Unconfirmed reports indicate that health minster Dr Aaron Motsoaledi will present his department’€™s plan to Cabinet and further details will be released at a media briefing on Thursday.

It is expected that the policy proposals will be released for public comment.

The NHI scheme will be implemented parallel to a massive effort to strengthen the health system over the next five years, according to a confidential NHI policy proposal.

South Africa’€™s health system is already undergoing a transformation that will see a shift from the current hospital based curative approach focus to a community- and clinic-based primary health care system. There are many building blocks that need to be put in place as part of the process that will take many years to complete.

The confidential proposal explains that an NHI system will provide a mechanism for improving cross-subsidisation in the overall health system, with funding contributions being linked to an individual’€™s ability to pay while benefits would be in line with an individual’€™s need for care.

The government accepts that, in order to implement the NHI, there will have to be a parallel effort to improve the public health system, with the major focus on improved infrastructure, human resources and management.

Provincial consultations held in communities by Black Sash over the past year have found that health rights are undermined by an overburdened health service.

Community representatives and health-affiliated organisations reported a consistent picture of a national health system in dire need of redress.  

There are not enough clinics, doctors and nurses to meet patient demand and clinic hours are restricted ‘€“ leading to high travel costs, long queues and patients turned away from service points.    

Verbal abuse, discrimination, and the violation of patient rights especially in relation to confidentiality were widespread.  

Shortages of medication at clinics are common and painkillers are routinely handed out instead.   A severe lack of ambulances, undermining emergency care, was reported.   There is also widespread maladministration of patient records and referrals.  

Black Sash Advocacy Programme Manager Elroy Paulus says the Black Sash initiated the provincial workshops as there has been very little public engagement on the principles that should inform healthcare reform.

‘€œ85% of our population depends on our public health care system. It is these citizens’€™ values that should be driving the decision making process, and their experiences that should inform system reform.’€  

The Black Sash is aiming to share this information with government once the NHI policy has been released and public comment is invited.  

According to the Black Sash report, the overwhelming majority of participants supported the introduction of a tax funded NHI system on condition that it would be able to provide a substantially improved health care system, which is accessible to everyone.

Participants argued that sick people should be afforded the dignity of health care even if they cannot afford to pay for it.   They agreed that everyone who can contribute to the health system should do so, based on a proportion of their income.   They called for all people to have equitable access to health care.

Fidel Hadebe, spokesperson for the health minister, failed to confirm reports that the NHI proposal would be released this week.