NHI to reduce cost of healthcare

Health Minister Aaron Motsoaledi believes good quality private healthcare is no longer affordable in the country and that is why the country needs universal health coverage. 

The minister briefed the health portfolio committee on Parliament on the status of the National Health Insurance pilot districts on Friday.

He took members of Parliament through some of the progress in NHI piloting in the country, including efforts to reduce waiting time, the re-engineering of the primary health care system and infrastructure development and maintenance. 

Speaking after the presentation, he said the NHI was not about abolishing private healthcare, but about making quality healthcare more affordable, making an example of a couple who racked up R790 000 in bills in 10 days at the Life Flora Hospital last month after the birth of their quadruplets.

“That is the reason we are coming with universal health coverage is that what we are having now is no longer affordable. The reason that President [Barack] Obama is coming with affordable health care is that. And he is not abolishing private healthcare, he is just saying it must be made affordable.

“We are working to reduce the exorbitant cost of private healthcare and make sure the public healthcare system is of good quality. NHI is a healthcare system which we believe is going to be affordable. The assumption is that NHI is going to be expensive. Let me tell put my head on the block and tell you what is expensive is the current system,” said Motsoaledi.

The pilot sites are in OR Tambo (Eastern Cape), Gert Sibande (Mpumalanga), Vhembe (Limpopo), Pixley ka Seme (Northern Cape), Eden (Western Cape), Dr Kenneth Kaunda (North West), Thabo Mofutsanyane (Free State) and Tshwane (Gauteng). 

KwaZulu Natal was allocated two districts as NHI pilot sites; UMgungundlovu and Umzinyathi but then requested to add a third one, which is Amajuba district and committed to pay for its pilot exercise.

The health minister promised that the publication of the government’s white paper on NHI is imminent, though he could not give a date. The green paper on NHI was published in August 2011 and since then the health department has constantly said the white paper will be published soon.

He said they have completed it and have set the cabinet process in motion. 

“I’ve spoken to the Director General in the Presidency to expedite their process. On our side, on what the white paper must contain, that is completed.”

Motsoaledi told the committee that one of the problems they still faced in the implementation of the pilot projects was attracting general practitioners to work for clinics, especially in rural areas.

The problem, however, seemed to be minimised by hiring of an independent service provider to hire and pay the GPs, he said.

By March this year, they had 256 working GPs, with 287 contracts signed. The hardest place to attract doctors to was the OR Tambo District in the Eastern Cape, which only had one working GP by March 2015. In August the service provider managed to recruit 30 GPs to service the OR Tambo district.

Motsoaledi said it was not easy to get specialists to go to all the pilot sites, but said the lack of doctors was not limited to South Africa, but was a world-wide problem.

He said another problem faced was the regulation of the country’s community health and home based care workers whose training, job descriptions and employment contracts have not been standardised.

“[A] lot of people cropped up in the country between 1996 and 2000 due to the increase in HIV and Aids. People who are home based care workers care for the sick until they die. Hospices cropped up, lay counsellors, lots of people. Some hired by NGOs, others by department of health. I’m not saying that was bad, but it was done without a plan.”

While community health workers have worked in SA for decades, the country experienced a dramatic growth in the number of workers from around 5 600 in the mid 1990s to 72 839 in 2011, according to health department figures. 

Some workers earn stipends or salaries; others work for free. Workers’ skill levels differ ssignificantly, depending on who employs them. 

“Quite a number of them are registered nowhere. They just come and tell you they have been volunteering for five years. And when you check, you find that its true. But it is not very clear when the agreement was made, what skills they have.”

He said it was a big mountain for the department to climb, and they were working on it. A number of health activists have criticised Motsoaledi for dragging his feet on publishing a national community health worker policy, which he had promised to do since 2011.

In countries like South Africa that have a serious lack of doctors and nurses, community health workers are often used to address the crippling health worker shortage through “task shifting” – transferring some of the easier but time-consuming tasks of professional health workers, such as following up on HIV or TB patients to ensure they take their medication correctly.

Motsoaledi took the committee through some of the measures they had in place to reduce waiting time, including less registers to be filled by nurses and the possibility of getting chronic medication delivered to stable patients so they did not have to queue for hours on end.

He was grilled by MPs on the use of grant money, the tendering process and the rebuilding of infrastructure, which had to be done in clinics that did not meet even the barest minimum of requirements for providing quality healthcare.

Motsoaledi said people did not trust the concept of NHI because it is still new. He stressed it was not about doing away with the private sector.

The committee will meet with the minister again on Wednesday, September 2, to discuss some of the challenges and progress made in implementation of NHI.

  • Corrections were made to this article and more details on the KZN pilots have been added.

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