National Health Insurance (NHI) Public Health & Health Systems

NHI: To prevent rather than cure disease

Written by Khopotso Bodibe

At the heart of the National Health Insurance system is the desire to afford all South Africans access to better quality health care. The system seeks to move from the current health care model and employ one which will be based on the system of primary health care.

fafe6b4c893b.jpg‘€œThe health care system that is taking place in South Africa now can be characterized by three things. It is destructive, unsustainable, extremely expensive curative system’€, is how Health Minister Dr Aaron Motsoaledi described the country’€™s health system at a debate on health care funding held at the University of Johannesburg, recently.

Motsoaledi said the health system needs a complete ‘€œoverhaul’€. He said no ‘€œcountry can survive’€ the current health care model. Under the National Health Insurance (NHI) system, the health care model will focus more on preventing disease than curing it.

‘€œOur overhauling it means primary health care and this is the only time we can win this battle. For instance, when last did you see a nurse in any school in South Africa? It’€™s not there. What are we waiting for? We are waiting for the child to get sick and get cured in the hospital. The nurses in the schools used to prevent them from getting ill ‘€“ massive immunization, check their ears, check their teeth, check everything, and then refer them. But, at the moment we’€™re all waiting for them to get sick. All these things need to be brought in ‘€“ immunization, schools health programmes, primary health care teams to stop the curative health care system’€, the Health Minister said.

The move towards the National Health Insurance system has faced opposition from some quarters. At the University of Johannesburg debate, deputy Vice-Chancellor Professor Adam Habib, reminded the Health Minister of the opposition that he is facing.

‘€œThere are powerful stakeholders in the health care system that will lose out as a result of you moving to a primary health care system and they are opposing this in quite a significant way. And the big question that confronts you is how do you mobilise alternative stakeholders to be able to contest that?’€ , Professor Habib asked.

‘€œWhy is NHI under attack more than any other programme? (It’€™s) because it’€™s going to be for the first time that it brings some form of equality. The gap between the rich and the poor in South Africa is too big. The reason that many so-called experts believe the National Health Insurance won’€™t work, is going to be very expensive, is based on this destructive health care system which doesn’€™t work anywhere in the world.When we introduce the NHI, it is going to go hand in glove with primary health care. If we introduce it as it is now, you can give me a trillion rand, it will disappear completely’€, Motsoaledi responded.  

When the National Health Insurance system finally launches, it will come in to fix a largely flawed health system. Some are skeptical that it will fix the ills of the health system. An unidentified member of the audience at the University of Johannesburg debate voiced his concern.

‘€œThe NHI, it appears like a panacea the way the Minister is putting it’€.

The university’€™s deputy Vice-Chancellor, Professor Habib, put it to the Health Minister that for a long time the health system has been fraught with problems.    

‘€œFrankly put, the hospital systems are in a complete crisis and you could put billions of infrastructure in, but the fact that they have declined so dramatically and that the systems don’€™t work, including information systems, is something that has to be addressed. And, frankly, for 15 years we’€™ve allowed that situation to become messed up and, partly, half of this Cabinet was in the previous Cabinet and are complicit in that’€, he said.

In his reply, Motsoaledi agreed that all is not well with the public health system. But he gave an assurance that under the NHI poor services at public hospitals will be a thing of the past.

‘€œIs NHI a panacea for all our problems? We never said do. At the moment I know that nobody believes us because public health care has lost credibility. It has lost credibility because we have made terrible mistakes. And that is definitely going to change under all these programmes that we are having’€, answered Motsoaledi.

‘€œOn the quality of health care, we are going to establish an office of standards compliance, which will be passed by a law of Government where you’€™ll have inspectorates to have every right to go to any hospital and inspect. And, actually, no hospital will be accredited to NHI until it has passed particular standards about cleanliness, the queues, the drug stock-outs, security, etc’€, the Health Minister added.

About the author

Khopotso Bodibe