The recent announcement National Health Insurance Bill (NHI) has caused alarm amongst government employees in rural areas because many believe it’s only a way to financially boost those in power.

Improve the existing system

A recently employed Technical and Vocational Education and Training (TVET College) lecturer, who wished to remain anonymous, is under the Government Employees Medical Scheme (Gems) and believes the country is not ready to implement the NHI with the current health care system in rural-based facilities.

“Our government has dismally failed to maintain its state-owned enterprises because of corruption. If [the NHI] is meant to solve the inequalities in the health system, the government should prioritise improving services offered in public hospitals for those who can’t afford medical aids and leave us [to choose] medical services from private hospitals.”

The TVET lecturer adds that having a medical scheme is a dream come true for many civil servants. 

Too soon

Saphokazi Makhetha, a government employee in Flagstaff, says she doubts that many of the Eastern Cape facilities will meet the required quality standards by 2026. 

“I think 2026 is too soon to have health facilities meet the compliance standards [of the NHI],” she says. 

“Our health facilities, especially in rural areas, are still in dire conditions. I once heard that there are facilities identified to pilot NHI but even there, there isn’t much difference.  The reason we opted for services offered by the private hospitals, even though medical aid schemes are expensive, is to access quality health care which we don’t receive from our state health care facilities.”

Makhetha says she welcomes the implementation of NHI only if services provided will be exactly like the health services at private hospitals. 

Long queues, unavailability of medicines, staff attitudes, unavailability of doctors, and poor infrastructure remain the biggest challenges experienced in public health care facilities, Makhetha says, and it is why she opted to pay expensive medical aid schemes.

Support for the NHI

Despite criticism about the NHI, the South African National Aids Council (SANAC) civil society forum applauds the introduction of the Bill.

“We’re happy, we are in full support and we’re ready to engage in this journey. As a society, we’ll debate this bill to ensure it reflects our views of what universal health coverage should be in line with Section 27 of the South African constitution,” says Mabalane Mfundisi SANAC resource mobilisation committee co-chairperson. 

But Bomikazi Mhlongo, who works for a local non-governmental organisation (NGO), the Flagstaff Community Advice Centre, says government should improve working relations with NGOs because they work closely with people on the ground and this could improve the public participation regarding the NHI. 

“The Bill is meant to close inequality gaps between the rich and the poor in the country, as an NGO we are always in support of programmes that aim to alleviate the lives of ordinary rural-based citizens, but the NHI seems impossible to implement especially in the Eastern Cape Province,” Mhlongo – Health-e News

An edited version of this story was published by Health24.