South Africa’s new National Health Insurance (NHI) scheme is set to be introduced in several stages and not all at once, says health minister Joe Phaahla.
Responding in a recent written parliamentary Q&A, Phaahla said this is necessary given the magnitude of reforms the new system will introduce, with a programmatic approach required based on the financial resources available.
It is important to recognise that reforms of the magnitude anticipated in the NHI Bill need to be phased in over time, he said.
The health minister noted that phase 1 of the NHI implementation will:
- Continue with the implementation of health system strengthening initiatives, including alignment of human resources with that which may be required by users of the Fund;
- Include the development of National Health Insurance legislation and amendments to other legislation;
- Include the undertaking of initiatives which are aimed at establishing institutions that must be the foundation for a fully functional Fund; and
- Include the purchasing of personal health care services for vulnerable groups such as children, women, people with disabilities and the elderly.
Phaahla said the current status and availability of resources and capacity are only a starting point for the new NHI.
“The resources available for the establishment of the reformed health system, where providers are paid by the fund, are the current resources of the entire public and private health sectors. This includes all health establishments, personnel and technologies currently in use.
“The capacity to roll out the reforms described in the NHI Bill starts with the commitment and stewardship of parliament to improving the health system for all. The leadership will be provided by the National Department of Health. To this end, the minister of Public Service and Administration has approved a special transitional NHI Branch in the Department of Health to serve as the incubator for the Schedule 3A entity.”
He added that the new posts will initially be financed through earmarked funds from National Treasury.
State of South Africa’s hospitals and staff
The health minister was also asked to comment on the status of the country’s public hospitals and personnel, and whether they are fit for the introduction of the NHI.
Ultimately, private medical aids and hospitals are set to be scrapped under the new system, meaning state infrastructure will have to rapidly expand and scale services to cope with treating all South Africans.
“The state of public hospitals and clinics varies widely from immaculate to extremely poor. The department maintains an infrastructure condition assessment and all provinces submit User Asset Management Plans (UAMPS) annually as required by the Government Immovable Asset Management Act (GIAMA),” Phaahla said.
“There is a quality improvement programme in nineteen locations covering over 100 establishments as we have reported to the house in the recent past. Private establishments also vary in their condition.”
He added that the current health system suffers from shortages of professional personnel in all categories.
“The biggest challenge is the inequitable distribution of personnel but there are nominal shortages. The public sector budgets allocated for conditions of employment are fully committed so there is extremely limited room for the recruitment of additional personnel.
“It is for this reason that the NHI envisages a ‘universal’ system for everyone in the country where the NHI Fund purchases services from both public and private providers.”