Health tax only way to fund NHI scheme

10 August 2011 - 02:58 By HARRIET MCLEA and NASHIRA DAVIDS
Dr Aaron Motsoaledi
Dr Aaron Motsoaledi
Image: KEVIN SUTHERLAND 09/06/2009

The highly-anticipated National Health Insurance scheme moves a step closer to reality when it comes before cabinet today.

A policy document from the Department of Health - which has been rejected twice already over questions about its affordability - will, if it is accepted, be unveiled tomorrow.

After years of discussion and controversy, Health Minister Aaron Motsoaledi said in an interview yesterday that he was determined that the policy document be approved.

"We believe it's the final time," he said.

"I feel very relieved because it is long overdue. People have been waiting. People will have to read for themselves and it will start a big public discourse."

Offering only a broad description of what the NHI policy document contains, Motsoaledi said it would provide "the definition of what actually NHI is - what animal it is".

Although details of how it will be funded was the "domain" of the Treasury, he did say: "There will be a glimpse of what we are thinking in terms of the financing of NHI."

This includes a possible health tax.

"I don't see any other way in which government systems can be financed . no person can opt out of [NHI]".

Although Motsoaledi was reluctant to put a price tag on the scheme, economists, who have been critical of it, have estimated the cost at 28% of total government spending. A discussion document on the NHI by the ANC put the cost at R376-billion in 2010 financial terms if phased in over 14 years.

Other details expected tomorrow include what the NHI hopes to achieve and "how will it affect the healthcare system in the country and how it will affect individuals and households," Motsoaledi said.

This week's announcement comes against the backdrop of a scathing report by international organisation Human Rights Watch on the country's maternal mortality rate.

The report, titled "Stop making excuses: Accountability for maternal healthcare in South Africa", was released ahead of Women's Day and revealed that:

  • The country's maternal mortality rate had more than quadrupled in 10 years - from 150 deaths per 100000 live births to 625; and
  • HIV/Aids was responsible for 43% of all deaths of women giving birth in the country.

The report also included harrowing allegations of abuse - including slapping and pinching - by nurses at clinics and hospitals in the Eastern Cape, with some of the 157 women interviewed claiming that their cries for help were ignored for hours.

Motsoaledi, who said he was shocked by the report, admitted that understaffed maternity wards and poor nursing were to blame for many deaths of mothers and infants during childbirth.

He said there were enough gynaecologists in the country, but pointed out that most of them were in private practice.

"At Park Lane Clinic [in Johannesburg] alone you'll find 27 gynaecologists. If you take Mpumalanga, Limpopo and North West and add [state hospital gynaecologists] together you'll never find that many," he said.

Although the report showed that 43% of maternal deaths could be blamed on HIV/Aids, Motsoaledi revised that figure up to 49%, citing research conducted between 2008 and 2010 by the National Committee on Confidential Enquiries into Maternal Deaths.

However, Motsoaledi was confident the figure would decrease.

"The present study, which takes the figure up to 49%, includes the two years before we introduced the new treatment protocols . The next three years - 2011, 2012 and 2013 - will indicate whether the steps we have taken are reducing maternal mortality," he said.

The Health Department's new treatment protocol was implemented in April last year.

It involves placing all HIV-positive pregnant women with a CD4 count of 350 on treatment, and beginning treatment to prevent mother-to-child transmission in the 14th week of pregnancy.

Motsoaledi said healthcare facilities were already indicating that HIV maternal mortality rates have gone down.

"The causes of maternal mortality cannot be fought in hospital, then it is too late.

"We will try our best in the hospital but we need our communities to stand up," he said.