by Chris Bateman
The National Health Insurance Fund, the NHI, will be a very different creature to controversial State-owned enterprises like Eskom and SAA, unable to speculate financially and with budgets strictly applied to defined areas, says SA’s Health Minister, Dr Zweli Mkhize. Opening the annual Hospital Association of South Africa, (HASA) conference in Cape Town’s foreshore on Monday, he said accountability would be paramount with a strong anti-corruption team complemented by advanced technology monitoring all transactions. Regulatory and financial intelligence bodies would form backstops to this.
The primary focus would be on strengthening primary healthcare, particularly community healthcare workers, community services and clinics with outreach to far-flung rural communities. Contrary to oft-expressed fears of a regimented, centrally-controlled bureaucracy, South Africa’s universal healthcare, aimed at full implementation by 2026, would be split into numerous district health management offices consisting of health promotion, disease management, screening, palliative care and rehabilitation, with ‘full scope’ for engagement with alternative healthcare practitioners like acupuncturists, homeopaths, and traditional healers. These relationships were ‘still being worked on,” Dr Mkhize said.
In a transparent address, he said the long patient queues, dilapidated infrastructure, drug stockouts, corruption and maladministration that dominated media coverage obscured the many committed hard-working and competent physicians who dedicated their lives to delivering healthcare. An NHI social compact signed at the George Mukhari Academic Hospital north of Pretoria several weeks ago was evidence of the growing collaboration between the private sector, NGO’s and a host of other bodies.
Engaging the private sector to boost the quality of services, improve financial management and develop a robust information system was central to the government’s NHI strategy. Mkhize said the World Health Organization, WHO, had stressed that a country did not have to wait for a better system to be instituted, but should forge ahead. Since the NHI bill was announced, a robust national discourse was dominated by a “campaign to spread false information to scare people into believing that this is a monster coming to destroy everybody.”
On the contrary, the package of healthcare services offered would be rooted in available resources and evolves in constant consultation with Treasury. The 2020 NHI rollout budget had already been finalized and by 2026 the current estimate was of a shortfall of some R20 billion. “We’re focusing on the next five years. Beyond that, it will be a work in progress, “he said. Critics of the NHI who claimed it would involve the nationalization of private healthcare facilities were fundamentally mistaken.
Private sector to adjust but not change. “The government has enough hospitals not to want to try and nationalize others. All private practices, dispensaries and the like will remain in the hands of their owners. What will be possible is for private facilities to render NHI services in addition to their current services; that’s what we want to talk about,” he added.
Introducing Dr Mkhize, HASA chairperson, Dr Biren Valodia, said the country was embarking on one of the most seminal moments in its history.
“What we do next will define us as a nation. We must tread carefully, but confidently. We’ve faced tremendous challenges in the past as a nation but we’d prevailed. We mustn’t lose sight of our resilience. The soccer World Cup was a great example of proving our critics wrong,” he added.
In February this year, the HASA board had expanded its mandate to pro-actively contribute to improved access to quality healthcare. At the recent Presidential Health Summit, HASA presented its plan to train 50 000 nurses and had already contributed to leadership development, research, post-graduate studies, and achievement of qualifications through the Public Health Enhancement Fund. “We want to find new ways of doing things and help create a new mindset. We need to work openly and honestly with one another,” he added.