Frontline Africa Advisory


On the 10th of July, Cabinet approved the contentious National Health Insurance (NHI) Bill which will now be tabled in parliament for further processing. The Minister of Health Dr Zweli Mkhize did not give much detail of how the NHI will be funded during his Budget Vote in Parliament on the 12th of July 2019.

The NHI is South Africa’s shot at Universal Healthcare Coverage and is aimed at providing quality healthcare to all South Africans based on their healthcare needs and concerns, regardless of their socio-economic status. While the intentions of the Bill are noble and aimed at addressing the unequal nature of healthcare provision in South Africa, there is very little to guarantee its effectiveness in improving the public healthcare sector, which is plagued by a myriad of challenges.

The Presidential Healthcare Summit held in 2018 highlighted multiple challenges within the country’s public healthcare sector. The system is characterised by poor infrastructure ranging from shortages of beds, medicine and medical equipment. There has also been severe service delivery shortcomings and low staff morale as a result of an overburdened public healthcare system. The inability of the system to absorb qualified personnel and the loss of experienced healthcare professionals to the private sector also adds to issues afflicting the public health sector. The Health Minister has promised that the NHI will be accompanied by the filling of vacant posts within the current Financial Year, as well as the refurbishing of poor infrastructure. Such promises are not new and have been a constant tune of government for the past few years, with very little tangible results.

In responding to criticisms regarding the current state of public healthcare and the need to address its shortcomings before rushing to roll out the NHI, Dr Mkhize listed the UK as an example of a country that has managed to implement universal healthcare despite a weak economy at the time of its implementation. Despite the Minister praising the UK’s National Healthcare System (NHS) as a shining example of optimal healthcare, the NHS is currently overburdened with issues such as ridiculous waiting times and service backlogs. Research from the British Journal of Anaesthesia uncovered that patients are often turned away from surgery at the last minute due to a lack of resources and capacity.

There has been widespread concern over the government’s ability to fund the NHI and how it would impact the public purse. The Department of Health requires additional funds from the public purse to allow for sufficient support and capacity to successfully rollout the NHI. With the economy on its knees and SOEs constantly requiring bailouts, the NHI is viewed by many as yet another drain to the dwindling fiscus. Unless the economy miraculously recovers and starts registering significant growth in the near future, the NHI is likely to face major headwinds that could doom it to failure.

The NHI pilots that ran from 2011 to 2018 saw government pumping over R5 billion in 11 identified districts around the country. A report on the progress of the pilots shows that medical care in those areas has not improved much. The lack of improvement was attributed to underspending, lack of coordination amongst Local, Provincial and National governments, and confusion over allocation of roles.

Rolling out an ambitious plan as the NHI on a weak foundation is a recipe for disaster. Trusting that the challenges that the public health sector is currently experiencing will be ‘fixed along the way’ of the implementation of NHI could be construed as somewhat irresponsible. It is important for the government to objectively analyse the reports of the pilots and work towards reforming the system as it stands before forging ahead with the NHI.

Written by Pearl Mncube

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