Published in the Sunday Times on 6 June 2016
Despite the government having pumped more than R1-billion into 11 National Health Insurance pilot districts over the past five years, medical care in these areas has not improved much – and in some cases has worsened.
Last week, doctors, dentists, nurses, physiotherapists, activists and business people filed their responses to the NHI white paper, which details an initiative to improve clinics and create a single state-run medical aid – which would spell the end of medical aids in their current form.
According to the Health Department’s proposal, medical aids will only be allowed to offer complementary cover for rare diseases and a few procedures not covered by the NHI.
Maretha Smit, CEO of the South African Dental Association, said the department was proposing that medical scheme members pay 85% of their contributions into the NHI, for which they would receive only public cover.
According to various submissions, there was little to show for the money spent on the NHI pilot project, and the state sector remained in appalling shape.
In February, the National Treasury allocated a further R4.5- billion for the improvement of healthcare at the NHI pilot sites. Financial reports show that between R1-billion and R2- billion has been allocated to the NHI pilot project, although much of this has not been spent.
The most recent government report on the NHI, presented last year to parliament, acknowledges the poor state of clinics and confusion over how the extra money dedicated for the NHI has been spent. The Treasury, the Health Department and district officials have clashed over how the money ought to be spent.
About 45% of the funds earmarked to improve medical equipment at clinics has been spent on computers.
The Health Department said clinics had claimed they needed R130-million rand for equipment, yet to date R150-million had been spent and NHI pilot district clinics still did not meet minimum standards for equipment.
The Helen Suzman Foundation said in its submission that much of the 2014-15 grant had been underspent – yet a shortage of funds had prevented the recruitment of 150 GPs to work in under-served areas last year.
The South African Private Practitioners Forum, which represents about 2600 specialists, said in its submission that according to an audit by the Office of Health Standards Compliance, two-thirds of state clinics and hospitals did not offer the standard of healthcare required and should be decommissioned.
“The first phase of the implementation of the NHI is nearing completion and very little progress has been made regarding the quality of government services,” said Chris Archer, the forum’s CEO.
Section27 said: “We are deeply concerned about the dire state of the health system. The Office of Health Standards Compliance’s assessment has indicated that on average health facilities across the country achieved 46% for quality, service and medicine supply at clinics. This suggests that most health facilities are unlikely to be of a standard to support NHI.”
Health Department economist Vishal Brijlal said only 322 of 3500 clinics met the “ideal clinic” standard measuring quality, service and infection control, but it was working on improving infrastructure and staff to rectify this.
He said the department was modernising IT systems and patient records to decrease crowding in clinics and reduce waiting times.