There are few things more devastating than being denied quality healthcare because of one’s socio-economic status. This sadly is a reality, which is faced by the majority of South Africans.
The current South African health system has over the years resulted in disparities in how it is administered. It is based on both the private and public health system. 84% of the population receive their services through the public health facilities; which are inadequately resourced, while 16% of the population receive their health services through the private health system; which is highly resourced.
The sad reality is that even those that are members of private medical schemes, more often than not, exhaust their benefits before the end of the financial contribution annual cycle due to the exorbitant price structure in the private health system.
In redressing this, anomaly our National Development Plan (NDP) envisages a healthcare system that works for everyone. It provides for a number of key elements that we would put in place to meet the constitutional imperatives that we need to provide health care services to all South Africans; irrespective of their socio-economic background within the available resources.
One of those elements in the NDP proposes that we put in place a financial health system that will be based on universal health coverage. It is a system that will pool funds to provide access to health services for all South Africans that are in need of health services. This system commonly, referred to as the National Health Insurance (NHI), will in a phased approach, tackle the unacceptably high levels of inequalities; particularly as they relate to the health care services in the country.
Addressing the country during his recent State of the Nation Address, President Cyril Ramaphosa said: “By introducing the NHI together with a multi-pronged quality improvement programme for public health facilities, we are working towards a massive change in the healthcare experience of South Africans.”
As the President indicates, the programme to change the manner in which we provide health care services to all South Africa will be multi-pronged. This will amongst many interventions; deal with the country’s preventative programmes, improve the quality of our health infrastructures, human resource capacity in our health facilities, strengthen the partnership between the private and public sectors and strengthen our current governance structures and information system.
Through the NHI, we envision that both private and public healthcare can equally share resources to accommodate all South Africans who are in need of medical care, without compromising the quality and service standards.
It will draw in hospitals, clinics, doctors, specialists and dentists from across the health sector.
Work has already begun to strengthen this sector and to engage stakeholders through the Presidential Health Summit convened in October 2018.
In June 2018, Cabinet approved the NHI Bill to be released for public comments over the 90 days period ending in September 2018. The Bill proposes the establishment of the NHI Fund Entity in terms of Schedule 3 of the PFMA. This structure will oversee the funding and the procurement of the health services of all registered beneficiaries.
Out of the public consultations in 2018, this bill was enriched with more inputs from these consultations.
Earlier in July, a revised bill was presented for consideration by Cabinet. It was approved for submission in Parliament to also go through another rigorous parliamentary process. The parliamentary process will again entail public consultations and will be debated in both the National Assembly and National Council of Provinces.
The Bill will be made into a law that will serve its intent, once all inputs are canvassed through public consultations.
In line with section 27 (1) b of the Constitution, the NHI will be implemented in phases in line with the available resources. In addition, it will take into cognisance a number of other bills that will need to be repealed to enable the NHI to transition into the new system in a smooth and systematic manner. An implementation plan will also be put in place in a transparent manner.
The implementation plan of the NHI together with a number of key elements to be put in place, will help reverse inequalities in healthcare inherited from the apartheid system.
Prior to 1994 health services were racially segregated and black people were provided with an inferior public health service compared to their white counterparts. Black South Africans had limited access to public health facilities, particularly in rural areas, where people often had to travel vast distances to access a health facility which more often than not lacked bare basics. The NHI will help undo the legacy of disparity where the standard of healthcare depends on one’s socio-economic status.
This disproportion is also reflected in the country’s spending of over 8% of its GDP on health. More than half of this percentage goes to private care; however, this covers less than 16% of the population. Such a split in resources is neither desirable nor sustainable.
This reality is further mirrored in eight out of ten patients having to depend on public clinics and hospitals. The public facilities also have to carry the patients that have exhausted their medical schemes contributions, yet are still in need of health services. It is also true that the bulk of the country’s doctors, dentists and specialists serve a small section of the population who can afford private healthcare.
There have understandably been many varying opinions about the proposed NHI, with some claiming that it will harm the private healthcare sector. It is therefore, important to state that the NHI will create space for both private and public sector to complement each other in serving the health needs of our people.
In implementing the NHI, we are a step closer to achieving a healthcare system that works for everyone and produces positive health outcomes as envisaged by the National Development Plan 2030 (NDP).
As set out in the NDP, the heartbeat of NHI is primary healthcare that focuses on prevention, education, disease management and treatment to ensure healthy lives. It also calls for hospitals that are effective and efficient in providing quality secondary and tertiary care for those who need it.
To take us closer to the envisaged goals of quality health services; lets us all participate in the public engagements that will be organised by the Parliament in the various Provinces. Through the implementation of NHI, we are giving effect to Section 27 of the Constitution that commits the government to the realisation of the right of access to health services within available resources.
We are confident NHI will bridge the gap between our health systems and reduce healthcare costs.
– Ms Phumla Williams is the Acting Director General of the GCIS.