion 0046 DIRECTORY

36 HASA PULSE #3 THE SUSTAINABILITY ISSUE HEALTH CALIBRATE 147 Garsfontein Road Pretoria 0081 ICAS MANAGED CARE Post Box 2280 Parklands 2121 ICON MANAGED CARE Post Box 15531 Panorama 7506 INTERGRATED CLINICAL MANAGEMENT SERVICES T/A KHULA CLINICAL CARE SERVICES Post Box 784541 Sandton 2146 KAELO PRIME CURE Private Bag X2108 Houghton 2041 KNOWLEDGE OBJECTS SOLUTIONS Post Box 7687 Centurion 0046 LIBERTY HEALTH ADMINISTRATION Post Box 786722 Sandton 2146 MEDIHELP MEDICAL SCHEME Post Box 26004 Pretoria 0083 MEDISCOR PBM Post Box 8796 Centurion 0046 METROPOLITAN HEALTH CORPORATE Post Box 2212 Belville 7535 METROPOLITAN HEALTH RISK MANAGEMENT Post Box 2212 Bellville 7535 MOMENTUM HEALTH SOLUTIONS Post Box 2338 Durban 4000 MOMENTUM THEBE YA BOPHELO Post Box 1672 Gqeberha 6001 OPTIMAL MANAGED CARE 6th Floor Oasim North North Havelock Street Central Gqeberha 6001 HEALTH WINDOW 41 De Havilland Crescent The Woods Persequor Technopark Pretoria 0200 IMPROVED CLINICAL PATHWAY SERVICES The Workshop 70 - 7th Avenue Parktown North 2193 KNOWLEDGE OBJECTS HEALTHCARE Post Box 7687 Centurion 0046 LIFESENSE DISEASE MANAGEMENT Post Box 52493 Saxonwold 2132 MEDSCHEME HOLDINGS Post Box 1101 Florida Glen 1708 MOMENTUM DENTAL RISK MANAGEMENT Post Box 7400 Centurion 0046 NATIONAL HEALTH GROUP Post Box 44331 Claremont 7736

HASA PULSE #3 THE SUSTAINABILITY ISSUE 37 PERFORMANCE HEALTH Post Box 521058 Saxonwold 2132 PROFESSIONAL PROVIDENT SOCIETY HEALTHCARE ADMINISTRATORS Private Bag X1031 Lyttelton 0140 RX HEALTH Post Box 90346 Garsfontein Pretoria 0042 SOUTH AFRICAN ONCOLOGY CONSORTIUM Post Box 1053 Centurion 0046 THEBE HEALTH RISK MANAGEMENT Post Box 15738 Doorfontein 2028 PRIVATE HEALTH ADMINISTRATORS Post Box 343 Westville 3630 PROFESSIONAL PROVIDER ORGANISATION SERVICES Albury Office Park 3 Magaliezicht Ave Dunkeld West Johannesburg 2196 SCRIPTPHARM RISK MANAGEMENT Post Box 1101 Florida Glen 1708 SUPPLEMENTARY HEALTH SERVICES Post Box 3095 Paarl 7620 UNIVERSAL CARE Post Box 1141 Rivonia 2128

38 HASA PULSE #3 THE SUSTAINABILITY ISSUE ACCREDITED SCHEME ADMINISTRATORS DIRECTORY 3SIXTY HEALTH Post Box 10436 Johannesburg 2000 BESTMED MEDICAL SCHEME Post Box 2297 Pretoria 0001 DE BEERS BENEFIT SOCIETY Post Box 1922 Kimberley 8300 GENESIS MEDICAL SCHEME Post Box 144 Observatory 7925 MEDSCHEME HOLDINGS Post Box 1101 Florida Glen 1708 AFROCENTRIC INTEGRATED HEALTH ADMINISTRATORS Private Bag X5 Strubens Valley 1735 AGILITY HEALTH Post Box 7687 Centurion 0046 CAPE MEDICAL PLAN SCHEME Post Box 966 Parow 7499 CHARTERED ACCOUNTANTS (SA) MEDICAL AID FUND (CAMAF) Post Box 2964 Randburg 2125 DISCOVERY HEALTH Post Box 786722 Sandton 2146 FOODMED MEDICAL SCHEME Post Box 1067 Parow 7499 LIBERTY HEALTH ADMINISTRATION Post Box 786722 Sandton 2146 MEDIHELP MEDICAL SCHEME Post Box 26004 Arcadia 0007 MEDSHIELD MEDICAL SCHEME Post Box 4346 Randburg 2125

HASA PULSE #3 THE SUSTAINABILITY ISSUE 39 RAND WATER MEDICAL SCHEME Post Box 1127 Johannesburg 2000 SAMWUMED Post Box 134 Athlone 7760 SEDMED Post Box 468 Bloemfontein 9300 UMVUZO HEALTH MEDICAL SCHEME Post Box 1463 Faerie Glen 0043 UNIVERSAL HEALTHCARE ADMINISTRATORS Post Box 1411 Rivonia 2128 MOMENTUM HEALTH SOLUTIONS Post Box 2338 Durban 4000 WITBANK COALFIELDS MEDICAL AID SCHEME Post Box 26 Witbank 1035 PLATINUM HEALTH MEDICAL SCHEME Private Bag X82081 Rustenburg 0291 METROPOLITAN HEALTH CORPORATE Post Box 2212 Belville 7535 MOMENTUM THEBE YA BOPHELO Post Box 1672 Gqeberha 6000 NATIONAL HEALTH GROUP Post Box 44331 Claremont 7736 PRIVATE HEALTH ADMINISTRATORS Post Box 343 Westville 3630 PROFESSIONAL PROVIDENT SOCIETY HEALTHCARE ADMINISTRATORS Private Bag X1031 Lyttelton 0140

40 HASA PULSE #3 THE SUSTAINABILITY ISSUE DIRECTORY PUBLIC AND PRIVATE HOSPITALS GREENVILLE DISTRICT HOSPITAL Alfred Nzo District Municipality Bizana Private Bag X559 Bizana 4800 EASTERN CAPE PUBLIC HOSPITALS arranged by district municipality BEDFORD DISTRICT HOSPITAL Amathole District Municipality Adelaide Post Box 111 Bedford 5780 MOUNT AYLIFF DISTRICT HOSPITAL Alfred Nzo District Municipality Mount Ayliff Private Bag X504 Mount Ayliff 4735 CATHCART DISTRICT HOSPITAL Amathole District Municipality Cathcart Private Bag X10 Cathcart 5310 ST. PATRICK’S DISTRICT HOSPITAL Alfred Nzo District Municipality Bizana Private Bag X531 Bizana 4800 MADWALENI DISTRICT HOSPITAL Amathole District Municipality Elliotdale Private Bag X519 Elliotdale 5070 MADIZIKANE KA ZULU MEMORIAL DISTRICT HOSPITAL Alfred Nzo District Municipality Mount Frère Private Bag 9002 Mount Frere 5090 BUTTERWORTH DISTRICT HOSPITAL Amathole District Municipality Butterworth Private Bag X3051 Butterworth 4960 SIPETU DISTRICT HOSPITAL Alfred Nzo District Municipality Ntabankulu Private Bag X9005 Mount Frere 5090 KOMGA HOSPITAL (Provincial Aided) Amathole District Municipality Komga Post Box 33 Komga 4950 TAYLER BEQUEST DISTRICT HOSPITAL Alfred Nzo District Municipality Matatiele Private Bag 836 Matatiele 4730

HASA PULSE #3 THE SUSTAINABILITY ISSUE 41 S.S. GIDA DISTRICT HOSPITAL Amathole District Municipality King Williams Town Private Bag X012 Keiskammahoek 5670 B J VORSTER DISTRICT HOSPITAL Cacadu District Municipality Kareedouw Private Bag 41 Kareedouw 6400 ALL SAINTS DISTRICT HOSPITAL Chris Hani District Municipality Engcobo Private Bag X215 Engcobo 5050 THAFALOFEFE DISTRICT HOSPITAL Amathole District Municipality Kentani Private Bag X4960 Butterworth 4960 S.A.W.A.S MEMORIAL DISTRICT HOSPITAL (Provincial Aided) Cacadu District Municipality Jansenville Private Bag 3 Jansenville 6265 CONFIMVABA DISTRICT HOSPITAL Chis Hani District Municipality Cofimvaba Private Bag X1207 Confimvaba 5380 BHISHO DISTRICT HOSPITAL Buffalo City Metropolitan Municipality King Williams Town Private Bag X0043 Bisho 5605 SUNDAY’S VALLEY (Provincial Aided) Cacadu District Municipality Kirkwood Post Box 68 Kirkwood 6120 ELLIOT DISTRICT HOSPITAL Chris Hani District Municipality Elliot Post Box 523 Elliot 5460 STUTTERHEIM DISTRICT HOSPITAL (Provincial Aided) Amathole District Municipality Stutterheim Post Box 40 Stutterheim 4930 KOUGA PARTNERSHIP/ HUMANSDORP HOSPITAL (Provincial Aided) Cacadu District Municipality Humansdorp Private Bag X536 Humansdorp 6300 CALA DISTRICT HOSPITAL Chris Hani District Municipality Cala Private Bag X516 Cala 5455 VICTORIA DISTRICT HOSPITAL, LOVEDALE Amathole District Municipality Fort Beaufort/Alice Private Bag X1300 Alice 5700 SOMERSET EAST HOSPITAL Cacadu District Municipality Somerset East Private Bag X03 Somerset East 5850 DORDRECHT DISTRICT HOSPITAL (Provincial Aided) Chris Hani District Municipality Dordrecht Post Box 80 Dordrecht 5435 FRERE PROVINCIAL HOSPITAL Buffalo City Metropolitan Municipality East London Private Bag X9047 East London 5200 NOMPUMELELO DISTRICT HOSPITAL Amathole District Municipality Peddie Private Bag X13 Peddie 5640 WILLOWMORE HOSPITAL (Provincial Aided) Cacadu District Municipality Willowmore Private Bag X239 Willowmore 6680

42 HASA PULSE #3 THE SUSTAINABILITY ISSUE BURGERSDORP DISTRICT HOSPITAL Joe Gqabi District Municipality Burgersdorp Private Bag X6 Burgersdorp 9744 GLEN GREY HOSPITAL Chris Hani District Municipality Lady Frere Private Bag X1142 Lady Frere 5410 LIVINGSTONE PROVINCIAL HOSPITAL (TERTIARY) Nelson Mandela Bay Metropolitan Municipality Gqeberha Stanford Road Korsten Gqeberha 6000 MACLEAR HOSPITAL (Provincial Aided) Joe Gqabi District Municipality Maclear Post Box 93 Maclear 5480 INDWE HOSPITAL (Provincial Aided) Chris Hani District Municipality Indwe Private Bag 1 Indwe 5445 UITENHAGE DISTRICT HOSPITAL Nelson Mandela Bay Metropolitan Municipality Uitenhage Private. Bag X36 Uitenhage 6230 DORA NGINZA PROVINCIAL HOSPITAL (TERTIARY) Nelson Mandela Bay Metropolitan Municipality Bethelsdorp Private Bag X11951 Gqeberha 6000 MOLTENO DISTRICT HOSPITAL (Provincial Aided) Chris Hani District Municipality Molteno Post Box 132 Molteno 5500 CANZIBE DISTRICT HOSPITAL O.R.Tambo District Municipality Umtata Private Bag 104 Ngqeleni 5140 JAMESTOWN HOSPITAL (Provincial Aided) Joe Gqabi District Municipality Aliwal North Private Bag X03 Jamestown 9742 HEWU DISTRICT HOSPITAL (PPE/Life Esidimeni) Chris Hani District Municipality Whittlesea/Sada Post Box 1409 Queenstown 5320 PORT ELIZABETH PROVINCIAL HOSPITAL (TERTIARY) Nelson Mandela Bay Metropolitan Municipality Gqeberha Buckingham Road Gqeberha 6000 TAYLER BEQUEST DISTRICT HOSPITAL ( MT FLETCHER ELUNDINI) Joe Gqabi District Municipality Mount Fletcher Private Bag X1129 Mount Fletcher 4770 MARTJE VENTER DISTRICT HOSPITAL (Provincial Aided) Chris Hani District Municipality Tarkastad Post Box 45 Tarkastad 5370 BAMBISANA DISTRICT HOSPITAL O.R.Tambo District Municipality Lusikisiki Private Bag X1046 Lusikisiki 4820 EMPILISWENI DISTRICT HOSPITAL Nelson Mandela Bay Metropolitan Municipality Motherwell Private Bag X5016 Sterkspruit 9762 STERKSTROOM HOSPITAL (Provincial Aided) Chris Hani District Municipality Sterkstroom Post Box 168 Sterkstroom 5425 FRONTIER REGIONAL HOSPITAL Chris Hani District Municipality Queenstown Private Bag X7063 Queenstown 5320

HASA PULSE #3 THE SUSTAINABILITY ISSUE 43 ISILIMELA DISTRICT HOSPITAL O.R.Tambo District Municipality Port St .Johns Private Bag X1021 Port St. Johns 4930 ST. ELIZABETH’S MISSION REGIONAL HOSPITAL O.R.Tambo District Municipality Lusikisiki Private Bag X1007 Lusikisiki 4820 MJANYANA DISTRICT HOSPITAL O.R.Tambo District Municipality Umtata Post Box 1204 Idutywa 5050 ZITHULELE DISTRICT HOSPITAL O.R.Tambo District Municipality Umtata Private Bag X504 Mqanduli 5080 NESSIE KNIGHT DISTRICT HOSPITAL O.R.Tambo District Municipality Qumbu Private Bag X420 Qumbu 5180 HOLY CROSS DISTRICT HOSPITAL O.R.Tambo District Municipality Flagstaff Private Bag X1001 Flagstaff 4811 ST. LUCY’S DISTRICT HOSPITAL O.R.Tambo District Municipality Tsolo Post Box St.Cuthberts Tsolo 5170 MTHATHA GENERAL PROVINCIAL HOSPITAL (TERTIARY) O.R.Tambo District Municipality Umtata Private Bag X5014 Mthatha 5100 ST. BARNABAS DISTRICT HOSPITAL O.R.Tambo District Municipality Umtata Post Box 15 Libode 5114 DR MALIZO MPHELE DISTRICT HOSPITAL O.R.Tambo District Municipality Tsolo Private Bag X1004 Tsolo 5170 MATATIELE PRIVATE HOSPITAL Independent Alfred Nzo District Municipality Matatiele Post Box 1392 Matatiele 4730 EASTERN CAPE PRIVATE HOSPITALS arranged by district municipality BEACON BAY HOSPITAL Life Healthcare Buffalo City Metropolitan Municipality East London Post Box 1585 East London 5200 ST. DOMINIC’S HOSPITAL Life Healthcare Buffalo City Metropolitan Municipality East London Post Box 11187 Southernwood 5213 EAST LONDON PRIVATE HOSPITAL Life Healthcare Buffalo City Metropolitan Municipality East London Post Box 1585 East London 5200 SETTLERS DISTRICT HOSPITAL (PRIVATE/PUBLIC) Netcare Cacadu District Municipality Makhanda Post Bag X1007 Makhanda 6140

44 HASA PULSE #3 THE SUSTAINABILITY ISSUE QUEENSTOWN PRIVATE HOSPITAL Life Healthcare Chris Hani District Municipality Queenstown Post Bag X7183 Queenstown 5320 ST. MARY’S PRIVATE HOSPITAL Life Healthcare O.R.Tambo District Municipality Umtata Post Box 52780 Mthatha 5100 GREENACRES HOSPITAL Netcare Nelson Mandela Bay Metropolitan Municipality Gqeberha Post Box 27488 Greenacres 6057 ISIVANA PRIVATE HOSPITAL Life Healthcare Cacadu District Municipality Humansdorp Post Box 12051 Centrahill 6006 ST. GEORGE’S HOSPITAL Life Healthcare Nelson Mandela Bay Metropolitan Municipality Gqeberha Post Box 12051 Centrahill 6006 CUYLER CLINIC Netcare Nelson Mandela Bay Metropolitan Municipality Uitenhage Post Box 1082 Uitenhage 6230 MERCANTILE PRIVATE HOSPITAL Life Healthcare Nelson Mandela Bay Metropolitan Municipality Gqeberha Post Box 4031 Korsten 6014 PORT ALFRED DISTRICT HOSPITAL (PRIVATE/PUBLIC) Netcare Cacadu District Municipality Port Alfred Post Box 227 Port Alfred 6170 MTHATHA PRIVATE HOSPITAL Independent O.R.Tambo District Municipality Umtata Post Box 522 Mthatha 5099 KWAZULU-NATAL PUBLIC HOSPITALS arranged by district municipality NEWCASTLE REGIONAL HOSPITAL Amajuba District Municipality Newcastle Private Bag X6653 Newcastle 2940 DR PIXLEY ISAKA SEME MEMORIAL HOSPITAL eThekwini Metropolitan Municipality KwaMashu 310 Bhejane Street KwaMashu 4360 MADADENI REGIONAL HOSPITAL Amajuba District Municipality Newcastle Private Bag X6642 Newcastle 2940 NIEMEYER MEMORIAL DISTRICT HOSPITAL Amajuba District Municipality Newcastle Private Bag X1004 Utrecht 2980 HILLCREST PUBLIC HOSPITAL eThekwini Metropolitan Municipality Hillcrest Private Bag X7001 Hillcrest 3650

HASA PULSE #3 THE SUSTAINABILITY ISSUE 45 INKOSI ALBERT LUTHULI CENTRAL (TERTIARY) eThekwini Metropolitan Municipality Durban Private Bag X03 Mayville 4058 KING EDWARD VIII REGIONAL HOSPITAL (TERTIARY) eThekwini Metropolitan Municipality Durban Private Bag X02 Congella 4013 MAHATMA GANDHI MEMORIAL HOSPITAL (REGIONAL) eThekwini Metropolitan Municipality Phoenix Private Bag X13 Mount Edgecombe 4300 ADDINGTON REGIONAL HOSPITAL eThekwini Metropolitan Municipality Durban Post Box 977 Durban 4000 KING GEORGE V REGIONAL HOSPITAL eThekwini Metropolitan Municipality Durban Stanley Copley Drive Sydenham 4091 PRINCE MSHIYENI MEMORIAL HOSPITAL (REGIONAL) eThekwini Metropolitan Municipality Umlazi Private Bag X07 Mobeni 4000 R.K. KHAN REGIONAL HOSPITAL (DISTRICT) eThekwini Metropolitan Municipality Chatsworth Private Bag X004 Chatsworth 4030 WENTWORTH HOSPITAL eThekwini Metropolitan Municipality Durban 1 Boston Road Bluff 4026 STANGER REGIONAL HOSPITAL (PROVINCIAL) iLembe District Municipality Ballito Private Bag X10609 Stanger 4450 ST. MARY’S HOSPITAL MARIANHILL (Provincial Aided) eThekwini Metropolitan Municipality Pinetown 170 Abbot Francis Road Mariannhill Pinetown, 3610 MONTEBELLO DISTRICT HOSPITAL iLembe District Municipality Wartburg Fawn Leas Road Montebello 90640 UMPHUMULO DISTRICT HOSPITAL iLembe District Municipality Mapumulo Private Bag X9219 Maphumulo 4470 CHRIST THE KING DISTRICT HOSPITAL Sisonke District Municipality Ixopo Private Bag X542 Ixopo 3276 RIETVLEI DISTRICT HOSPITAL Sisonke District Municipality Harding Post Box 501 Port Shepstone 4240 G.J. CROOKES DISTRICT HOSPITAL Ugu District Municipality Scottburgh Private Bag X5501 Scottsburgh 4180 EAST GRIQUALAND AND USHER MEMORIAL DISTRICT HOSPITAL Sisonke District Municipality Kokstad Private Bag X506 Kokstad 3699 ST. APOLLINARIS DISTRICT HOSPITAL Sisonke District Municipality Bulwer Private Bag X206 Creighton 3263 MURCHISON DISTRICT HOSPITAL Ugu District Municipality Port Shepstone Private Bag X701 Port Shepstone 4240

46 HASA PULSE #3 THE SUSTAINABILITY ISSUE PORT SHEPSTONE REGIONAL HOSPITAL Ugu District Municipality Port Shepstone Private Bag X5706 Port Shepstone 4240 APPELBOSCH DISTRICT HOSPITAL uMgungundlovu District Municipality Wartburg Private Bag X215 Ozwathini 3242 GREY’S TERTIARY HOSPITAL uMgungundlovu District Municipality Pietermaritzburg Metro Private Bag X900 Pietermaritzburg 3200 ST. ANDREWS DISTRICT HOSPITAL Ugu District Municipality Harding Private Bag X1010 Harding 4680 EDENDALE REGIONAL HOSPITAL uMgungundlovu District Municipality Pietermaritzburg Metro Private Bag X509 Plessislaer 3216 BETHESDA DISTRICT HOSPITAL Umkhanyakude District Municipality Mkuze Private Bag X605 Ubombo 3970 MOSVOLD DISTRICT HOSPITAL Umkhanyakude District Municipality Ingwavuma Private Bag X2211 Ingwavuma 3968 EMMAUS DISTRICT HOSPITAL Uthukela District Municipality Bergville Private Bag X16 Winterton 3340 EKHOMBE DISTRICT HOSPITAL Uthungulu District Municipality Nkandla Private Bag X20 Kranskop 3268 NORTHDALE DISTRICT HOSPITAL uMgungundlovu District Municipality Pietermaritzburg Metro Private Bag X9006 Pietermaritzburg 3201 CATHERINE BOOTH DISTRICT HOSPITAL Uthungulu District Municipality Empangeni Private Bag X105 Amatikulu 3801 ESTCOURT PROVINCIAL HOSPITAL Uthukela District Municipality Estcourt Private Bag X7058 Estcourt 3310 ESHOWE DISTRICT HOSPITAL Uthungulu District Municipality Empangeni Private Bag 504 Eshowe 3815 MBONGOLWANE DISTRICT HOSPITAL Uthungulu District Municipality Manidin Private Bag X126 Kwa-Pett 3820 NKANDLA PROVINCIAL HOSPITAL Uthungulu District Municipality Nkandla Private Bag X102 Nkandla 3855 LADYSMITH REGIONAL HOSPITAL (PROVINCIAL) Uthukela District Municipality Ladysmith Private Bag X9928 Ladysmith 3370 NGWELEZANE REGIONAL HOSPITAL (TERTIARY) Uthungulu District Municipality Empangeni Private Bag X20021 Empangeni 3880 QUEEN NANDI REGIONAL HOSPITAL (EMPANGENI HOSPITAL) Uthungulu District Municipality Empangeni Private Bag X20005 Empangeni 3880

HASA PULSE #3 THE SUSTAINABILITY ISSUE 47 ST MARY’S KWAMAGWAZA DISTRICT HOSPITAL Uthungulu District Municipality Empangeni Private Bag X808 Melmoth 3835 CHURCH OF SCOTLAND DISTRICT HOSPITAL Umzinyathi District Municipality Tugela Ferry Private Bag X502 Tugela Ferry 3010 GREYTOWN HOSPITAL Umzinyathi District Municipality Greyton Private Bag X5562 Greytown 3250 CHARLES JOHNSON MEMORIAL DISTRICT HOSPITAL Umzinyathi District Municipality Nqutu Private Bag X5503 Nqutu 3135 DUNDEE DISTRICT HOSPITAL Umzinyathi District Municipality Dundee Private Bag X2011 Dundee 3000 UNTUNJAMBILI DISTRICT HOSPITAL Umzinyathi District Municipality Kranskop Private Bag X216 Kranskop 3268 BENEDICTINE DISTRICT HOSPITAL Zululand District Municipality Nongoma Private Bag X5007 Nongoma 3950 ITSHELEJUBA DISTRICT HOSPITAL Zululand District Municipality Pongola Private Bag X0047 Pongola 3170 VRYHEID DISTRICT HOSPITAL Zululand District Municipality Vryheid Private Bag X9371 Vryheid 3100 CEZA DISTRICT HOSPITAL Zululand District Municipality Nongoma Private Bag X200 Ceza 3866 NKONJENI DISTRICT HOSPITAL Zululand District Municipality Empangeni Private Bag X509 Mahlabathini 3865 NEWCASTLE PRIVATE HOSPITAL Mediclinic Amajuba District Municipality Newcastle Private Bag X6626 Newcastle 2940 CITY HOSPITAL Joint Medical Holdings eThekwini Metropolitan Municipality Durban Post Box 48143 Qualbert 4078 ASCOT PARK MEDICAL HOSPITAL Joint Medical Holdings eThekwini Metropolitan Municipality Durban Post Box 48143 Qualbert 4078 AHMED AL-KADI PRIVATE HOSPITAL Independent eThekwini Metropolitan Municipality Durban Post Box 37472 Overport 4067 CHATSMED GARDEN HOSPITAL Life Healthcare eThekwini Metropolitan Municipality Chatsworth Post Box 56602 Chatsworth 4030 KWAZULU-NATAL PRIVATE HOSPITALS arranged by district municipality

48 HASA PULSE #3 THE SUSTAINABILITY ISSUE ETHEKWINI HOSPITAL AND HEART CENTRE Lenmed eThekwini Metropolitan Municipality Durban Post Box 40586 Redhill 4071 ISIPINGO HOSPITAL Joint Medical Holdings eThekwini Metropolitan Municipality Amanzimtoti Post Box 23035 Isipingo Rail 4110 HILLCREST PRIVATE HOSPITAL Busamed eThekwini Metropolitan Municipality Hillcrest Private Bag X7040 Hillcrest 3650 DURDOC HOSPITAL Joint Medical Holdings eThekwini Metropolitan Municipality Durban Post Box 520 Durban 4000 GATEWAY PRIVATE HOSPITAL Busamed eThekwini Metropolitan Municipality Umhlanga Private Bag X36 Umhlanga Rocks 4320 KINGSWAY HOSPITAL Netcare eThekwini Metropolitan Municipality Amanzimtoti Post Box 94 Umbogintwini 4120 MOUNT EDGECOMBE HOSPITAL Life Healthcare eThekwini Metropolitan Municipality Phoenix Post Box 204 Mount Edgecombe 4300 SHIFA HOSPITAL Lenmed eThekwini Metropolitan Municipality Durban Post Box 15234 Dormerton 4015 THE CROMPTON HOSPITAL Life Healthcare eThekwini Metropolitan Municipality Pinetown Post Box 1466 New Germany 3620 PARKLANDS HOSPITAL Netcare eThekwini Metropolitan Municipality Durban Post Box 37014 Overport 4067 ST. AUGUSTINE’S HOSPITAL Netcare eThekwini Metropolitan Municipality Durban Post Box 30105 Mayville 4058 MAXWELL CLINIC Joint Medical Holdings eThekwini Metropolitan Municipality Durban Post Box 48143 Qualbert 4078 VICTORIA HOSPITAL Mediclinic eThekwini Metropolitan Municipality Tongaat Post Box 1000 Tongaat 4400 ALBERLITO HOSPITAL Netcare iLembe District Municipality Ballito Private Bag X09 Umhlanga 4320 KOKSTAD HOSPITAL Netcare Sisonke District Municipality Kokstad Post Box 112 Kokstad 4700 WESTVILLE HOSPITAL Life Healthcare eThekwini Metropolitan Municipality Westville Post Box 467 Westville 3630 KWADUKUZA PRIVATE HOSPITAL Independent iLembe District Municipality Ballito Post Box 1255 Stanger 4450 UMHLANGA HOSPITAL Netcare eThekwini Metropolitan Municipality Umhlanga Private Bag X09 Umhlanga Rocks 4320

HASA PULSE #3 THE SUSTAINABILITY ISSUE 49 MARGATE HOSPITAL Netcare Ugu District Municipality Margate Post Box 1922 Margate 4275 DAYMED PRIVATE HOSPITAL Independent uMgungundlovu District Municipality Pietermaritzburg Metro Post Box 842 Laxmi 3207 HOWICK PRIVATE HOSPITAL Mediclinic uMgungundlovu District Municipality Howick Post Box 41 Howick 3290 EDEN GARDENS PRIVATE HOSPITAL Independent uMgungundlovu District Municipality Pietermaritzburg Metro Post Box 890 Pietermaritzburg 3200 HILTON PRIVATE HOSPITAL Life Healthcare uMgungundlovu District Municipality Hilton Post Box 1311 Hilton 3245 HIBISCUS HOSPITAL Independent Ugu District Municipality Port Shepstone Post Box 1703 Port Shepstone 4240 PIETERMARITZBURG HOSPITAL Mediclinic uMgungundlovu District Municipality Pietermaritzburg Metro Post Box 3342 Pietermaritzburg 3200 LA VERNA HOSPITAL Lenmed Uthukela District Municipality Ladysmith Post Box 1210 Ladysmith 3370 RICHARDS BAY HOSPITAL Melomed Uthungulu District Municipality Richards Bay PostNet Suite 180 Private Bag X1040 Richards Bay 3900 ST. ANNE’S HOSPITAL Netcare uMgungundlovu District Municipality Pietermaritzburg Metro Post Box 595 Pietermaritzburg 3200 EMPANGENI GARDEN CLINIC Life Healthcare Uthungulu District Municipality Empangeni Post Box 2136 Empangeni 3880 MIDLANDS MEDICAL CENTRE PRIVATE HOSPITAL Independent uMgungundlovu District Municipality Pietermaritzburg Metro Post Box 8174 Cumberwood, 3235 ABAQULUSI PRIVATE HOSPITAL Independent Zululand District Municipality Vryheid Post Box 1970 Vryheid 3100 NONGOMA PRIVATE HOSPITAL Independent Zululand District Municipality Nongoma Post Box 181 Nongoma 3950 THE BAY HOSPITAL Netcare Uthungulu District Municipality Richards Bay Private Bag X1027 Richards Bay 3900

50 HASA PULSE #3 THE SUSTAINABILITY ISSUE MANKWENG TERTIARY HOSPITAL Capricorn District Municipality Tzaneen Private Bag X1117 Sovenga 0727 LIMPOPO PUBLIC HOSPITALS arranged by district municipality SESHEGO DISTRICT HOSPITAL Capricorn District Municipality Polokwane Private Bag 4016 Seshego 0742 HELENA FRANZ DISTRICT HOSPITAL Capricorn District Municipality Bochum Private Bag X5002 Bochum 0790 ZEBEDIELA DISTRICT HOSPITAL Capricorn District Municipality Zebediela/Mgoto Private Bag X342 Gompies 0631 PIETERSBURG TERTIARY HOSPITAL (POLOKWANE) Capricorn District Municipality Polokwane Private Bag X9315 Polokwane 0700 BOTLOKWA HEALTH DISTRICT CENTRE Capricorn District Municipality Mphakane Private Bag X544 Dwarsrivier 0812 WF KNOBEL DISTRICT HOSPITAL Capricorn District Municipality Polokwane Private Bag X65 Lonsdale 0710 LEBOWAKGOMO DISTRICT HOSPITAL Capricorn District Municipality Lebowakgomo Private Bag X14 Chuenespoort 0745 GROBLERSDAL DISTRICT HOSPITAL Greater Sekhukhune District Municipality Middelburg Private Bag X8604 Groblersdal 0470 JANE FURSE DISTRICT HOSPITAL Greater Sekhukhune District Municipality Jane Furse Private Bag X429 Jane Furse 1085 DILOKONG DISTRICT HOSPITAL (HC BOSHOFF HOSPITAL) Greater Sekhukhune District Municipality Steelpoort Private Bag X9119 Driekop 1129 MATLALA DISTRICT HOSPITAL Greater Sekhukhune District Municipality Marble Hall Private.Bag X9624 Marble Hall 0450 PHILADELPHIA DISTRICT HOSPITAL Greater Sekhukhune District Municipality Dennetton Post Box 1 Dennilton 1030 MECKLENBURG DISTRICT HOSPITAL Greater Sekhukhune District Municipality Burgersfort Private Bag X1012 Burgersfort 1150 CN PHATUDI DISTRICT HOSPITAL Mopani District Municipality Tzaneen Private Bag X4056 Tzaneen 0850 DUIWELSKLOOF DISTRICT HOSPITAL Mopani District Municipality Tzaneen Private Bag X744 Duiwelskloof 0835 ST. RITA’S REGIONAL HOSPITAL Greater Sekhukhune District Municipality Jane Furse Private Bag X1303 Glen Cowie 1061