Public Health and Health Systems

Preparing for National Health Insurance

Written by Health-e News

Turning the huge public health service ‘€˜ship’€™ around to get it ready for the National Health Insurance (NHI) scheme is both complicated and slow

Although few changes are visible to Citizen Average, government has been involved in a wide variety of policy and institutional reforms in the last 18 months, as reported by Health Director General Malebona Matsoso and UK Department for International Development (DFID) senior health advisor Dr Bob Fryatt in the 2012/13 SA Health Review.

 The aim of the NHI is to make quality healthcare available to all South Africans, so improving the quality of services at public hospitals and clinics is the obvious cornerstone.

 An ambitious audit of virtually all public health facilities – 3 880 in total ‘€“ was recently completed to assess standards, based on six markers including attitude of staff to availability of medicines. This is the baseline against which all future improvements will be judged. Facility Improvement Teams have already been to 1000 facilities to address some of the problems raised.

 The Office of Health Standards Compliance is soon to be set up, once the necessary Bill has been passed by Parliament. This not only sets norms and standards for health facilities, but also ensures that they are inspected regularly.

 In preparation, inspectors have been recruited and trained and by January, 171 institutions had been inspected. Central hospitals have fared best, while many district hospitals and clinics have failed to meet required standards.  

Much has been done to improve the quality of hospital managers, with new job descriptions for CEOs and 118 new CEO positions being advertised, 102 of which are now filled.

 A Leadership and Management Academy aimed at improving management was launched last October and has already held a five-day training session with new CEOs.

Gauteng hospitals are getting particular attention, with a World Bank project that is focusing on financial management.

 One of the big question marks hanging over the NHI is where all the extra healthworkers are going to come from to make it work. South Africa has once again turned to Cuba to train 1000 South Africans as doctors as well as to supply 95 Cuban doctors due to start work in 2013.

Since February, nurse education and training falls under the national health department in a bid to standardise and improve training. A Chief Nursing Office is to be appointed to develop a national curriculum.

Citizen Average is most likely to have come across ‘€œprimary healthcare re-engineering’€, which is the revving up of clinics and community centres. At present, services at this level are often so poor that people would rather skip to local hospitals.  

The re-engineering is mostly taking part in the 11 NHI pilot districts (one per province, but an extra two in KwaZulu-Natal funded by that province). It is based on three pillars:

* District Specialist Teams that include a paediatrician, gynaecologist, family physician, midwife and paediatric and PHC nurse, to advise district healthworkers. It is aimed particularly at improving the health of pregnant women and children.

* PHC outreach teams in each municipal ward, made up of community healthworkers;

* School-based PHC services to promote health services in schools, including assessment of students (eye, ear tests; TB screening etc) and health promotion.

Government has contracted some 500 private doctors to start providing services in the NHI pilots in under-served places.

Some R150-million has been allocated to the NHI pilot sites for the current financial year, doubling in 2013/14 and rising to R450-million in 2014/15. The pilot sites will be testing grounds for innovative ideas aimed at making public health service delivery better.

Government intends to make all health payments from a single, central fund so it is currently exploring how this should be funded and how it should work. The Treasury is considering a payroll tax and VAT increases, but will publish a paper later this year for comment.

The authors conclude ‘€œthere has been good progress in many areas but there is still considerable work to be done’€.

‘€œIt will take time for these major changes in the financing and delivery of services to impact on people’€™s lives.., Universal coverage [of health services] is no longer a dream for South Africa and if all players work together, it will become an increasing certainty’€. ‘€“ Health-e News.

Click here for the full report: District Health Barometer

Click here for the full report: SA Health Review

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Health-e News

Health-e News is South Africa's dedicated health news service and home to OurHealth citizen journalism. Follow us on Twitter @HealtheNews

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