Public Health and Health Systems

NHI pilot districts announced

Written by Khopotso Bodibe

Eleven districts across the country have been chosen as launch pads for a future National Health Insurance (NHI) system. One district per province, with the exception of KwaZulu-Natal, from where three districts have been selected, will pilot the NHI system.

9518e639bbfd.jpgHealth Minister, Dr Aaron Motsoaledi, announced the districts that will launch the onset of the National Health Insurance system, whose phasing in starts on the 1st of April, at a press briefing in Pretoria this week.

‘€œIn the Eastern Cape, it’€™s OR Tambo with 1.3 million inhabitants. In Mpumalanga, it’€™s Gert Sibande with 944 000. In Limpopo, it’€™s the Vhembe district with 1.3 million people. In Northern Cape, it’€™s Pixley ka Seme with 192 00 people. In KwaZulu-Natal, it’€™s Umzinyathi with 514 000 people and Umgungundlovu with 1. 066. The reason that we put two in KZN is that in terms of the population, it’€™s the second biggest after Gauteng, but, in terms of size and rural districts, it’€™s the most problematic in the country. In the Western Cape, it’€™s the Eden district with 558 000 people. In the North West, it’€™s Dr K Kaunda district with 807 000. In the Free State, it’€™s Thabo Mofutsanyane district with 832 000 people. In Gauteng, Tshwane district, with 2. 6 million people ‘€“ that makes it the biggest district in the whole country. If you remember, last year, when they merged it with one other rural district, Tshwane became the biggest metro. We thought it will be good for piloting because it’€™s a rural district plus a very urban one put together and we want to see how it works’€, he announced.          

The pilots will serve about 10 270 000 people or 20% of the country’€™s population. National Treasury has allocated R1 billion for the pilots and additional money is coming from international funders. KwaZulu-Natal has added a third district onto the two that have already been selected by the national Health Department. A total of R110 million has been allocated by the province from its own budget for this purpose.

‘€œKwaZulu-Natal has to do it better and faster because all the health indicators in the country are low because of KwaZulu-Natal. We are the second largest province, but with the heaviest burden of disease. We are taking a third district being Amajuba with a population of about 510 000. One of the things that we think we could get out of that district is the possibility of quick wins because it is the second lowest in terms of HIV prevalence after Mzinyathi. And, also, the leadership in that district, we think could actually assist us to compare quick wins as opposed to Mgungundlovu, which is one of the three triplets in the province with the burden of disease, HIV, included’€, explained Dr Sibongiseni Dhlomo, the MEC for Health in KwaZulu-Natal.          

Health Minister, Dr Aaron Motsoaledi said part of the objectives of the NHI pilots is to reduce the burden of disease and congestion in hospitals in the selected districts.

‘€œThe pilots will focus on the most vulnerable sections of society across the country. They will be intended to reduce high maternal and child mortality through district-based health interventions. They will strengthen the performance of the public health system in readiness for the full roll-out of NHI. We want to emphasise that the pilot is to lay the building blocks for NHI’€.

‘€œIt’€™s also meant to strengthen the functioning of the district health system. The objectives of the pilot again is to assess whether the health service package ‘€“ the primary health care teams and strengthened referral systems will improve access to quality health care services, particularly in the rural and previously disadvantaged areas of our country’€.

He said the pilot programme will also test the viability of District Health Authorities that the NHI system envisages to establish as custodians of the health system in the country’€™s 52 districts.  

‘€œWe also want to test the ability of the districts to assume greater responsibility associated with purchaser-provider split required under NHI. If NHI is to start in full force tomorrow which district will be ready to assume responsibility without us at the centre having to do things for them? Can they stand alone and acquire things within the district? We also want to assess the cost of introducing a fully-fledged District Health Authority as a contracting agency and implications for scaling up such institutional and administrative arrangements throughout the country. Each district must be able to be a contracting agency for NHI’€.      

The districts were selected based on a number of factors, including socio-economic data, such as income levels, access to private medical aid and access to water, sanitation and electricity.      

‘€œThe selection criteria that were utilised were, firstly, the demographic data in terms of population numbers from various studies, the socio-economic conditions, health service performance in that district, district management capacity and, of course, the burden of disease’€¦ in that district, how much of HIV/AIDS and TB and all the other burden of disease that affect the country’€¦ how much is it in that particular district?’€, said Motsoaledi.

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Khopotso Bodibe

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