NHI Will Not Replace Inefficient Health Services



Speech to the NCOP during the health and social development budget debate


The Western Cape’s strategic objective of wellness aims to achieve the best health outcomes for the 5.8 million people in our province who is dependent on public health services. Towards this aim, we are in agreement with the 10-point plan of the National Minister. The national policy priorities and budgets for the financial year 2012 / 2013 highlights the burden of disease, the integrated strategic plan for HIV Aids and TB as well as high maternal and child mortality. All of these are in line with the health objectives of the World Health Organization and the Millennium Development Goals, which:

* Aim to reduce infant mortality by two-thirds by 2015

* calls for increased efforts to improve maternal health, especially to reduce by three-quarters the maternal mortality ratio and achieve universal access to reproductive health

* aims to combat HIV/AIDS, tuberculosis, malaria and other diseases

A large part of the budget speech focuses on improving the efficiency and effectiveness of the health care system through National Health Insurance.

But Speaker, NHI does not and will not fix the real problem of low-quality healthcare provision in the public sector. The NHI is still in green paper phase, and the national budget allocates a billion rand to pilot projects in each province. We say first get the management structures in place, implement structures to run the health system in each province on good business principles, implement interventions to monitor and evaluate efficiency, then we can develop a model for national health insurance. This is certainly the route that we are following in the Western Cape. Patients are referred to regional and specialised facilities according to their medical needs, and government provides the transport infrastructure. It is a system that leverages our system’s strengths, minimizes its deficiencies and delivers good health services in a responsible and sustainable manner.

In its current format the NHI does not address the real problem of inadequate and low-quality healthcare provision in the public sector.

NHI does not adequately attend to accountability and management structures. While the Green Paper calls for an Office of Standards Compliance – which we support in principle – its members will be appointed by, and answer to, the National Health Minister. It will not be independent, making it vulnerable to political influence and manipulation.

The country lacks the human resources to implement NHI which demands that we triple the 27,000 doctors that we currently have. But since we currently only train enough doctors each year to keep pace with the numbers who retire, enter private practice or emigrate, the state will be unable to train the necessary number of doctors, amongst other key health professionals, to implement NHI within the envisaged time frame.

The creation of a centralized fund will over-bureaucratize the public healthcare system rendering it more inefficient and costly than it is currently. The size and scope of a provincial health department will be reduced to that of a de facto branch office of the national department. In essence this means the nationalization of provincial health services. Whilst this is in our view unconstitutional, it will reduce the effectiveness of a health service such as that currently delivered by the Western Cape Government and be counter-productive to the objective of a quality health service to all

“Throwing money at a problem does not always solve it!” South Africa spends R2 766 on public healthcare per person each year – far more than other developing countries and yet as a country we have poor health outcomes and inexcusable wastage due to fraud, incompetence and mismanagement in many provinces.

NHI in its current format will inevitably destroy the important and significant private health care and health insurance industries in South Africa and reduce and subject every citizen to a less than average health service. In the drive to improve health care for all it is my view that this step will reduce the overall standard of health care in South Africa and discourage foreign investment in the country those we so desperately need.

We have thus serious concerns that NHI in its current format will reduce the current generally high quality standard in the private health sector instead of improving the standard in the public sector.

At this point in time it is common knowledge that the health system in the Eastern Cape is falling apart. A special Iinvestigation unit probe into the Eastern Cape health department revealed corruption involving R200 million and thousands of officials. The investigation, launched in December, found that 15 900 department officials were illegally receiving child support grants totaling R58 million per year. The leaked report also revealed that almost 4 000 officials were illegally receiving housing subsidies from the human settlements department amounting to R86 million. Assets valued around R19 million, which were transferred to district offices, apparently went missing.

The Eastern Cape health department reportedly paid R42.8 million to 226 companies linked to 235 civil servants, while 174 officials’ spouses were linked to companies that benefited R9 million. The Eastern Cape health department lost R800 million to corruption between January 2009 and June 2010. One of the manifestations of the break down in health services in the Eastern Cape is the failure to pay suppliers and in recent times even pay staff. 30 doctors from just one region in the Eastern Cape had not been paid in April and two people had worked for three months without pay. It seems some of the problems were caused by clerical errors, others by the health department hiring staff without the authorization of the provincial treasury.

Reports that doctors have not been paid in the Eastern Cape recently is supported by the fact that a nurse who was appointed from the Western Cape to a hospital in the Eastern Cape was never paid. In desperation she returned to the Western Cape where fortunately the Department was able to re-employ her. A situation such as this cannot promote quality health care and is to an extent the cause for the continued rise in patient numbers in the Western Cape over the last several years.

I have been informed that in Gauteng unpaid suppliers are a major part of the health services problem, but also inefficiency in ordering and holding sufficient stock.

Speaker, it is evident that maladministration in ANC-governed provinces is leading to a collapse of their health system. At the same time there is an unnatural haste to expedite the National Health Insurance which is only in pilot project stage, and I am informed that the national minister is driving to present a NHI white paper in the weeks to come.

I stand by my stance – first govern well, get the systems in place, maintain financial discipline. Then we can talk about national health insurance.

In the long term the National Minister will have to address the in-migration of foreign nationals and the impact of their numbers on our health services. The present budget scarcely allows adequately for the treatment of South Africans, and the resources are not sufficient for our growing numbers. It would be unfair to tax South Africans in an effort to gain funds for a health insurance, but the insurance provides for foreigners migrating to a part of the continent where health services are better than in their own.

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