Health practitioners feel ignored while Ramaphosa plans to forge ahead with NHI

Health-care professionals feel ignored by the government after submitting proposals for a workable and smooth implementation of the National Health Insurance (NHI), which President Cyril Ramaphosa said this week would proceed this year.

The Universal Healthcare Access Coalition (Uhac) submitted its proposed framework for health-care reform, stating it was practical, evidence-based and could be designed to work with the country’s tight finances instead of raising taxes.

The group of health professionals formed Uhac after Ramaphosa's invitation for proposals of workable solutions to advance quality and affordable health care.

Ramaphosa said in last week’s state of the nation address (Sona) that the government would proceed this year in the preparatory work for establishing the NHI.

Uhac steering committee member and convener of the Progressive Health Forum Dr Aslam Dasoo said this was a sign that the state of health care would continue to crumble while government tries to figure out how to fund and implement an “unworkable NHI”.

“The Sona promised little more than policy stagnation and an untenable status quo. Uhac has developed a concrete, workable reform pathway to address the failures in the public and private health-care systems and achieve a high-performing system of universal access and coverage,” he said.

“What has happened is that while [government] was busy with the NHI they neglected the two major systems in health care [public and private], resulting in a decline in access to services and service quality and growth in the private sector, and prices have gone up.”

The proposals include free services. These are now available in the public sector but face poor service quality and accessibility issues. In addition, the private sector and medical schemes are now accessing prescribed minimum benefits.

In contrast, the NHI aims to provide universal free services at the point of care, financed through general taxation, with the state determining the services to be provided, said Prof Alex van den Heever.

Uhac proposes free services for income-compromised households while improving service quality in the public sector and that medical scheme benefits should be covered without co-payments, he said.

“This is the version of both, but supported by risk-equalisation, which solidifies and protects the coverage of mandatory minimum benefits. Not everything is free. Medical scheme members are paying for it through their contribution but as a point of service, essential health care should be free so that you don’t face a barrier of access.

“We want to make sure the system is structured in such a way that you are covered if you need the service,” Van den Heever said.

Another issue raised by Uhac is governance of the health-care system, which is politically influenced, leading to weak leadership structures due to wrong appointments.

The NHI proposal suggests no change, as it proposes a centralised government with political appointments in key leadership roles, said Van den Heever.

“The Uhac proposes decentralising governance with independent supervisory boards for hospitals and district health authorities and in this sense, independence means independence from the political appointments in government. Once strategic policy has been defined or a legislative framework has been established, there is no need for executive interference in the delivery of any aspect of a public service.”

Uhac steering committee member and chair of the SA Medical Association Dr Mvuyisi Mzukwa said the NHI Act was not universal health care but a vehicle to reach that goal. However, it could not get there due to the challenges outlined.

“There is confusion, even by the minister of health, that if one doesn’t want the NHI then they don’t want universal health coverage proposed by the NHI. Not true. We do want universal health coverage but make sure what is being proposed takes us there.”

Mzukwa said the act was “deeply flawed” as it did not resolve fundamental problems and weaknesses in the system.

Dasoo said as health professionals they have seen how the health system has deteriorated and hoped the proposals would be considered.

While they were ignored by government, they would rather turn to the public to bring awareness of their workable solution, with the hope the government would be pressured to consider implementing it. 

“This proposal synthesises all the concerns raised. It’s ready to go and the government can plug and play. We assumed when we went to the president that this was enabled, but the response from him and the health minister was unhelpful. There is no other plan that works for the system. Everything else, including the NHI, creates a risk for the ordinary person without private health care, the medical aid members and the private health-care practitioners.”

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