South Africa on the threshold of health for all

Year 2012 is designated to mark the start of the roll out of the South African National Health Insurance (NHI) scheme. The scheme is to be implemented in stages over the next 14 years with the aim to encompass the entire population of South Africa, currently standing at about 50 million.

Currently, South Africa has a parallel private and public medical system. This reflects the country’s position as a blend of the First and Third Worlds: some public health care facilities in rural areas are very basic, while some private facilities in urban areas offer highly specialised services for those who can afford it.

It is estimated that about 18 percent of the population, belonging to higher income groups, is covered by one of the private medical schemes. The rest depend on the free, but notoriously understaffed and underdeveloped public health system.

The current government has tried to correct that inequality. During the last seven years, spending in health has increased by 50 percent in real terms. In 2010, South Africa will spend more than R100 billion on health. This figure represents over 8 percent of GDP; that percentage is the biggest in Africa and is above what most upper middle-income countries spend on health.

In spite of that, the standard of health care remains poor, as indicated by the high infant mortality rate (43 per 1,000 live births) and the low life expectancy (50.6 years for mean and 53.2 years for women).

The details on implementation, funding and resourcing of NHI are vague and yet to be finalised. It is estimated that it will be necessary to “find” an extra amount of R11 billion in the first year to cover the costs of the planed health care improvement in rural areas. As for the subsequent years, some projections say that NHI will cost R267 billion in 2020 and R376 billion in 2025.

The officials say that there are no plans to increase taxes for the time being. The idea is to do everything possible in order to improve the efficiency of government spending in the public health sector in order to stop the wastage.

In any case, every employed South African will have to pay for medical cover. The only unknown is – what they will get in return. Particularly worried are the 5.5 million middle and higher income employees who make up the current pool of income taxes payees. Whatever the future holds for them – a single national healthcare or a continuation of parallel public and private system – they will feel a financial squeeze in the transitional period, when they will be expected to fund the expending public health sector, without directly benefiting from it. They will have to keep up with the private medical scheme payments, and will have to continue doing so until issues besetting public health care are resolved.

The public health sector record so far is not promising. The recent strike by nurses, who left dying patient to toy-toy (protest) for higher wages, left South Africans with even less faith in the public health care system. The biggest worry is that the additional financial sacrifices people will surely be expected to make may end up in the enormous black hole of mismanagement, wastage and misappropriation.

There is no doubt that South Africa has the know-how and the ability to set up and maintain complex events and systems. The impeccable organisation of the FIFA World Cup 2010 proves that. Even more, the remarkably efficient South African Revenue Service’s system of collecting taxes also proves it.

With such antecedents and with political will and determination, there is no reason to doubt that South Africa will manage to put in place even such an enormous scheme as national health care. 

The first step, planned for the next year, is for the health teams to visit people in rural areas to assess their health needs and provide transport to health facilities if necessary. Also in 2012, government plans to fill the vacant posts in the public health system. Retaining nurses and doctors is a big problem for South Africa. Filling the vacancies will require scholarship programmes and possibly "importing" foreign health workers.

Image: Rooibos tea harvest. Source: Media Club South Africa


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