NHI needs better management – Treatment Action Campaign

Last month, Health Minister Aaron Motsoeledi announced two new bills, the National Health Insurance Bill and the Medical Schemes Amendment Bill, which defines the infrastructure to finance a system that will provide quality healthcare services to all South Africans regardless of their socio-economic standing.

91 percent of South Africans believe that free healthcare is a human right in their country according to a 2018 survey by Ipsos, but for too long quality healthcare has been overshadowed by the discrepancies between the private and public healthcare sectors. South Africa’s public hospitals have deteriorated while private institutions have made the costs of access to quality healthcare exclusive. The private healthcare system caters to 16 percent of South Africans while 84 percent of South Africans rely on public healthcare.

A young woman at a Khayelitsha clinic said she was recently at the hospital visiting her 64-year-old ill mother. The woman, who wished not to be identified, said her mother was checked in at 1 p.m. and the woman returned at 7 p.m. to see her. “She was sleeping in a chair and there was blood on her. There were other patients lying on the floor because there were few beds. It’s heartbreaking to go there and find your relative laying there and you ask them, ‘did you see the doctor already?’ And they say ‘No, I’ve been here,’” she said.

Elitsha spoke with Mary-Jane Matsolo, the Western Cape Provincial Manager of the Treatment Action Campaign, an NGO working to promote access to quality public healthcare. “There is a gross injustice where many resources are invested for few, and little is given to the actual demand of people who need it,” said Matsolo. “NHI is the answer, the only problem is it needs to be managed extremely well. All these other issues of corruption need to be taken out of it or more South Africans will continue to bear the brunt of a crumbling healthcare system.”

In 2012 National Health Insurance was piloted in eleven districts all over South Africa. Key NHI interventions for the pilot projects were: appointment of district clinical specialists support, municipal ward-based primary health care agents, school-based services, human resources, information management, and an NHI grant.

Matsolo said there has been little statistical evidence reported from the NHI pilot phase, which makes anticipating a successful future difficult. “How are we supposed to implement NHI without a proper report to answer, ‘what were the gaps?’ And if we identify the gaps, how are we proposing to fill those gaps?” said Matsolo. “We engage with embassies at the provincial level but we never get clear answers when it comes to NHI – we get hope statements.”

The Ideal Clinic Programme assessed all the primary healthcare clinics in South Africa and found that after the first year of NHI, over 190 clinics had reached ideal levels of functioning, with 106 of those facilities being located within the pilot districts.

Understaffing plays a critical role in the quality of healthcare and is a problem NHI is looking to address. South Africans have to wait for hours to receive attention at many public health clinics. In a press release, the Democratic Nursing Organisation of South Africa (Denosa) wrote that it is “particularly happy” with the proposals to do away with the co-payment provision, abolishing of brokers and the abolishing of Prescribed Minimum Benefits, but would like to see the “severe shortage of nurses and other health professionals” be addressed.

“Currently, we do not see that forward-looking commitment and solutions-based plan, and already we are entering the second-phase of NHI,” Denosa wrote, asking for closed nursing colleges to be reopened to assist with the staffing problem.

The People’s Health Movement of South Africa also welcomed the NHI bill for its “insistence on a unitary system with a single purchaser of services funded through a solidarity mechanism”. PHM-SA, however, specified it wants to see a forum for meaningful public participation that includes civil society and labour voices, minimising a bias towards hospital-centred specialist care and a “narrow biomedical approach.”

Snaking queues inside and outside clinics have become the norm, as in this clinic in Gugulethu.
Photo by Noluthando Matshoba

The Clinton Health Access Initiative (CHAI) said the government should focus on the “critical role of national support and coordination” with “improved intergovernmental communication that utilizes data analysis from the pilot years to inform strategic and financial decision-making in phase two.”

Henru Krüger, the chief operating officer of the Alliance of South African Independent Practitioners Association, said that while those in healthcare services have been waiting for the bills to be changed, he believes the new proposal will not promote quality healthcare. In an email to Elitsha he wrote that NHI is “more rules and regulations that takes away the healthcare decisions from patients and doctors [and] giving them to medical schemes.” He believes NHI could drive doctors away from both the private and public healthcare system.

Motsoeledi did not confirm the extent to which this phase of NHI will be funded, but the Department of Health’s 2010 projection predicted it will cost around R255.8-billion by 2025. This money will come from taxes in some form, but the Treasury has not yet confirmed what these will be.