Image: The South African

New Health Minister, Zweli Mkhize and heads
of his Department will be meeting with all healthcare stakeholders in the next six
months to discuss government’s move towards the implementation of National
Health Insurance (NHI). Mkhize was briefing the media about the draft NHI Bill
that was approved by Cabinet this week. The Bill still needs to go through
parliament before it is eventually signed into law by President Cyril Ramaphosa.

Mkhize said to implement the NHI, strong co-operation
between healthcare professionals in the public and private sector, civil
society, patients’ associations, academics and researchers is needed. According
to the Minister, he has already consulted with some of the stakeholder groups
since his appointment in May and “is encouraged by their support in strengthening
the health system”.

Mkhize says there has been too much
discussion and analysis of the health system’s readiness to implement NHI and
that is now time “to jump into implementation”.

Presenting a basic outline of what the NHI
will look like, the new minister said an NHI Implementation Unit will be
established soon while the legislative processes are underway to ensure smooth implementation.

He noted that there is a ten-point plan to
improve healthcare services that includes dealing with staff and medicine shortages
and fixing inadequate equipment and ageing infrastructure while the implementation
of NHI is underway.

Same healthcare for everyone

According to Mkhize, NHI will give rise to
a system where healthcare would be the same for everyone whether they are
public or private patients, suggesting that there won’t be a division between public
and private facilities once NHI is rolled out completely. “Hospitals, clinics,
doctors, specialists, dentists, nurses and all other health workers will be
available to provide services equally.” Mkhize said.

Although vague about the funding of NHI, the
Minister suggested that the scheme will share all the money available for healthcare
including medical aid premiums.

“NHI is a way of providing good
healthcare for all by sharing the money available for healthcare among all our
people. The health benefits that you received will depend on how sick you are
and not on how wealthy you are.”

Mkhize said 42.6 million users of the
proposed NHI have already been captured on the DoH’s Health Patient
Registration System and that all South Africans will be registered by the end
of this financial year. NHI will require a digital health platform that will
support the operations of the NHI Fund and work has already commenced in this
regard, he added.

In the next few weeks, 30 managers who have
been identified at various levels of the health system, will be sent overseas
to receive training in NHI implementation, learning how it was implemented in
different parts of the world to ensure sustainability of implementation, Mkhize

Acknowledging that the public won’t accept
the NHI if it is built over a dilapidated and decaying infrastructure, Mkhize
said R19 billion rand has been set aside to refurbish hospitals and clinics while
the scheme is being introduced.

“A team of experts in finance and health
and infrastructure from both National Treasury and Health has been established
to seek creative financing mechanisms and alternative models of delivering of
health infrastructure. They have been given a clear directive to accelerate the
refurbishment of all old hospitals and clinics and deliver new ones within 5 to
7 years. This is the basis on which NHI will be operating. Preliminary
indications are that this is feasible. Based on the developed plan I will engage
provinces and other stakeholders on this matter,” Mkhize said.

Referring to the 4100 vacant posts for
doctors and 3932 for nurses in the public sector, Mkhize said his department is
planning to fill almost 2700 doctors’ and 2371 nurses’ posts within the
foreseeable future. R330 million rand has already been allocated for the
filling of posts in the 2018/2019 period which will go up to R600 million in
the 2019/2020 period.

The Health Department has also undertaken to
ensure that all the qualifying 2625 medical interns and the 700 Cuban graduates
are given posts.

He added that Treasury has made available R57
million to fund 50 interventions needed for NHI immediately. These include a capitation
model for GPs, removing user fees, increasing antenatal visits and extending the
distribution of chronic medicine. This amount will go up to R145 million next
year and R287 million in the Medium-Term Forecast.

He emphasised that the move towards
Universal Health Coverage through the implementation of NHI will be based on a primary
healthcare (PHC) approach which will require a strengthening of health promotion,
screening, disease prevention, rehabilitation and early treatment of disease.

“An expansive network of Community
Healthcare Workers and Community Care Givers serving a catchment population will
be linked to support the delivery of PHC services in our communities. A
well-organised upward and downward referral system needs to be built to support
the delivery of PHC services through referral to our clinics. Medical Officers based
at District Hospitals will be required to perform outreach services at clinics
so that we reduce the need for patients to be referred to hospitals to access
care,” Mkhezi explained.

He said government’s plan to expand the contracting
of GPs is supported by various stakeholders such as SAMA, the Unity Forum of
Family Practitioners and Progressive Health Forum amongst others.

Mkhize emphasised the legislation as it is now
is not cast in stone and will be refined “to adapt to the situation as needed”.