Universal healthcare for SA?

Commuters on their way home from work
at the Noord Street taxi rank in
Johannesburg. Under the National Health
Insurance system every South African
would have access to quality healthcare
services.
(Image: Chris Kirchhoff,
MediaClubSouthAfrica.com. For more free
photos, visit the image library.)

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USEFUL LINKS
ANC sticks to its guns on health plan
– Mail & Guardian
Secret health plan raises temperatures
– Business Times
ANC recommits to free education,
universal healthcare
– Polity.org.za
Department of Health
Human Sciences Research Council
Discovery Health

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Samson Mulugeta

The South African government is planning the rollout of universal health coverage in the country, in line with the Bill of Rights provision that “everyone has the right to have access to healthcare services, including reproductive healthcare”.

The ruling party, the African National Congress (ANC), first discussed the idea at its 52nd national conference in Polokwane, Limpopo province, in December 2007.

There it called for the “implementation of a national health insurance (NHI) to further strengthen the public healthcare system and ensure adequate provision of funding”.

The proposal received strong support among the ANC’s partners, the Congress of South African Trade Unions (Cosatu) and the South African Communist Party, and became one of the dominant themes of the party’s 2009 election campaign.

After the ANC won the April elections with 65.9% of the vote, President Jacob Zuma formally announced the introduction of a countrywide health insurance scheme with plans to rehabilitate public hospitals through public-private partnerships.

But the idea of a national health insurance scheme, particularly its cost, has sparked debate among all the parties involved, including private healthcare companies, healthcare workers, labour unions and politicians.

At the moment in South Africa the private health sector spends about R66-billion (US$8.4-billion) to service about 7-million people, while the rest of the population depends on R59-billion ($7.5-billion) spent through the often stretched and under-resourced public health sector.

Funding

At an estimated cost of R100-billion ($13-billion) a year, the NHI scheme would be compulsory for all South Africans to join. It would be funded by a levy or tax deducted from the salaries of those in the formal sector and by the state for the unemployed.

Deputy Minister of Health Molefi Sefularo has said that “under the NHI every South African will benefit from quality healthcare services”.

“The scheme will be funded partly by compulsory contributions by all persons who are earning an income – and partly by tax.

“All these funds will be placed in a single pool. This pool will be available to fund all healthcare in the public and private sector.”

A sector in crisis

An ANC task team led by Olive Shisana, head of the Human Sciences Research Council, has been working on the NHI proposal for more than a year. In an interview with Business Times on 5 June 2009 Shisana said the proposal was on track to be developed into a policy document and draft legislation.

In addition to the principal problem of a healthcare system that does not adequately provide for the majority of the country’s citizens, the team has identified further issues plaguing the sector.

These include deteriorating infrastructure, incompetency and inefficiency, inflated prices and excessive administrative expenses.

“Services delivered based on need rather than on ability to pay” is the task team’s mandate.

“To achieve a universal, comprehensive, free national healthcare system, founded on the primary healthcare approach, requires a well-funded and well resourced funded public health system,” Zwelinzima Vavi, Cosatu’s general secretary, told delegates at a South African Medical Association conference on 7 June 2009.

“Apartheid had a fundamental impact on people’s health and the organisation of the health system in South Africa. That legacy, despite many achievements in our healthcare system, continues to this day.”

Vavi added: “South Africa has enough resources to provide healthcare for everyone; what is required is the redistribution of these resources, from the minority of the population to the majority.”

Dr Jonathan Broomberg, head of strategy and risk management at health insurer Discovery Health, said the NHI proposal is “a potentially a huge reform, and the government owes the people of this country and all stakeholders a serious and rigorous debate”.

In an SAfm radio interview on 10 June 2009 Broomberg said he was worried that the private sector was seen as a problem instead of a big part of the solution.

“I think what you see underneath this, which is also worrying, is the sense from some people that the private healthcare system is part of the problem, whereas in fact what this is, is an asset in this society.

“You have world-class expertise in managing hospitals, great doctors and specialists, world-class pharmaceutical companies, world-class health fund managers and risk managers – and these are all assets that could be put to work in the public interest.”

NHI criticism

Like the ANC, the Democratic Alliance (DA), South Africa’s official opposition party, believes that “drastic improvement” is required to improve healthcare delivery – but the agreement ends there.

“Reform of our health system must aim at correcting the failures in public health and spreading wider the successes in private health,” DA leader Helen Zille said in her weekly newsletter on 19 June 2009, published on the party’s website.

“The DA takes a different approach based on the simple aim of finding the most just, efficient and economic system of providing every single South African with decent healthcare. We do not want revolutionary change. We just want to fix what is broken and to extend what is working well.

“There could be a requirement that, in order to stay registered, private doctors would have to work a certain number of hours in the public sector each year,” the DA stated. “There could be more private wards in public hospitals, to the benefit of both sectors and their patients.”

A critic of the planned NHI is Alex van den Heever, a health economist who has fought several battles over health system policy since 1994.

In an interview with Business Times on 6 June 2009 he expressed grave misgivings over the lack of consultation in the early “research” phase of the plan.

He also said the plan is “unworkable, unaffordable and uses the wrong institutional models”. He believes there will be a “backlash of unparalleled proportions”.

In reaction to this criticism, ANC spokesperson Jesse Duarte said in a statement on 8 June 2009 that the party “has noted with concern media reports attempting to deflect public attention away from the crucial work of the NHI task team”.

“We will transform healthcare in South Africa and will not be deterred by narrow interest groups and individuals bent on undermining the introduction of NHI before its work is made public,” she added.

A draft bill on the NHI, which will combine the public and private health sectors, is expected in Parliament by December 2009.