A public debate on the National Health Insurance (NHI) White Paper was held at the University of KwaZulu Natal hosted jointly by UKZN’s School of Nursing and Public Health, the Foundation for Human Rights (FHR), the Steve Biko Centre for Bioethics and the University of Witwatersrand.
The discussion focused on whether the NHI White Paper responds adequately to South Africa’s human rights obligations.
The white paper outlines the country’s path to universal health coverage for people over 14 years of age and proposes changes in the role of private medical aids and the National Health Laboratory Services, among others. The NHI is intended to ensure that the use of health services does not result in financial hardships for individuals and their families.
Deputy Director of the FHR, Dr Hanif Vally, said the medical aid system created a divide, as 50% of the country’s doctors and an even greater number of specialists, served around 18% of the country’s citizens. ‘Medical professionals are going into private practice, inequalities are becoming greater and government is finding it increasingly more difficult to maintain the provision of health services as a constitutional right,’ said Vally.
Heath Department Deputy Director-General for Health Regulation and Compliance Management, Dr Anban Pillay, said the provision of universal health care for all citizens was critical. ‘We currently have a system where people access care based on what they can afford. Clearly there are a number of barriers to access, particularly in the lower socio-economic groups.
‘The proposed NHI involves a massive reorganisation of the public and private health-care system.’
Pillay said the poor were often most in need of health care and funding for the NHI would come from taxpayers based on a principal of “social solidarity”.
‘Social solidarity means we all contribute to a fund so that when I am sick I will have access to healthcare. But maybe I may never need to, but somebody else will. It’s not a concept South Africans are particularly used to in the current context. If you look at the medical scheme organisation, which an individual contributes to as an insurance, you have a particular entitlement - it’s your money. This is very different to how the NHI works.’
Dr Mfowethu Zungu, Deputy Director-General for Macro-Economic policy, Planning and the NHI at the KZN Health Department, said only 48% of expenditure on health in South Africa was in the public sector which served 87% of the population. The balance was spent in the private sector, which served medical aid members who comprised around 17% of the population.
Medical Aid Schemes are a ‘crime against humanity’ and should be abolished because they cannot co-exist with the government’s proposed NHI, said SA Health Professions Council President, Dr Kgosi Letlape.
‘There can be no national health if it is not for all of us. You try to engage about NHI with the privileged, and they say “don’t touch my medical aid”,’ said Letlape.
Letlape said Health Minister Aaron Motsoaledi did not seem to have much support for NHI and people such as parliamentarians and judges also had an attitude of “don’t touch my medical aid”. However, he said it was possible to provide universal health care, which was not a new concept, as the country previously had one of the best health-care systems in the world under apartheid.
The debate was attended by communities which would benefit from the NHI, representatives of non-governmental organisations and the private and public health care sectors, and academics.
Other speakers included medical specialist, Professor Errol Holland; Professor Ames Dhai of the University of the Witwatersrand, and Professor Leslie London of the University of Cape Town.
‘UKZN’s School of Nursing and Public Health is pleased to have helped create space for this discussion and hopes it served as a catalyst for future engagements,’ said the School’s Dr Mergan Naidoo.