Ambitious NHI timeline leaves little space for public comment

Ambitious NHI timeline leaves little space for public comment

Government publishes an ambitious timetable for preparing health institutions for the National health Insurance scheme – but leaves virtually no space for public comment

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The public will have very little time to comment on the proposed National Health Insurance (NHI) scheme, as it will only see the official plan in November.

Yet government wants to enact laws to introduce the NHI by April, according to Deputy Health Minister Molefi Sefularo

Government’€™s programme of action, published recently on an official government website initially indicated that Cabinet would get a draft ‘€œ incorporating public comment by April 2010’€, with NHI legislation ready by July.

But Sefularo’€™s new deadline, announced last week, indicates that government may be fast-tracking the new scheme even more.

The NHI is the most far-reaching health reform since the abolition of segregated health services after 1994, and it aims to establish a single pool of money to finance health services based on compulsory individual contributions and an allocation from general taxes.

But exactly how this will be achieved is the subject of intense debate. The SA Communist Party and Cosatu want the complete nationalisation of health services, while the private health sector want to play a part in administering and running the NHI.

Government’€™s ambitious timeline sets out a multitude of tasks that need to be completed between now and July to prepare for the NHI.

By the end of this month (September 09), the health department aims to have started to implement measures aimed at improving ‘€œinfection prevention and control patient waiting times and cleanliness’€.

By October, it plans to have completed a ‘€œHuman Resources Plan for Health’€. This plan is expected to reverse the decision taken during Thabo Mbeki’€™s presidency to close nursing schools and colleges, as the department wants these to be opened in time for the 2010 academic year.

In addition, the department wants the National Health Council (NHC) to have approved plans to decentralise the management of health facilities to hospital managers or CEOs, with ‘€œ350 out of 400 of Chief Executive Officers (CEOs) provided with written delegations’€.

The NHC is made up of the health minister, provincial health MECs and top health officials.

March is crunch-month for the NHI, and the list of deadlines for this month is very long and ambitious. It includes:

·               Implementing  a ‘€œquality improvement plan’€ in 18 priority health districts with 1000 out of 3818 public health facilities implementing ‘€œquality improvement plans’€ covering safety, infection prevention and control measures, waiting times and cleanliness.

·               Finalising plans for the creation of ‘€œauxiliary personnel’€ to address acute staff shortages.

·               Developing a ‘€œframework for task shifting’€, for all categories of health professionals. This is aimed primarily at giving lower categories of workers more powers, for example, it could allow professional nurses to prescribe antiretroviral medication.

·               Decentralising the operations of health facilities. At present, some hospital managers are unable to hire and fire staff as this lies with the province.

·               Evaluating all hospital CEOs ‘€œto ensure that they meet minimum requirements for effective management’€. If they don’€™t, ‘€œcorrective measures’€ including further training are planned for.

·               Evaluating the District Health System and Primary Health Care and reporting back to Cabinet.

·               Refurbishing of all health facilities.

Government also aims to have made huge strides to implement the National Strategic Plan on HIV/AIDS by March.

Its deadlines include ensuring that 80% of pregnant HIV positive women get dual   antiretroviral therapy, and that 80% babies born to HIV positive mothers also get dual therapy. It also plans to start 215,000 new adults and 33,000 children on ARVs. ‘€“ Health-e News Service.

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