South Africa takes next steps towards the new NHI

 ·23 Oct 2019

The Department of Health is taking its next steps towards the introduction of South Africa’s new National Health Insurance (NHI).

Speaking at the International Society for Quality in Health conference on Tuesday (22 October), health minister Dr Zweli Mkhize said that his department is now focusing on the establishment of standardised high-quality care across all levels of the health system.

To achieve the required standards of care, Mkhize said his department would follow the findings and recommendations of a number of external reports including:

  • The South African Lancet Commission;
  • The Presidential Health Compact
  • The Health Market Inquiry Report
  • The findings of the Office of Health Standards Compliance (OHSC).

Following this, Mkhize said that government plans to produce a ‘standardised approach to quality improvement for the health sector’, which will be monitored and measured systematically across the country.

“South Africa has made great strides since the end of apartheid in 1994 in improving overall population health and well-being, reflected in increased life expectancy and reductions in mortality rates,” he said.

“The rights-based Constitution and other enabling legislation and policies, strong institutions and available resources provide a strong health system foundation for universal health coverage.

“However, South Africa’s democratic government faces significant challenges in providing high-quality healthcare.”

Mkhize said that these challenges include:

  • The ‘quadruple burden’ of disease (maternal, newborn and child health; HIV/AIDS and tuberculosis (TB); non-communicable diseases; and violence and injury);
  • The racialised nature of poverty levels and unemployment rates;
  • Huge spatial inequalities;
  • Inequities among provinces, between urban and rural areas, and between the public and private health sectors;
  • Inadequate resources (human, financial and physical);
  • Poor management and governance of the health system;
  • Gaps in ethical leadership and lack of accountability.

Doctor shortage

Government’s ability to provide standardised and high-level care across the healthcare sector is one of the major sticking points of the new NHI, with some opponents warning that government won’t be able to provide the same level of care provided by private medical schemes.

This issue is likely to be compounded by the fact that the public health sector is facing a shortfall in medical personnel.

In a recent parliamentary Q&A session, Mkhize said that the primary reason for this shortage is that the public health sector budget has not increased in real terms for the past 10 years.

This has impacted the number of staff that can be appointed, he said.

Mkhize added that the demand for health services in the country is increasing while there is no additional funding to address the change, which results primarily from immigration into the country and the increasing burden of disease.

“The shortage of health professionals is a global phenomenon and is more pronounced in low and middle-income countries as health workers are more likely to migrate to upper-middle-income countries in search of better living and working conditions,” he said.

However, Mkhize has previously indicated that the Department of Health has a number of plans to ensure that the required skills are in place for the successful implementation of the National Health Insurance (NHI).

Mkhize said that this will include training up new doctors, and incentivising doctors currently in the private sector.

“You actually just train the people and get the people with the necessary skills. The skills are not only locked in the private sector,” he said.

When asked about how the government plans to incentivise doctors in the private sector to work under the NHI in the public sector, Mkhize said that the answer was to ‘pay them’.

Read: The role of private hospitals and doctors under the new NHI

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