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NHI – Fixing what’s broke

By Youlendree Appasamy


The challenges and opportunities that lie ahead for South Africa’s implementation of the National Health Insurance were highlighted at a colloquium held at Rhodes University earlier this term.

According to the Institute of Social and Economic Research (ISER), approximately 50% of the GDP allocated to health is spent on private sector health care, which caters for only 16% of the South African population. The other 50% caters for public health needs of the remaining 84% of the population. These statistics considered there is clearly a need for reforms to address the healthcare issues of the majority of South Africans; healthcare needs to be adequately provided to all socio-economic classes.

As Section27’s statement on the NHI says, “Health is a fundamental right, not an ordinary commodity.”

Health inequality is as much an issue as that of land and security.

National health policies have been undertaken by other countries, most notably the National Health Service in Britain. Interesting parallels can be drawn between the policies and contexts of Britain and South Africa in their respective implementation of national and broad-reaching health policies.

However, as much as South Africa can obtain advice and look to previous national health policies, the question remains whether, within our unique context, NHI is a tenable feat.

Mail & Guardian writers, Mia Malan and Ina Skosana have been following the issue. They write that

Minister of Health, Aaron Motsoaledi, called the healthcare system in the Eastern Cape, “broken, inhumane and collapsed”.

This, following the Treatment Action Campaign and Section27’s investigations and recommendations into the provision of healthcare in the province.

The OR Tambo District is the Eastern Cape’s NHI pilot site and last year ordered the rebuilding of eight clinics and two hospitals in the District.

Despite the worsening state of public healthcare in the Eastern Cape (as these findings are a testament to), the NHI provides, if anything, a strong political will to change the inequity that exists in healthcare provision in South Africa. Challenges facing the current public healthcare system, such as infrastructural and equipment woes, staff shortages and lack of access to specialised care will still remain challenges for the NHI. It will not be a silver bullet that solves South Africa’s inequitable healthcare system. It will, if implemented by dedicated and committed individuals and institutions, however, be able to create a foundation from which the most vulnerable and marginalised can access their fundamental right to quality healthcare.

The colloquium aimed to address public health concerns from a historical and political perspective, with research findings conducted by ISER. It released a document outlining the first 18 months of the Department of Health’s engagement with implementing NHI, via various pilot sites. These sites are located throughout South Africa. Depending on their progress, additional reforms will be made. Essentially, these act as a barometer of the effectiveness of NHI (among other healthcare barometers).

Additional links:

Read up on the Eastern Cape Health Crisis here.

Equal access to healthcare and HIV/AIDS treatment


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