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Ramaphosa: 'Abandon self-interest and mobilise behind NHI'

President Cyril Ramaphosa said that public hearings show "broad support" for National Health Insurance and that South Africans "must move away from a culture driven solely by self-interest and embrace the spirit of ubuntu" to mobilise behind the NHI, writes MedicalBrief.

Ramaphosa devoted his most recent weekly newsletter to outlining the case for National Health Insurance (NHI) – saying it is "one of the greatest travesties of our time" that access to quality healthcare is determined by income level.

While health remains one of the largest items in the Budget – with a total proposed expenditure of R229.7bn in 2020/21 – there was little new about NHI in the Budget, apart from R55.6m in new funding prioritised to the Department of Health to "strengthen its capacity to phase in NHI", and a separate R25m grant to the National Quality Health Improvement Plan.

Countrywide public hearings on the NHI Bill have come to an end, and according to the National Assembly Health Committee, “the majority of participants … pronounced their unwavering support for the Bill”, calling for its “immediate implementation”. This, notes Pam Saxby for Legalbrief Policy Watch, is mainly because of the benefits poorer communities expect to receive under the universal healthcare system envisaged.

However, “in most cases” support for the Bill was expressed on the understanding that ongoing public sector healthcare “challenges” are addressed. Statements on hearings held in Tshwane and Mogale City refer to the shortage of doctors, nurses and medicines, glaringly inadequate infrastructure and low levels of ‘accountability’.

The NHI hearings have set alarm bells ringing, says a Spotlight report.
The report said: The NHI dream rolled into Gauteng this past weekend with the utopian hopes for South Africa’s national health insurance summed up in a double-page colour pamphlet handed out by the department of health at the hearings. The glossy pamphlet speaks of “ubuntu” and “taking care of each other”. The stock pic images show the big smiles of happy patients and practitioners. It states that quality healthcare will be “free through the right referral pathways” that “government will upgrade all facilities to ensure that there is no difference between a public and private facility” and that “government may introduce a small tax” to fund NHI.

But we had a wake-up call inside the community halls and centres. Members of the Parliamentary Portfolio Committee of Health, who arrived with blue light escorts and convoys, heard from people who attended the meetings the deep concerns they still have about the Bill, including exactly how NHI will touch their lives in terms of costs, funding and access to quality services.

In Gauteng the specifics that were raised included issues like how undocumented migrants and asylum seekers and the likes of zama zamas (the informal miners across the western suburbs) will be absorbed into the NHI, as a registration system will apply.n The inadequate services for mental health patients and health services to the lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) communities were also flagged as well as the sobering finding from the Office of Health Standards Compliance.

The OHSC’s findings showed that of 696 clinics in the country surveyed between 2016 and 2017 only five met the required norms and standards expected in the NHI.

Spotlight notes that civil society organisations have also been making their voices heard. For Mabalane Mfundisi, co-chair of the resource mobilisation committee of the civil society forum South African National Aids Council, NHI implementation is long overdue. Mfundisi put his comments to the committee and said afterwards: “These delays have come because government has kowtowed to the private sector, put profits before people and made side-deals.” Mfundisi said the urgency to get NHI up and running needs to run parallel with a committed programme to fix problems in the healthcare system, but “this revolutionary programme cannot be stalled any longer”.

Anele Yawa, general secretary of the Treatment Action Campaign (TAC) used his minutes at the microphone to ask the parliamentarians on the stage which of them use public health facilities. There was no response. Yawa said TAC supported the NHI but said there were deep concerns over the NHI purse and powers held in the hands of the health minister who will appoint members to the various NHI committees.

Chair of the Portfolio Committee on Health, Sibongiseni Dhlomo, is quoted in the report as saying that he has over the weeks listened to “the voices of hundreds of our people across the country raising their issues” and that he’s “learnt a lot from what people have said and how they have said it”. “This has been a lawmaking process that has got the collective response of South Africans.”

He acknowledged that the NHI Bill is “not the perfect product, but we cannot dilly-dally; we are way behind as a country on universal health care”. He said informing people about the Bill is not the role of the committee, but rather of the provincial health departments, which should have held workshops and awareness building initiatives.

Dhlomo said the committee will now return to Parliament. The next step will be reviewing the written submissions and then inviting oral submissions to Parliament.

MP and Health Portfolio Committee member Haseena Ismail is an Ekurhuleni local. Representing the Democratic Alliance (DA), Ismael said the hearings did not hit the mark in providing adequate information or answering people’s questions. “People have come here to say they support universal health coverage and the NHI, but… and it’s the ‘but’ that matters, because we still haven’t clarified issues for our people,” the report quoted Ismael as saying.

She said in Gauteng the pressing health care issues revolve around poor infrastructure and equipment in the public health service, overflow of catchment areas with high migrant populations and poor patient record-keeping that “means more people are falling through the cracks”.

The president says the government will implement it "in an incremental fashion" and aim to cover the whole country by 2025.

Business Day writes that the 2025 deadline was set in the government’s policy papers on NHI, but critics have said it is an unrealistically ambitious target for full implementation and Treasury officials have previously indicated that a more gradual approach is likely.

The government initially projected that NHI costs would increase public health spending from about 4% to 6% of GDP over 15 years. However, the Treasury said in its medium-term budget policy Statement (MTBPS) in October that the weak macroeconomic and fiscal outlook meant the estimates published in the NHI Green Paper in 2011 and in the White Paper in 2017 were no longer affordable.

Good quality health care for every South African would be good for social cohesion and the country’s economy. Polity reports that this is according to the president who, addressing Parliament during his reply in the State of the Nation Address debate, said a prosperous nation depended on all its citizens having access to quality healthcare. Ramaphosa said the National Public Health Bill (NHI) was a vital and necessary step towards that goal.

“It is about ensuring that the funds we spend annually on comprehensive health care under the NHI result in a better level of health care to our people, in standardised services and in better health care centres. It is about ensuring that our parents and grandparents, our children and ourselves receive proper treatment in well-run facilities, run by professionals regardless of where we live and how much or how little we have,” said Ramaphosa.

“We are clear that the pace and scale (of the rollout) will be determined by the means at our disposal. As we improve the quality of our public health system, as we work to improve access, we must apply ourselves with even greater effort to bring an end to Aids as a public health threat to our country. We are within reach of a goal of 90-90-90 where at least 90% of HIV-positive people at least know their status, 90% of these people are on treatment and 90% of those in treatment have undetectable viral loads,” he explained.

According to the report, Ramaphosa said the South African Aids Council was driving the broad strategic plan to achieve these goals and to also turn the tide against tuberculosis, through targeted prevention and efforts aimed at the vulnerable population, including adolescent girls and young women.

The President said in his latest newsletter:
The deliberations by Parliament on the National Health Insurance Bill are soon to enter a new phase as the portfolio committee on health’s country-wide public hearings wrap up. These hearings, held in a number of places around the country, have shown that there is broad support for fundamental change in our health care system.

Participants have made a number of proposals and have spoken about their views on National Health Insurance (NHI), personal experiences of illness, trauma, disability and suffering – and the difficulties they have had in accessing health care when they need it.

It is these experiences that inform South Africa’s support for the global goal of universal health coverage. This goal has become a major aim for health reform in many countries and a priority objective of World Health Organisation (WHO). It is instructive that WHO defines universal health coverage as a system that should ensure that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality while ensuring that the use of these services does not expose the user to financial hardship.

It is one of the greatest travesties of our time that access to decent and quality health care services is determined by one’s ability to pay.

South Africa has two parallel health care systems. Around R250bn is spent annually on less than 20% of the population. This is the section of our population that has access to private medical insurance. On the other hand our country spends R220bn on rest of the population.

This flies in the face of the Constitutional right of access to health care for all citizens regardless of their socioeconomic circumstances. It is a situation that cannot continue. It is inefficient and unsustainable. It is unfair and unjust.

The introduction of national health insurance will be among the most far-reaching acts of social transformation this country has experienced since 1994. We have enough resources in this country to enable every man, woman and child to receive appropriate standardised quality health care.

Our past has taught us that we must never be a country that promotes the interests of the few at the expense of the majority. In 1713 the Dutch colonialists who had brought a smallpox epidemic to our shores imported medicines from Batavia to treat those affected. They used the medicine to treat their own, leaving the indigenous Khoisan to be decimated by the outbreak.

The segregation of health services brings back bitter memories. Back in the 18th Century it was on the basis of colonial settler status. Under apartheid it was on the basis of skin colour. Today it is on the basis of who can afford to pay.

The key fundamental principles underpinning NHI are equity, solidarity, the acceptance and recognition of the equal worth of every individual, as well as the right of everyone to receive the medical care they need cost effectively. This is something for which we must all fight.

The escalating cost of health care is affecting South Africans from all social strata where it hurts most – in their pockets. As the report of the Health Market Inquiry published last year has shown, even those who have private health insurance are buckling under the pressure of rising premiums and shrinking benefits. Out-of-pocket payments are on the increase, draining disposable incomes and making it even harder for many to make ends meet.

As a nation, a large share of our national expenditure goes to health care, yet there is a fundamental mismatch between what we spend and the health outcomes of our citizens. Just as we demand quality standards of health care for ourselves and our families, we should do the same for others. Just as we would not treat a relative or friend badly because they earn less than we do, we should care enough that they have equal access to treatment and care when they fall ill.

We must move away from a culture driven solely by self-interest and embrace the spirit of ubuntu, meaning solidarity. This is the vision of the NHI. It is the vision of our Constitution.

We cannot build a prosperous and economically thriving nation if a small minority of our workforce is healthy while the majority is vulnerable to ill-health and disease. In this respect, NHI is as much an economic issue as it is a fight for social justice.

I call on all South Africans to mobilise behind the National Health Insurance and to see it implemented. I call on NGOs, community organisations and civil society at large to rally around the NHI in the same way that they did in the fight against HIV/Aids.

I call on the National Department of Health to prepare adequately for the implementation of the NHI. This includes working with stakeholders to implement the Presidential Health Compact, ensuring that public health facilities have the personnel, medicines and equipment to provide the care that people need.

I call on the private sector to join government in seeing the NHI realised. To transform the health care landscape to make it more efficient, cost-effective and value for money requires that we forge strong public-private partnerships for the delivery of services. We remain committed to ensuring there is effective consultation and engagement with all sector partners at all stages of the process.

We will not be reckless in implementing the NHI. We will implement it in an incremental fashion and aim to cover the whole country by 2025. We will use an affordable approach to progressively move towards a comprehensive NHI environment.

[link url="https://legalbrief.co.za/diary/legalbrief-today/policy-watch/legislation-unwavering-support-for-nhi-bill/#redirect"]Full Legalbrief Policy Watch report[/link]

[link url="https://www.spotlightnsp.co.za/2020/02/24/nhi-hearings-hit-soweto-and-west-rand/"]Full Spotlight report[/link]

[link url="https://www.businesslive.co.za/bd/national/health/2020-02-24-south-africans-must-rally-behind-nhi-cyril-ramaphosa-urges/"]Full Business Day report[/link]

[link url="https://www.polity.org.za/article/ramaphosa-says-access-to-good-quality-health-care-boosts-social-cohesion-2020-02-20"]Full Polity report[/link]

[link url="https://mailchi.mp/presidency.gov.za/president-desk-24-feb20"]President’s newsletter[/link]

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