South Africa's quest for universal healthcare coverage has reached a crucial juncture.
Amidst recent legislative developments regarding the National Health Insurance (NHI) Bill and the emergent debates around the future health services in South Africa, our collective aspiration for universal healthcare access and a healthier more productive society remains consistent across all spheres of healthcare and industries.
The NHI intends to provide equitable access to quality healthcare services for all health citizens, but the challenges in achieving this goal are notably substantial. Within these challenges, Private Public Partnerships (PPPs) have emerged as a strategic tool to strengthen the healthcare system in South Africa.
According to the World Health Organisation (WHO) and World Bank Group, 400 million people worldwide do not have access to essential health services and 6% of people in low- and middle-income countries are tipped into or pushed further into extreme poverty because of health spending.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in May 2023 called for a substantial increase in investments in health and health systems to get back on track towards the Sustainable Development Goals. Furthermore, the WHO also states that the private sector plays an important role in most of the world’s health systems with this s role expanding in many countries.
The WHO, the Organisation for Economic Co-operation and Development (OECD), and the World Economic Forum (WEF) have all highlighted the role of the private sector in achieving equitable, affordable access for citizens across the globe and recognized the potential value of PPPs in healthcare in delivering healthcare services efficiently and effectively.
PPPs are the ideal model for the attainment of universal healthcare in South Africa, with collaboration across the sectors throughout the value chain providing benefits in the following ways:
1. Expanding Access: One of the primary objectives of NHI is to extend healthcare access to underserved communities, the employed but uninsured population, as well as the informally employed. Commercial partnerships models under the auspices of the Medical Scheme Act have unlocked access to care for the vast number of public sector employees, providing cover for over 2.8 million South African public sector employees and their families. Furthermore, the introduction of telehealth, such as HelloDoctor, has expanded access in remote areas, providing convenient and cost-efficient access to health.
2. Improving Service Quality: The scale, competition and accountability inherent in PPPs can drive healthcare providers to deliver better care to meet outcome targets, resulting in enhanced service quality and efficiency.
3. Innovation and Technology: In driving a competitive edge, innovation and advancement in technology are key to significantly improve end consumer experience, wellbeing, diagnostics, treatment, and overall healthcare outcomes. Healthcare administrator organisations have investment heavily in technology and artificial Intelligence, delivering advanced healthcare processes at scale with the added benefit of a positive user experience and health outcomes.
4. Reducing Wait Times: A focus on reducing the long wait times experienced by the majority of South Africans when seeking medical care is critical. Telehealth platforms like HelloDoctor provides expert medical advice to patients on their mobiles. Piloted in various community Health Centres waiting rooms in Gauteng and the Western Cape it has assisted in reducing high patient load and waiting times in public clinics in these areas.
5. Economic Growth: With a diverse direct and indirect supply chain, PPPs have the potential to stimulate economic growth by attracting private investment and creating job opportunities. Providing a positive cascading effect on the nation’s overall well-being.
South Africa has a rich history of PPPs which have delivered significant economic value. Learnings from developments in key sectors, such as energy, water, and rail, where public and private stakeholders are partnering to address challenges and implement long-term solutions can be applied.
Successes such as those seen in the Lesotho Highlands Water project, the Gautrain Rapid Rail Link, Airports Company South Africa, and most recently the implementation of the Renewable Independent Power Producer Programme all bear testament to the opportunities that exist.
We have seen these successes in our local pharmaceutical sector where government procures essential medicines from private manufacturers or distributors. These PPPs have been vital in ensuring the availability of medications to combat diseases like HIV/AIDS and tuberculosis. Furthermore, entities like the South African National AIDS Council (SANAC) brought together government, civil society, and private sector to create a collective response to HIV, TB, and STIs, alleviating the social burden of HIV and AIDS on the South African population. These collaborations have facilitated access to critical medications, contributing to the management and control of major diseases and have also helped reduce drug costs and improve the efficiency of medicine supply chains.
These examples highlight the rich opportunity that exists for the sector to partner and help move towards a common goal of delivering more healthcare to more South Africans for less. Our position on NHI has always focused on the importance of putting people at the centre of this discussion and, in doing so, prioritising the importance of PPPs in enabling universal healthcare. Government wishes to enhance the lives of its citizens, and partnerships with the private sector mean that they can de-risk their ambitious goals. The private sector wants to invest in capability, skills, and assets that allow for this de-risking.
Healthcare is ripe for innovation and comes with significant multiplier effects for our society. As one of the leading stakeholders in the industry, we are constantly seeking these opportunities, and look forward to establishing and nurturing new partnerships within the public sector that will create positive impact.
The COVID-19 pandemic demonstrated in a devastating way that when health is at risk, everything is at risk. The pandemic was more than just a health crisis; it disrupted businesses, economies, schools, families, societies, and more.
Our health reforms present a historic opportunity for South Africa to achieve universal healthcare coverage. With broad collaboration, careful planning, transparency, and a focus on equity, PPPs can drive positive change in the healthcare landscape, aligning with the recommendations of global bodies. As South Africa embarks on this transformative journey, it must seize the potential of PPPs to create a healthier, more equitable future for all its citizens.