SA to import thousands of docs

Shisana, who heads a ministerial advisory committee helping to design the compulsory medical insurance scheme, told the Sunday Times on the sidelines of the ANC's national general council that the scheme might also need to recruit nurses abroad in the initial phase.

Zweli Mkhize, premier of KwaZulu-Natal and chairman of the ANC's health committee, announced the launch date this week, saying the scheme would be phased in over 14 years from 2012.

He said every citizen resident in South Africa would be enrolled automatically and would contribute through a variety of special taxes and levies, but no-one would be obliged to use the NHI's services.

He said that, in its first year, the scheme would cost R11-billion more than the R117-billion already in the government's health budget for 2012.

This is equivalent to about R220 that year for every man, woman and child, but much more for the relatively few corporate and individual taxpayers who support the economy.

Shisana, a doctor, president and chief executive officer of the statutory Human Sciences Research Council and a former director-general of health, said her organisation would be responsible for monitoring the management and quality of the scheme.

"There are many doctors in South Africa who are working hard ... but they are mainly in urban areas, and the need is mainly in rural areas," she said. "At least in the beginning, we will have to bring in more doctors from outside the country. We've done the gap analysis - it will be thousands, not tens of thousands, but certainly thousands."

She declined to say which countries the government would approach to fill the gap. However, she said there were many countries producing more doctors than they needed.

"The priority goes to expanding the services in the public sector to make sure it can provide the services the NHI will need. Then, in the event that we don't have the facilities in the public sector, we will have to look for alternatives in the private sector," she said. "This is a long-term investment from which everyone will benefit eventually."

Though all South Africans will start paying for NHI membership in 2012, the scheme will be piloted first in under-serviced rural and urban areas.

The team setting up the system is still negotiating with minister of finance Pravin Gordhan's Treasury about where and how to find the additional money that will be needed. The government will continue to contribute what it does now.

The additional cost will come from a combination of a special additional VAT charge, a tax surcharge, a special levy on pay-as-you-earn taxes and the abolition of tax rebates for medical aid contributions.

Shisana said planners were looking at a real-time "risk engine", which would monitor all spending from the massive NHI fund and would be able to identify overpayment for services or materials, and many other potential forms of fraud and corruption.

"As we bring in the NHI, it is very important that we mitigate the risks that are associated with such a huge financial project."