Quality health services for all – that is the promise of government’s National Health Insurance (NHI). Local experts spoke to Grocott’s Mail reporters Nick Hedley and Jessica Caroline Taylor about their concerns.
The much debated NHI aims to provide universal healthcare access to all legal South African residents, regardless of their socio-economic status. It is to be gradually implemented over 14 years, with pilot projects beginning in 10 districts next year. These districts are still to be decided.
According to the NHI's policy document, the Green Paper, the NHI will involve four key interventions: a complete transformation of healthcare service provision and delivery, the total overhaul of the entire healthcare system, the radical change of administration and management, and the provision of a comprehensive package of care underpinned by a re-engineered primary healthcare service.
Quality health services for all – that is the promise of government’s National Health Insurance (NHI). Local experts spoke to Grocott’s Mail reporters Nick Hedley and Jessica Caroline Taylor about their concerns.
The much debated NHI aims to provide universal healthcare access to all legal South African residents, regardless of their socio-economic status. It is to be gradually implemented over 14 years, with pilot projects beginning in 10 districts next year. These districts are still to be decided.
According to the NHI's policy document, the Green Paper, the NHI will involve four key interventions: a complete transformation of healthcare service provision and delivery, the total overhaul of the entire healthcare system, the radical change of administration and management, and the provision of a comprehensive package of care underpinned by a re-engineered primary healthcare service.
According to the Green Paper one of the major problems in South Africa is unequal access to healthcare. Access has increased in the public sector, but the quality of healthcare services has deteriorated or remained poor. The Green Paper also states that the public sector has underperforming institutions that have been attributed to poor management, underfunding and deteriorating infrastructure.
Mia Malan, a health journalist at the Discovery Health Journalism Centre at Rhodes University welcomes the initiative with reservations. “The NHI is a brave step to address that problem,” she said; "However, its implementation requires careful consideration.”
Malan asks three key questions about the NHI: “How will it get funded, how will it be administered and how will it benefit?”
She believes that one solution to the enormous task of providing quality universal healthcare could lie in public-private partnerships, such as at Grahamstown’s Settlers' Hospital – where the Eastern Cape Department of Health partnered with a private consortium consisting of Nalithemba Hospitals and Netcare.
The provincial health department is proud of the partnership at Settlers', reporting in a press release that “partnering and collaboration with the private sector has so far proved fruitful beyond measure.”
Kirsty-Lee Barford, a community service pharmacist in Fort Beaufort, raises questions about the NHI’s impact on medical research in South Africa. “There will only be a few advancements in medicine,” she said. “There is not enough of a budget to support the population fully without restrictions being placed on future research and advancements.”
Reg Rumney, director of the Centre for Economics Journalism in Africa, also poses a key question: “Why insurance… Why do we need an NHI scheme? It will be an extra tax. We’re already paying tax for a public healthcare system, so why are we paying twice?”
Rumney said, “I don’t see the logic of taking the NHI route when we have a public healthcare system already, which could be improved and expanded. I would prefer to pay more tax to see a public healthcare system that works.” He further explained: “It’s not a question of cost, it’s a question of managing what you have.” In other words, there’s no point in spending more money until you’ve actually got a system that works. He suggested increasing VAT by one percentage point. "It’s a more transparent, fairer way of doing things,” he said.
Despite the uncertainties that hover around the NHI scheme Malan concluded, “I think we have a very competent health minister. If there’s one person that can make a start to this it’s really him.”
The NHI is a bold move by the government, but whether it’s the right move remains to be seen.
