Public health infrastructure remains a challenge as NHI is rolled out

Health Minister, Aaron Motsoaledi, briefed MPs of the Health Portfolio Committee today, 26 February, on the roll out of the National Health Insurance (NHI) programme and the progress made so far throughout the provinces.

The NHI is being implemented as a way to make quality health care available for all South African citizens. However, health systems financing - one of the building blocks of a functional health care system according to the World Health Organisation – is one of the greatest challenges hindering global health care. All over the world, “the money is not reaching the people on the ground”, says the Minister. He stated that there were still concerns around the world as to whether the NHI was necessary or not, and he would not be surprised if the matter went to the United Nations to be debated at the end of the year.

The Minister’s presentation showed that the NHI system would have to implemented in phases, complemented by a “reduction in the relative cost of private medical care and supported by better human capacity and systems in the public health sector”.

According to the Minister, the first priority is to strengthen the capacities of public health infrastructure to provide effective and safe health services.

“Many health care systems that were implemented in African countries have not performed well. In 2012, the ministers of health and finance all over the world were called together to talk about this. One of the reasons the free health care fails is because nothing is done about [public health] infrastructure.”

Four provinces were selected for locations where clinics would be built for the NHI pilot: The Eastern cape, Free State, Limpopo and Mpumalanga. These were referred to as the “NHI districts”. Facility audits were completed on each hospital in the districts over a period of 18 months, where hospitals were graded according to their condition. A grading of 5 means the hospital is in excellent condition, while a grade of 1 means that the building needs to be completely replaced.

Hospitals in the NHI district of OR Tambo in the Eastern Cape fared the worst. The assessment was an extensive project with CSIR engineers checking the facilities from top to bottom. Three hospitals will have to be rebuilt in the district, while eight more clinics will be constructed as well.

Hospitals that are being expanded or rebuilt will not be built conventionally – the hospitals will now boast a steel frame structure that is easily replicable and has a lifespan of 50 years.

The Minister also spoke to the prototype for the “ideal clinic”, saying that the clinic would ensure the provision of quality health services to the community through good infrastructure, adequate staff, medicine and supplies, good administrative processes, the use of applicable policies and stakeholder support. He called this “the heartbeat of primary healthcare” and hoped that these clinics would help “abolish inequalities”.

10 prototype clinics are being constructed: Two clinics in the Gert Sibande Disctrict in Mpumalanga, four in the Tshwane district of Gauteng, 1 in Thabo Mofutsanyanye in Free State, and three in Umgungundlovu district in KwaZulu-Natal.

“One of the components for an ideal clinic is to get help from communities in the area. We need individuals to encourage other people from their communities to use the clinics and get tested and screened. People need to work with these clinics and share information”, says the Minister. He went on to say that implementing the NHI means “changing the culture” in current clinics.

MPs noted that although the NHI was being rolled out, there was still a mass exodus of local doctors going abroad. This was of great concern to the Committee, as they also needed to know how many doctors were interested in being part of the NHI programme. The Minister told the Committee that this was a problem that was happening all over the world, and South Africa could not compete with salaries offered in the United States and the Middle East.

When asked what the cost implications were for expanding and rebuilding hospitals and clinics, the Minister merely answered that the Committee “should ask the Minister (referring to the Minister of Finance) who is responsible” for that part of the programme.