National Health Insurance is a noble and noteworthy programme or exercise that was formulated by the government in order to address the pressing problems that have dogged the Health Care industry for decades on end. South Africa was poised at the threshold of implementing important and much obligatory alterations to its health structure; an alteration hinging on the ideology of communal commonality, even-handedness and equality.
A National Health Insurance (NHI) was the medium that was proposed to put this change into fruition and as was anticipated to have a permanent and inveterate influence on the wellbeing of all South Africans. The guiding principle of NHI was to make certain that all and sundry had right to use apposite, competent and superior health care services. Proposed to be ushered in a time frame of about 14 years, such a scheme would need momentous revamp of the current service delivery systems, organizational and administrative structures.
This essay will attempt to comprehend the consultation process followed before implementation, advancement and prospective strategies for the introduction of the NHI in South Africa. In view of the fact that the NHI Green Paper was launched in August 2011 significant development has been evident in putting together the ultimate NHI policy and in preparing South Africa’s health structure for the materialization of NHI. This essay will also delve into the growth in opposition to the main characteristics of the NHI’s progress as stated in the Green Paper.
It also looks at contributions on important aspects and programmes that have been ear-marked for the thriving execution of NHI. It is inclusive of the following, along with others, administrative changes, hospital reimbursement reforms, formation of the Office for Health Standards Compliance; making sure that there is a national health facility audit, quality enhancement and accreditation, and reinforcement of district health establishments.
Several obstacles and problems would be unavoidable but measures to alleviate these would be continually formulated; particularly, to bring continuity to the procedure of consultation, getting better with regards to communications (inclusive of the schedule for changes to take place), reinforcing omissions of the restructuring course in existing and prospective pilot communes and maintaining attention on impartiality to make certain that the introduction of NHI would make way to an acceptable and reasonable healthcare structure.
Before one strives to decipher what transpired in the consultation process prior to the implementation of NHI, it is or grave importance that they understand the underlying principals as to why there was such a need for the NHI. The National Health Insurance (NHI) is a financing structure that would ascertain that the entire populace of SA (and legal long-term residents) are accorded vital healthcare services, in spite of of their employment position and aptitude to earn a direct fiscal payment to the NHI Fund.
Healthcare is a person’s basic right – this being the commonly acknowledged global law. This right should however not be solely dependant on how affluent one is or where we happen to live and or come from. The right to access basic healthcare services is indeed engraved in the Constitution of the Republic Of South Africa. However, a great number of South African citizens are victims of untimely deaths and endure unwarranted suffering from poor health. Containable ailments are not being contained swiftly and treatable illnesses are not being treated.
This nonetheless is happening despite the states concerted efforts form 1994 to make sure that everybody in South Africa has unbiased right to use essential healthcare services. There are still stern hiccups largely catalyzed by a distorted healthcare financing scheme. Without NHI, the unprecedented burden of ailments in South Africa would be near impossible to deal and cope with because the highest number of the demographic populace of the country – and those largely affected by bad health– will not manage to get high-quality healthcare.
STEPS AND ACTIVITIES IN THE CONSULTATION PROCESS. In South Africa, the argument with regards to the formation of a national health insurance scheme (NHI) became more critical as there were some real signs that the pilot project was gathering momentum and its formulation was evidently becoming a reality. The ruling party (ANC) wrote in its 2009 Election Manifesto that the NHI was among the top programmes on their to-do-list. This was later reiterated by the Head of State President Jacob Zuma, in that same year’s State of the Nation address.
The initiative of formulating a National Health Insurance policy is hardly a new thought process and the desire to offer complete treatment is one that constitutes the health reforms of several first world, second World and some third world countries. The most significant matter from a fiscal standpoint is the outlay of such a proposal, particularly considering a supposition of total access. A number of scholars and experts had since voiced concern claiming that the planned NHI would be extremely costly or even completely fiscally unaffordable.
Clearly, there is a need for proper economic analysis of the pros and cones of NHI in South Africa. There have been some steps taken in order to address some of the challenges that would have hindered the implementation of the (NHI). The implementation of the (NHI) attracted extensive denigration for being overzealous for the country at this phase in the game. The pessimistic stance that several media institutions took in response to the news of an NHI system resulted in the relevant authorities coming together by bringing forward an NGC meeting by 7 days.
It was discovered that the problem of overcrowding that seemingly characterized healthcare facilities in the public sector was chiefly caused by two main problems: a lack of adequate staff and gross incompetence and mismanagement of these healthcare facilities. In order to see the goals of the NHI achieved, the concerned stakeholders, led by the government decided to take action by fighting to give better health services. During the consultation process, there also was another factor that had to be addressed that was also raising concern among the common populace.
The masses were hugely worried about what this new policy would mean to the less affluent members of society with certain quarters conjuring up varying theories that made the public believe that they would pay for the enactment of the NHI. This unrest had to be addressed expediently and the Government moved swiftly to quash the concern by assuring the public that the policy would advocate for free basic healthcare for all. the 14% of government expenditure on healthcare; even though mediocre, also served as a way of showing the country that the scope of the plan was indeed to be free and fair for all citizens.
Another step that had to be taken was that of addressing the concerns of the uninsured recipients of healthcare who had been at the receiving end of acts of gross mismanagement of medical centres, medical equipment and medicinal drugs coupled by understaffed clinics and hospitals. This was of greater concern to facilities in the rural areas and a host of peri-urban centres. There however were activities and steps that were formulated by the government to address the above. There was the idea of looking for
financiers and funding to help the facilities by bringing more human resources and hiring more experts in the medical field. It also has to be noted that for little over a decade now, civic groups with the help of government and non-governmental organisations have been really trying to alleviate some of these problems with real aplomb and notable improvements can be identified. This help from other parties and groups in the social stratosphere then helps by lessening the burden on the government as it will not have to do everything alone.
With efficient public-private-partnerships between the state, public society and other corporations, effective assistance can be greatly increased. The government then realised that bringing in various stakeholders into the frame and allowing them to assist where ever they could mange would go a long way in making the NHI a successful operation. A very good example of an independent organisation that has offered considerable assistance is Africa Health Placements (AHP), who have made it their mandate to provide doctors by placement.
Their initiative has benefited the public and rural health centres for over 8 years. From the time of its formation in 2005, nearly 1750 medical doctors have been brought to South Africa, Swaziland and Lesotho with up to 900 of these being foreign professionals. The idea of hiring foreign doctors and healthcare professionals such as nurses is the other step that was taken during the consultation process in trying to address the issue of under staffing. This recruitment drive is seen as a solution to the problem in the long run.
The logical and accepted notion is that when healthcare facilities are well staffed and administered professionally local human resources will gladly commit their services to the country’s health department. Several healthcare institutions were this program has been implemented are testament to the above notion with institutions such as Ngwelezane and Isimilela hospitals having been beneficiaries of this placement program which has in turn brought about a positive turn around to healthcare in the Eastern Cape and Kwazulu Natal.
Ngwelezane Hospital is a brilliant illustration of how a medical institution can be completely changed to perform to its greatest potential through this foreign recruitment drive. The geographical location of this facility; Richards Bay Informal Settlement area, is also strategic as the influx of violence and alcohol induced patient cases is astronomical. There also is a high prevalence of the HIV/Aids pandemic and Tuberculosis in this area. The drive by AHP to place doctors has seen patients being attended to faster there by saving several lives.
The positive drive and energy in the institution was evident as worker relations and morale increased with each new placement. This facility has been luring local doctors, interns and community service medical personnel, ultimately leading in them staying for the foreseeable future. Owing to the efficient employment of a small number of overseas doctors, who have since left, the competence of this facility has been improved, and will remain that way owing to the fact that it is sufficiently staffed in terms of human resources.
Having addressed the above issues, there was yet another sticking point as to who would then oversee the management of the system, especially the fiscal aspect of management. The step that was taken after deliberation and consultation was that there would be the formation of a publicly administered and funded National Health Insurance Authority (NHIA). The NHI pitch advocates for the formation of a single-payer fund to be achieved through the NHIA. This subsidy will collect funds, share resources and procure services for the whole South African populace.
Financial support will be sourced from an amalgamation of employer contributions, employee contributions and existing monetary funding for the health department. The employer and worker contributions would need a supplementary tax for all tax payers and their employers, while the active monetary and financial support for the health department would keep on being received from the government’s income pool which, in reality, is primarily funded by revenue tax contributions.
Also, some categories of low income employees will be excluded from contributions to the NHIA. The above are some of the steps and activities that were done during the consultation process on the implementation of the NHI. There however some issues that were not fully are addressed for example the issue of South Africa’s Burden of Sickness.