South Africa’s health ombud has warned Parliament that government health facilities won’t make the grade to provide services under National Health Insurance (NHI) because not only are they so bad, with, in fact, a number actually deteriorating, but efforts to raise standards are also moving too slowly.
The NHI Bill, currently before Parliament, proposes that a central fund should purchase services from public and private health facilities, which must first be inspected and accredited by the Office of Health Standards Compliance (OHSC).
“But as things stand today we couldn’t go into the NHI with the level of inspections and certification we have done so far, because I suspect most of the hospitals will not meet the high standard required of the NHI,” health ombud Malegapuru Makgoba told Parliament’s Portfolio Committee on Health, reports BusinessLIVE. He added that the compliance office was also failing to keep up with checks.
The plans to introduce universal healthcare through the NHI scheme were “fraught with hurdles and may not be implementable at the pace that the government wants”, he added.
BusinessTech reports that Makgoba said complainants often describe healthcare facilities as being in a mess, and that service levels are not conducive to effective care.
Makgoba was appointed health ombud in 2016 and has overseen a series of high-profile investigations into failings in the public health sector. He said he had visited every province this past year and found deteriorating health services in all but the Western Cape. “While we are preparing for NHI, we don’t seem to be raising the standards (of) the service we are giving to the population in SA.
“The only province that has its act together is the Western Cape … The other provinces are really in difficulties and need … to jack up their work,” he said.
The OHSC works closely with the office of the health ombud, and both have consistently told Parliament they are unable to fulfil their mandate because they are under-resourced. The OHSC says in its five-year plan that it aims to inspect each of SA’s more than 5 000 health facilities at least once every four years, meaning it needs to assess on average 1 200 a year.
However, it inspected only 544 out of SA’s 3 741 public health facilities in the year to 31 March, slightly up on the 387 it scrutinised the year before. No private health facilities were inspected because their assessment criteria have not yet been finalised.
OHSC CEO Siphiwe Mndaweni said the pandemic had delayed inspections and added to the budget and staff constraints that limited the number of facilities that could be inspected, contributing to lags in resolving complaints. Worsening issues was that the complaints directorate has only three staff.
Only 39 of the 146 complaints received from patients of health facilities were resolved within the OHSC’s 30-day target. Seven of the 158 serious complaints that warranted an investigation were completed in its six-month target, and two were resolved within a year.
Makgoba noted that despite the problems, this doesn’t mean that the plans should be abandoned. “It doesn’t mean we should stop trying – this is an important project of the new government. We should all put our effort into it.”
He added that he had worked in the National Health Service in the UK for 15 years, and that universal health coverage is an appealing prospect. But his observations show that, while there are pockets of good, there are many issues – in Gauteng and Limpopo in particular – that give rise to troubling complaints over service delivery.
Despite this, “the NHI is a necessary evil we must swallow,” he said.
In September, Health Minister Dr Joe Phaahla said that the plans to roll out the NHI in phases would proceed, despite a High Court ruling declaring parts of the National Health Act unconstitutional.
Private healthcare groups believe that the scheme is unsustainable and unmanageable, given the scale of what the government wants to achieve against the backdrop of how it has already failed in the public healthcare space.
There are also concerns over an exodus of healthcare professionals who refuse to be subject to the scheme’s harsh conditions, as evidenced by the court ruling the department is appealing.
Treasury’s warnings come from a financing standpoint – there is simply no money to feed into the scheme without raising taxes.
Finally, the Department of Health has raised red flags over the scheme’s administration, conceding that it is vulnerable to maladministration and mismanagement.
DA health spokesperson Lindy Wilson, who is a member of the committee, said the OHSC did not have the resources to do its job properly.
“It is not making a dent in the situation at all. There is no improvement in health. It is actually declining,” she said. “It is not entirely their fault.”
BusinessTech article – Health ombudsman says South Africa’s NHI is a ‘necessary evil’ (Open access)
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