Doctors plan to leave South Africa because of the NHI

Trade union Solidarity has published its latest report on the National Health Insurance (NHI), showing that a significant number of healthcare workers plan to leave the country due to concerns around the new system.

The report was compiled by the Solidarity Research Institute and is based on an opinion survey conducted among healthcare workers. They were asked to share their knowledge and insight on opinions concerning the NHI.

The survey drew a response from 1,410 healthcare workers in three separate studies conducted in 2018, 2019 and 2021.

Across the studies, the overarching response from healthcare professionals is one of uncertainty and mistrust around the NHI, with general sentiment towards the system being overwhelmingly negative.

“Almost all the respondents have serious concerns regarding the state’s ability to manage and administer the NHI,” Solidarity said. “The total administration and management of funds and decision-making will be in the hands of the state.

“Most are seriously concerned about the fact that the state can determine and enforce tariffs, place of work, type of diagnostic tests and type of medication and treatment.”

Solidarity said that respondents’ opinions are likely shaped by the observed mismanagement and maladministration at institutions such as Eskom, the SAA and the SABC. The NHI will be significantly larger and more complex, must serve a population of more than 55 million people, and will have to manage and execute many contracts, it said.

Emigration

When asked whether they are already taking steps to emigrate because of the NHI plans, 13.7% of the respondents said they have already started the emigration process.

However, once the NHI is in effect, the number of healthcare workers intending on leaving the country increases to over a third (35.9%). By contrast, only 15.3% of healthcare workers are confident they will stick around once the NHI is in full effect.

Between 2012 and 2017, the government rolled out NHI pilot projects in 11 health regions across South Africa, Solidarity said.

“These projects cost about R4 billion, and it was found that none of the NHI pilot projects contributed to improving health care. The main reasons for this were poor infrastructure and equipment, vacancies and too few health care workers, and poor financial planning.”

55 out of 75 medical practitioners who served in 17 clinics participated in a Department of Health study after the trial run to determine their experiences.

More than 60% of them were convinced that the NHI would not improve the quality of service delivery, and most of them indicated that they would not want to work under the NHI.

Solidarity said that four factors might lead to the destabilisation of the healthcare sector in South Africa:

  • A shortage of specialists, doctors, nursing staff and other healthcare workers;
  • Financial management of the NHI;
  • Purchasing and distribution of medicines and equipment;
  • Maintenance of infrastructure and equipment.

“In recent years, the media has been inundated with reports of shortages of well-trained staff, doctors and specialists, equipment shortages, lack of maintenance of equipment and infrastructure, and negligence claims of between R80.4 and R98 billion that have been instituted against the state from the public health care sector.

“Although it has been argued that some of the claims involve corruption, service delivery has been negatively affected, especially if the pattern were to increase.”

One of the many troubling questions is for whom medical practitioners will work, Solidarity said.

“Will everyone be employed by the NHI, or will they have to enter into compulsory contracts with the state? Almost 86.6% of the respondents indicated that medical practitioners should be able to work for themselves in private practices and that it should be their own choice for whom or where they work.”

Not in favour 

More than 85% of the healthcare workers who participated in the study indicated that the implementation of the NHI would lead to healthcare workers leaving the country.

“South Africa will therefore be left with a shortage of medical staff, which implies that quality and specialist healthcare services will be extremely scarce. All South Africans will suffer because of this, and access to healthcare will consequently diminish instead of healthcare becoming more accessible,” said Nicolien Welthagen, a senior research psychologist at Solidarity.

Healthcare workers have indicated that they have no confidence in the government or its ability to manage such a system effectively. According to them, this will destabilise healthcare in South Africa, and it will be detrimental to the quality of care provided.

“Healthcare workers have specifically pointed out that the government is incompetent and that a system such as the NHI will only create another opportunity for further corruption by the government as this will give them access to more funds that can then be looted.

“Healthcare workers are also of the opinion that the Covid-19 pandemic made it abundantly clear that the government does not have the ability to manage a system of this magnitude,” Welthagen said.

The report also shows that healthcare workers believe that the government should focus on improving the current public healthcare system. Cooperation with the private sector should be encouraged rather than centralising and controlling the entire healthcare sector.

Most healthcare workers do not want to work with or for the government. They do not trust the state and do not want to be accountable to the state or be told how to do their jobs.

“The fact that so many healthcare workers could leave the country is a major cause for concern. This will plunge South Africa’s healthcare into a crisis for which there will be no solution. We cannot allow the state to continue with its plans to implement the NHI and thus alienate and push away our healthcare workers,” Welthagen said.


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Doctors plan to leave South Africa because of the NHI