Speaking yesterday (THURS) at the opening plenary of the National Health Assembly McIntyre, who is also a key NHI advisor to the health minister, reiterated that NHI was about the comprehensive reform of the health system.

She said her key concerns while establishing NHI was the human resources constraints, the underfunding of the NHI pilot sites by Treasury and the ‘€œenormous pressure to protect the positions of the high income groups and private sector profits’€.

‘€œR11-million per pilot district. You can’€™t do anything with that to rebuild health services, it must be funded properly,’€ she said.

She said the vision of the NHI was ‘€œto create a universal health system that is built on the principle of social solidarity by helping to fund health care that is accessible to all and not only those who have the ability to pay.

‘€œIt can no longer be a health system that only delivers if you have the ability to pay,’€ added McIntyre, of the University of Cape Town.

Although these rights were embedded in the Constitution it has not been realised.

McIntyre said government would fund the NHI via a tax funded system whereby money would be put in a pool and used to make sure anyone who needs health services can access a comprehensive basket of services for free at the point of care.

However, she said, the starting point for NHI had to be at the service delivery side and not so much the money side at this point, even though more money was needed.

‘€œWe need more money, but it is important to focus on the first part and rebuild the public health system. In the 1990s public health services were underfunded despite HIV and it is not surprising that matters have deteriorated,’€ said McIntyre.

She outlined a number of activities that were currently taking place as part of the establishment of NHI. These included an audit of all health facilities in the country around indicators such as the state of buildings, the need for more facilities, equipment, human resources and drug supply.

Another involved an audit of the skills and qualifications of managers at facilities and hospitals, as well at district level, providing additional training where required.

McIntyre said measures were being developed to move decision-making authority to managers allowing them to authorise among others the appointment of staff or the repair of a toilet.

In terms of quality of care, the department was establishing the Office of Health Standards Compliance with facility improvement teams working on the ground to address and solve problems.

‘€œSo, there are many different initiatives going on with a fundamental realisation that there needs to be an improvement in services at primary health care level,’€ said McIntyre.

In terms of the funding mechanisms McIntyre said it could involve an NHI Fund -an organisation that was a public entity, with autonomy, but accountable to Government.

Its main role would be to pool money into a single entity and from that buy pool services for all.

‘€œSo, it would be actively ‘€˜purchasing’€™, taking responsibility for looking at the health care needs of the population and using the money to ensure that good, quality services are actually available.

‘€œIt would change the way in which providers are paid and could involve the purchasing of services from the private sector, where the majority of doctors are working,’€ said McIntyre.

She predicted that the major areas of contestation would be around the funding of NHI, the issue of co-payments and the structure of the NHI Fund.

McIntyre said the Green Paper did not address the funding of NHI as Treasury had insisted on taking responsibility. Treasury had already missed the April deadline for a promised discussion paper, but it was likely to propose either increasing allocations from a general tax or increase tax in some areas such as VAT or personal income tax and taxes on employers.

McIntyre said co-payments undermined the vision of the NHI and that this was being presented in the Green Paper, but contradicted in another section where it said services would be free.

In terms of the funding of the NHI Fund, the Green Paper also presented two contradictory positions ‘€“ one being a single fund which pooled all the money, the other a multi-payer system which gave the medical schemes a piece of the pie.

The National Health Assembly brings together government representatives, community organisations, trade unions, social networks, individuals and community health workers with health activists, civil society organisations, academics, and health professionals from across South Africa.