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NHI – Not All Plain Sailing

The proposed National Health Insurance (NHI) system is slowly but surely finding its way back into the media after a long lull. Reports earlier this week included a number of observations from luminaries involved in the process using phrases such as “soon” and “in the near future” when asked about the publication of the long awaited white paper on the NHI.

An article in Beeld this week also commented that waiting almost two years for this to happen is too long. It quotes Department of Health spokesperson, Joe Maila, as saying that the White Paper will be issued some time this year, ‘but we cannot say exactly when’.

The Green Paper was issued in August 2011. Minister Aaron Motsoaledi said in his budget overview in May that the White Paper would be released ‘soon’. Kate Francis, of the Helen Suzman Foundation’s health reform project, said a deviation from the initial timeframes was expected because of the controversy, ‘but a delay of more than a year and a half is a bit excessive’. Mediclinic’s Roly Buys questioned why everybody was rushed to comment within three months after the Green Paper’s release and are now greeted by a silence. He also questions the transparency of the process. ‘What happened with the comments, and why isn’t there a public debate about the issues that were tabled?’ he asked.

Health Department Director General, Malebona Matsoso, presented a progress report to members of the National Assembly Health Committee this week. An article in Legalbrief Policy Watch quotes her as saying the NHI system ‘can be done’, but ‘it is not going to work in the existing environment’.

Presenting a report on progress made during the first year of the NHI pilot phase to the National Assembly Committee on Health, she referred in particular to the importance of appointing ‘people with the proper profiles’ to district management positions and the need to ‘ring-fence’ budget allocations earmarked for health districts but often redirected elsewhere. Nevertheless, if challenges identified during the first 12 months of the pilot process are seen as opportunities, universal access to quality health care is, in fact, a viable proposition.

Elaborating on the apparent lack of capacity at district level to implement the NHI system as proposed in the Green Paper, Matsoso said that her department is ‘strongly motivating’ for the establishment of district health authorities,with executive rather than co-ordinating powers. With this in mind, district heads will need appropriate financial management skills. Turning to the role of hospital CEOs, she expressed obvious concern about the extent to which post-graduate degrees do not necessarily equip a candidate to manage administrative, clinical and ‘hotel’ services among others fundamental to the smooth running of a sophisticated health facility. ‘We need a special school for this,’ she said.

Among a plethora of problems that have arisen in some – if not all – pilot districts during the past 12 months is that most primary health care (PHC) clinics do not have adequate facilities in place for a contracted private general practitioner to function effectively. As a result, while contracts have been finalised with as many as 300 private practitioners, only 125 have been placed. Other ‘weak links’ in the PHC system as it currently operates include lack of access to transport to and from the nearest clinic; poor pharmacy services; and a shortage of suitably trained nurses.

There were also discussions with the department of Finance on where the money will come from. For most commentators, this is an even bigger obstacle than the lack of skills in so many areas.

If nothing else comes of the proposed NHI system, then at least rectifying the logistical problems identified above should lead to a vast improvement of facilities for those unable to afford proper healthcare.

Hopefully, proper planning will lead to success, albeit a very ambitious project. In a way, it reminds me of something I read in the UCT rag magazine in the seventies.

They published a list of imaginary book titles written by luminaries. The one written by the Pope was called: “The Pill’s grim Progress.” It seems a fitting heading for the White Paper, when it is eventually published.

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