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An impossible reality for some

12 July 2018Myra Knoesen

As healthcare systems around the world move towards achieving universal healthcare, efforts to move towards action plans seem an impossible reality for some.

FAnews spoke to some medical schemes, the Board of Healthcare Funders (BHF) and the Council for Medical Schemes (CMS) about the progress being made on universal health coverage across Africa. 

Mixed progress and perceptions

“There is mixed progress towards universal healthcare across the African continent. Most countries retain government funded systems which have the potential to provide universal healthcare to their citizens. However, limited funding and poor management impair the quality of care and accessibility of services in many countries,” says Dr Jonathan Broomberg, CEO of Discovery Health. 

“To this end, many African countries are seeking to expand health insurance coverage, but health financing continues to be a challenge in many countries. For countries such as Ghana, Tanzania and South Africa, to a large extent, healthcare financing policies are largely progressive however, out-of-pocket payments, private health insurance premiums can be viewed as excessive. In most of these countries, the distribution of healthcare benefits is generally pro-rich,” says Nondumiso Khumalo, Senior Health Economist at the Council for Medical Schemes. 

“Various scholars and policy experts also acknowledged that most people in South Africa are currently living in deplorable conditions and in great poverty. There is a high level of unemployment, inequitable access to healthcare services, affordability challenges for private healthcare, poor health outcomes and inadequate social security. Health financing experts often recommend that financing reforms should therefore not only consider how to generate funds for healthcare, but also explicitly address affordability, availability and barriers to access to achieve equitable financing,” continues Khumalo.

Drawing valuable lessons

“While the perception amongst a number of countries is that to achieve universal healthcare, there must be a lot of funding made available by governments across Africa, that perception needs to be dispelled, as achieving universal healthcare is not necessarily about the financial resources of a country,” says Dr Katlego Mothudi, Managing Director of the Board of Healthcare Funders of Southern Africa (BHF). 

“Some African countries with less resources than South Africa have been able to make great strides in achieving universal health coverage. Most African countries have adopted universal healthcare in terms of future health policy and are working towards achieving universal healthcare for their populations. Kenya has been successfully implementing universal healthcare through their National Hospital Insurance Fund (NHIF), and Rwanda presents a compelling case in this regard as well. These case studies will be showcases to provide insights of how universal healthcare is being achieved in some parts of the continent from which we can draw valuable lessons,” continues Dr Mothudi. 

“If we take a closer look at the African countries in which universal healthcare is being implemented, we realise that the systems are structured differently across the various countries. With the different structures, these instances present different results. The World Health Organisation (WHO) recognises that the universal healthcare structure would be unique for each country given the different country specific structural issues and those are some of the things we should bear in mind when structuring universal healthcare,” says Dr Mothudi. 

“In South Africa, the objectives of universal healthcare would be most likely to be achieved through a system that integrates the best skills, resources and expertise available in both the public and private sectors, allocating these to those parts of the system where the returns would be highest,” says Dr Broomberg. 

A few quick wins

“South Africa requires a health system that improves healthcare coverage and accessibility to more of our citizens. Clearly funding is the start. Strengthening the health system is the next step,” says Dr Boshoff Steenekamp, Strategic Projects at Momentum Health Solutions.

“Obvious initial steps would include the sourcing of private health services to address the priority projects identified in the NHI White Paper. This may include pilot projects whereby primary care services for government patients are purchased from public and private providers on a capitation basis. The objective of pilots of this nature is to refine models for public-private partnerships to address public health priorities in a sustainable manner through public-private collaboration,” continued Steenekamp.

“Public and private sector information systems and technology infrastructure requires scaling up to create access to universal healthcare and manage the envisaged rapid growth as the citizens start accessing it. Merging the two systems presents both challenges and opportunities, the technology infrastructure will require much investment from both the private and public systems,” says Dr Mothudi. 

“There are a few quick wins that the medical scheme industry can leverage on to drive the transformation of the sector, which do not require legislative reform and the BHF’s contemplated Action Plans are an example of some of these quick wins. For example, a reduction and simplification of benefit plans, expansion of preventive care benefits and promoting the gatekeeping role of the family practitioner. A stronger focus on preventable ailments can begin to make a positive impact on the hospitalisation and the prevalence of complications resulting from undiagnosed or untreated conditions. Health citizens can thus start making substantial savings and membership of medical schemes can be more attractive from a pricing perspective,” continues Dr Mothudi. 

“The most fundamental requirements are adequate funding, adequate human resources for healthcare and competent management systems and skills. The highest priorities are to improve service delivery at the primary care level within the public healthcare system, as well as within the public hospital system. At the margins of this system, some quick wins could be achieved by procurement of selected services from private providers, particularly in areas where skills or equipment are in short supply in the public healthcare system,” emphasises Dr Broomberg. 

Editor’s Thoughts:
Recently the Minister of Health, Aaron Motsoaledi, announced the introduction of two Bills: the National Health Insurance (NHI) Bill and the Medical Schemes Amendment Bill. These Bills, according Motsoaledi, will pave the way for more access to medical healthcare through NHI. However, only time will tell on the efforts to move towards these action plans. Do you believe we are making great strides in achieving universal healthcare coverage for all South Africans? Please comment below, interact with us on Twitter at @fanews_online or email me your thoughts myra@fanews.co.za.

Comments

Added by Nancy Bowring, 18 Jul 2018
As said by John and Leon maladministration is the cause of poor healthcare for all.
Population growth through
1. having more children than you can afford to
support just to have access to the child
grants.
2. Keeping us oldies alive through medical intervention when we should make way for the young people who have a right to a health life.
3. Lack of migration control of illegals crossing our borders
We wait to see whether the ANC can manage an NHI effectively and without corruption plundering our coffers once again.
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Added by old timer, 13 Jul 2018
The real problem is population growth not funding or quality of health care.
Rather focus on persuading people not to have children that they cannot afford ,then health care, unemployment , education , service delivery and many other governance issues will correct themselves.
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Added by Jono, 12 Jul 2018
Yes agree with John, I fail to see how our current public health system is not universal health by another name. Currently all South Africans and foreiners have access to our public health system. The problem is that the quality of system has effectively being demolished over the last 10 years. Infrastucture is falling apart, there is a 50% shortage in staff across all levels and money is being stolen and mispent accross the system. i fully support quality health care for all South African especially the poor. I also personally would like to pay less for Private health care, but not at the expense of the current quality of that care. If public heath was fixed and offered qulaity health care to all citerzens this would be the easiest way to pressurize private medical aids as people would migrate by choice. No legislation required. The state simple has no track record anywhere it can possibly run NHI on its own in the format it has proposed.
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Added by LEON, 12 Jul 2018
John you are CORRECT - and in some areas this works very well

The STATE HEATH experience we have in our town is fantastic - and even better than some medical funds - as the optical benefit from the STATE facility is much better than most funds can provide


It is a matter of PROPPER PROFESIONAL management of the available recourse that would fix this in RSA and a counter check on wastage done by Treasury.
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Added by John, 12 Jul 2018
I thought all South Africans already had access to health care?
All these debates always fail to mention the fact that universal healthcare is already available to all, via the public healthcare system.
The fact that it doesnt work very well has nothing to do with funding and everything to do with maladministration.

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