South Africa’s NHI pilot project shows ‘mixed’ results

 ·26 Jul 2019

The successful implementation of the National Health Insurance (NHI) will rely on unified collaborations and effective political will, says health minister Zweli Mkhize.

The minister made the remarks during a media engagement on the Public Health Strengthening (Genesis) Report on the NHI. The release of the report comes a day after the release of the Presidential Health Compact signed by the Ppresident on Thursday.

The evaluation report was the collaborative effort of a consortium led by Genesis Analytics (Genesis), with support from PriceWaterhouseCoopers Advisory (PwC), the Centre for Health Policy (CHP) at the University of Witwatersrand and Insight Actuaries and Consultants (Insight) at 10 pilots projects across the country.

At the Presidential Health Summit held in 2018, government and key stakeholders agreed on the development of a Presidential Health Summit Compact.

It is a culmination of a collaborative effort by government, civil society, business, private providers, academia and health professionals to develop a plan that includes clear objectives, timelines, indicators and financial resources to effectively address challenges in the sector.

Addressing reporters, Mkhize said it was important to note that universal health coverage was largely supported by society.

“There are those who are concerned because of the impact it has on the way they are running their businesses. That’s not a big issue because we are [building] a system that will make everybody adjust,” he said.

Across the world, Mkhize said, the success of any system begins with political will.

“Without it, it doesn’t happen. For any of these things to happen, the system will need champions. Staff must be championed by people who know where we are going and what we need to do.”

Collaboration is another critical element in the implementation of the system.

“Working together to achieve better results creates a sense of a unified vision. It’s not only collaboration between government and outsiders, but also collaboration within government. Departments have to work together. Even in the Department of Health, sections have to work together.

“Someone asked last week why we have a war room in the Presidency [on NHI]. Well, that’s collaboration. That war room helps all departments come together and discuss NHI, so it doesn’t become the problem of the Department of Health. We are the implementing agents of this government programme. Collaboration is what will make or break the NHI,” Mkhize said.

Evaluating of Phase 1 of the implementation, the report in its findings and discussion notes that overall, the implementation of the pilot intervention had mixed success across the pilot district.

“None of the interventions can be considered ‘failures’, as all were implemented at scale. However, as with the implementation of any programme, there are important lessons to be learned, which can strengthen these programmes in the future,” notes the report.

Where successful, the panel identified a few common factors. Among these are strong political will, adequate human and financial resources for implementation, good coordination and communication, and good monitoring systems put in place at the time of implementation.

The interventions, highlights the report, to a great degree hindered success. These included inadequate planning, lack of resources, inconsistent communication, a lack of coordination where necessary and insufficient mechanisms to monitor progress to ensure course correction.

Read: Why the NHI is headed for disaster

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