At a gathering of health professionals in Cape Town, recently, the issue of improving working relations and trust between the private and public health sectors was raised as very important towards the establishment of the National Health Insurance (NHI). Director-General of the National Health Department, Precious Matsoso, says government is working hard to improve on this.
‘We need to start building trust, we need to start being transparent and we need to be accountable. Both the public and private sectors are accountable to the South African public. So, the question is: How do we do it? The very first step in building the trust is making the information available and meeting our commitments because it is not fair to make empty promises. If we can start with those small things, we can also regain public confidence’.
Chief Executive Officer of the Human Sciences Research Council (HSRC), Dr Olive Shisana, says the private sector’s lack of trust in the NHI process stems back years ago.
‘We still have a private sector that is refusing to implement NHI from 1926. Some of the doctors did not want to become employees of the state and that is the problem’.
Shisana says the reluctance of the private sector to work with government on the NHI fails to recognise the long-term benefits for health care in the country.
‘If you have NHI and have everyone working under NHI, it should be possible to find a formula that will allow them to live a comfortable life while providing health care to all people in the country regardless of their income. One of the other challenges is to ensure our public sector is functioning adequately. It should not matter if it is a private or public sector facility if the standards are the same on both sides’, Shisana says.
She says the NHI’s objective is to make quality health care accessible to all South Africans, irrespective of how deep one’s pocket is.
‘If you need health care you ought to be able to get health care at that particular time and you should get good health care from public or private facility. And it should be financed from the National Health Insurance Fund’, she says.
But the Chairman of the Global Health Workforce Alliance, Lord Nigel Crisp, says there are many reasons why the private sector could be fearful. High up on the list is the slice of the private sector’s clientele. However, Lord Crisp says private sector co-operation with government – sooner rather than later – is vital to cushion the long-term effects.
‘Some of the fears would be that they will end up being compromised in some way. They should be fearful because the government is very determined in South Africa to making improvements and that, over time, will affect the private sector. So, it is in the private sector’s best interest to become partners with the public sector by working together to the benefit of the whole population’.
Lord Crisp says public and private health sector collaboration under the NHI will go a long way to help the country address challenges such as HIV/AIDS.
‘You do have the huge problem of HIV/AIDS and I think anything you do in health care in South Africa has got to take account of the impact of HIV/AIDS. You have the burden of HIV/AIDS that will be with you for a very long time. There is another generation or so to face it. That is why you need everyone to pull together and bring their expertise to the party’, says Lord Crisp.
The NHI system will be phased in over time. It will first start in 10 districts that are yet to be named.