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The big NHI Dialogue: Delegates engage on whether NHI is fit for purpose, and prioritising the needs of the health citizen

30 September 2021 Board of Healthcare Funders (BHF)

The National Health Insurance (NHI) Bill has sparked unprecedented interest, with the Parliamentary Portfolio Committee on Health receiving more than 100 000 submissions in response to the bill, demonstrating the enormity of the challenges ahead.

Speaking at the NHI Bill Dialogue hosted by the Board of Healthcare Funders (BHF), Dr Yogan Pillay, Country director of South Africa at the Clinton Health Access Initiative (CHAI) shared some findings from the Lancet Commission on High Quality health Systems which show that poor-quality health systems result in more than 8 million deaths per year in low and middle income countries (LMICs), leading to economic welfare losses of $6 trillion.

The research found that approximately one third of patients in LMICs experience disrespectful care, short consultations, poor communication and long wait times.

Furthermore, the research found that less than a quarter of the people in LMICs believe that their health systems work well, compared to half of the people in high-income countries believing that they do.

“Within the context of South Africa, as the country continues with engagements and preparations for the next steps for the NHI, it’s crucial that the NHI Bill addresses these and other important aspects around healthcare fairness in the treatment of patients,” Dr Pillay said.

Vishal Brijlal, Executive Director of CHAI concurred. He pointed out that the kind of healthcare system that we want should be one that is available to people when they get sick, be of sufficient quality, and it should be one that won’t leave people out of pocket when care is needed. “It should be a healthcare system that treats everyone fairly. It should be one that provides access to specialists and healthcare professionals who are adequately trained and have all the resources that they need to do their work. In delivering healthcare, they should do so, in a caring, friendly and professional manner,” he said. "This kind of utopian perspective is what the NHI needs to deliver, and the question on our minds is, will the NHI Bill give us that?”

Brijlal expressed that based on the inputs made to the Portfolio Committee of Health, people are concerned that the NHI Bill doesn’t seek to deliver all of that.

He noted that concerns raised in the inputs made to the Portfolio Committee of Health on the NHI Bill are not around the principles of universal health coverage.

“There needs to be transparency in the entire process, around how decisions are going to be made, because these are some of the challenges making people uncomfortable and anxious,” he said.

“The discussions around NHI should not be about integration between the private and public sectors, or about nationalisation of the healthcare system, but about a responsive system that delivers when it is needed and about moving towards that.”

So, in essence the question of whether the NHI Bill is fit for purpose is centred in the fact that people are uncomfortable about what is currently being proposed and those issues need to be resolved between government and parliament. There needs to be transparency in the process for the process to achieve the efficiencies needed to truly transform the healthcare system.

Delegates at the NHI Bill Dialogue agreed that lessons can be learnt from the kind of efficiencies that have been achieved by the National Healthcare Service (NHS) in the United Kingdom. From the regulatory framework right through to implementation, there are seamless efficiencies that the NHS has achieved.

In addition, delegates highlighted that the healthcare system that we are trying to create should be based on pragmatic solutions that place the needs of the patient first.

Dr Katlego Mothudi, Managing Director of the BHF stressed that there needs to be a standardised approach to the use of technology models across the board, in the public and private sectors.

“The current challenge is that the approach being taken and proposed presents a fragmented approach to healthcare. There is fragmentation between schemes and administrators in the private and public sectors, across the board. The state should not look at the private sector as a competitor, we need a unified industry to tackle healthcare needs,” Dr Mothudi said.

“We need to standardise our approach to technology models. A priority of the NHI Bill should be about outcomes monitoring and reporting, fairness, and resolving the fragmentation in the system. This is not a short-term policy, but a long-term policy of national importance.”

He also emphasised the need to address corruption head on.

“Good governance is crucial, accountability of public officials needs to be addressed. We should ensure that no one is given unyielding power and responsibilities, and good governance practices should be strictly implemented to countercheck the functionality of the NHI and universal health coverage.

“We need to deal with corruption and inefficiencies, because corruption denies the health citizen appropriate healthcare resources,” Dr Mothudi said.

In closing, delegates highlighted that the drafting of the NHI Bill did not capture key healthcare needs, and these issues need to be addressed in a fair and transparent manner that places the needs of the health citizen first and should protect citizens from going bankrupt while seeking care. We need, a system that harnesses the private and public sector healthcare skills in the best way possible, if we want to have a sustainable system.

The problems identified must be fixed.

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