Convincing a corruption-embattled population to trust a centralised and procurement-based National Health Insurance (NHI) system becomes more difficult with each graft scandal, writes Section27’s Sasha Stevenson on Spotlight.
But the reform of the health system to create equity and ensure quality is needed now more than ever. Strong governance and transparency are the minimum requirements for a trustworthy NHI.
Parliament must demand provisions in the NHI Bill to meet these requirements if we are to protect the integrity of the new system and if the public is to have any trust in the health system and those who run it.
Writing on the Spotlight site, Section27’s Sasha Stevenson notes that NHI seeks to fix inefficiencies and resource imbalances across the health system by allowing for procurement of services by the state from public or private health facilities at set prices. The same health services will be available to all and the state will enter into contracts with health facilities to provide services according to treatment guidelines. However, the “astonishing” extent of the misuse of funds and exploitation of lax contracting processes during this global pandemic “has confirmed fears about our ability to secure the integrity of a health system based so directly on contracting and procurement”.
How can the population be convinced to support a massive shift in the operation of the health system that will divert all health spending to a single fund for procurement of health services for all?
Stevenson believes that strong governance systems and transparency in all decisions would be essential. She says the currently envisaged NHI Fund is overwhelmingly reliant on the Minister of Health. However, she believes centralisation creates weakness and opens systems up to abuse, adding it is unnecessary – given the legal structure of the fund – for so much power to rest with the Minister.
“Good governance must be the central pillar of NHI if it is to overcome the public’s fears of corruption and maladministration,” she adds. Furthermore, it is “imperative” that all NHI-related processes and decisions are as transparent as possible. “This requires specific provisions in law to guarantee such transparency.”
Details of all transactions of the NHI Fund; details of decisions relating to the benefit package under NHI; details of decisions about what to procure and from whom; and details of decisions to contract certain facilities should be made available to the public as a matter of routine.
[link url="https://www.spotlightnsp.co.za/2020/09/09/opinion-what-ppe-graft-means-for-nhi/"]Full analysis on the Spotlight site[/link]