
25 AUGUST 2019
The NHI is but not the ultimate remedy to South Africa’s Health Care System challenges; however, its disapproval by the private sector, DA and white people in their majority is myopic, self-serving, unreasonable, and anti-poor black South Africans.
The NHI’s main objectives are to unify the historical two-tier health system of South Africa, wherein you have the private sector, which caters for 16% of the wealthy population and the public sector that caters for 84% of the population majority, which is black and poor. Consequently, all healthcare resources within the health system will be available to all irrespective of their socio-economic status. The current health private sector, in practical terms, will be outsourced by the state. Individuals will have the right to choose their health care provider accredited by the Office of Health Standards Compliance.
Health care providers will be compensated by a national health insurance fund, which is an entity funded by mandatory tax on income. Essentially any citizen would be able to access free health care services at their facility of choice, whether private or public, as a result the two-tier system becomes a subject of history. The NHI radically reshapes the public health care system from being a site of commercial transactions, typical of a health system under capitalism, to a more socialised health care system.
The NHI obviously diminishes the role of medical aids schemes; instead of paying medical aids schemes, citizens contribute mandatory tax to the fund, which is responsible for every citizen’s health care needs in South Africa, both poor and the wealthy. Medical aids schemes under NHI will be relegated to play a complementary role, and subsidize services that are not covered by NHI.
The NHI is met with resistance by the private sector and white people in South Africa, through the DA for three reasons. The business interests of medical aids schemes, which have been a structure pursuing commodified health care in South Africa, will ultimately cease to exist. Secondly, the private hospitals accessible to only the wealthy will no longer be at liberty to selfishly pursue profits by unreasonably escalating health cost unabated.
The DA acknowledges the global effort to implement universal health coverage but suggest it must be done through progressive legislation, and based on their obsession to protect private hospitals we can extrapolate that in their case “progressive” denotes sustaining the two-tier health system. One for the poor, and the other for the wealthy white minority.
Thirdly, all hospitals, both private and public will be accessible to all South Africans, a reality white people struggle to contend with because only they deserve quality health care. They cannot imagine sharing hospitals with black people. The DA in their statement opposing the NHI says; “the ANC seems to think that in order to fix state hospitals private health care sector needs to be destroyed,” suggesting that to make private health care accessible to the general population, black and poor in their majority is collapsing health care. The subtle DA racist character finds itself exposed in its disgust for all to share in the country’s health care resources.
The opposition to this bill fails to point out how the NHI represents a regressive policy position on health. This is because the capitalist apparatus and countries the DA normally rely on for policy wisdom have also invested in universal health coverage. The World Health Organisation defines universal health coverage as quoted, “that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship”.
Therefore, rejecting the NHI bill conclusively communicates the DA’s uncomfortability in ensuring provision of free quality health care for the poor black majority. Furthermore, 12 December 2012 United Nations General assembly, reaffirmed the world health organisation’s leading role in supporting countries with challenges of implementing universal health coverage, inevitably this was to become an effort to meet the sustainable development goals as adopted by all United Nations member states in 2015.
It is therefore quite clear, and well documented, that the world health policy position, even by capitalist countries, admit health provision for all, irrespective of income, is the future of a healthy society. It’s well known and an open secret that those who stand to benefit the most are poor black people in the context of South Africa. Why must people buy health care? Why must people die of diseases because they lack the required income to pay the necessary health care skill? The suggestion by DA to keep health care a commodity for the wealthy is immoral and insensitive.
In 2005, the Turkish government introduced what they called the, Family Medicine Programme (FMP), an equivalent of NHI. This program extended basic health care services to the entire Turkish population under a free of charge system fully financed and administered by the central government. The backbone of this initiative was the assigning of each citizen to a family physician offering a basic health care service, in accessible community based family health centres. In 2010, the programme had been fully implemented. In essence, the Turkish state introduced a socialised health care system for all citizens that offered comprehensive health care services free of charge despite individual socio-economic status.
Research by the United Nations Research Institute for Social Development indicated that the overall effect of the programme an equivalent of the NHI in South Africa reduced mortality by 11% among all-age category, 25.6% among infants, 22.9% among children ages 1-4 and 7.7% among elderly, much of the impact of the programme was prominent in poorer provinces of Turkey.
Another example of the NHI equivalent is Thailand’s 30 Baht Programme, which was found to have increased health care utilization and subsequently the health status of the country with more pronounced effects among the poor people of Thailand.
It is also a known fact that Cuba under the resolute leadership of EL commadante, Fidel Castro, collapsed a two-tier health system similar to that of South Africa and implemented a unified health system accessible to all Cubans. The health system of Cuba as measured by its health outcomes, until today, remains a progressive example for the world to replicate.
There is no evidence to suggest that the NHI is a bad policy position. The fact is poor black South Africans stand to benefit from the implementation of the NHI. Its ill-informed for the DA to suggest that the NHI will cripple the health system, when, in actual fact, the two tier system, one for the poor and the other for the wealthy, currently in place suggests an already crippled health system.
The NHI must be implemented for the greater good of the population, and as a step towards the de-commodification of Health Care, a basic right as enshrined in our constitution.
However, I still maintain that NHI is not the ultimate answer to South Africa’s health care challenges. Its total implementation must be preceded by the total revamp of the public health system. The attempts on efforts to revamp prior its implementation are documented in the “Presidential Health Compact” which unsurprisingly falls short of pragmatic solutions.
Government’s Preventative health care strategy remains weak and lacks the undivided attention it deserves. To ensure that the implementation of the NHI yields desirable health outcomes, there must be a permanent consolidated community ward based preventative health care programme. Because the success of a health system will not be on the number of people it cures, but will however, be the number of people it is able to keep healthy and out of hospitals.
The preventative health care initiative obviously needs to be human resource capacitated. The “Presidential health compact” correctly identifies this fact but is not descriptive as it relates to how this will be solved. To address the skill shortage there must be a deliberate effort to expand all existing medical schools to ensure an output of medical professionals necessary to complement the NHI. The question of infrastructural deficits in the public sector must be addressed by the necessary political will.
The DA must not use courts to delay the implementation of what could rescue the health of the majority of South Africans, poor and black in majority, given the preferable conditions necessary to implement NHI. Their love for capital interests must never supersede and infringe on the rights of the majority to access free quality health care services.

