Arguing that unless the public health system is strengthened to better serve users and a clear path is laid out for public-private partnerships, a patient-centered health care system will remain an illusion under National Health Insurance. do Bernard Mutsago and Haseena Majid.
National Health Insurance (NHI) is South Africa's chosen funding instrument for universal health coverage (UHC). This plan is one step closer to becoming a reality with the passing of the NHI Bill by the National Council of States in Parliament on December 6, 2023.
The law aims for a single NHI fund that would purchase services from public and private providers. It would be free at the time of childbirth, meaning that the medical system would no longer be able to cover the services provided by the National Health Insurance. The bill is likely to be signed into law by President Cyril Ramaphosa too soon, but it could be several years before all of its provisions come into force.
However, achieving a universal, affordable, high-quality, comprehensive, and patient-centered health care system under the National Health Insurance system is a challenge to meet the needs of the public. will remain an illusion unless fixed. This can be achieved through structured systems that enable efficient and fair pooling and distribution of resources across public, private and civil society sectors, improving service delivery.
Barriers to progressive planning
Currently, progressive planning is hampered by the absence of a clear framework for public-private partnerships in health service delivery.
South Africa has seen a significant decline in the state of its health sector over the past decade. Despite efforts such as primary health care (PHC) reengineering programs and outreach services to improve access to services, health systems face myriad challenges. Budget constraints are crippling human resource capacity. Corruption, mismanagement, and neglect have left facilities dilapidated and unable to sustain the growing demand for basic and complex health services.
Most importantly, data management systems, administrative processes and referral pathways require significant intervention to align with the digital age and the potential role of artificial intelligence to improve health service delivery. As a result, the set of data indicators for communicating health service delivery needs according to geographic and institutional needs may become less representative and possibly outdated.
Applying a comprehensive approach to health interventions in the absence of significantly strengthened data collection and evaluation pathways has led to questionable methods for achieving universal health coverage through the NHI. The implementation of NHI pilot sites in building towards NHI delivery failed to demonstrate how the health system would move from its current therapeutic approach to a more patient-centered approach. Failure to establish patient-centered pathways early in government and health care delivery systems will continue to leave some people without access to the cheapest and closest health care services. It also has far-reaching implications for preventive strategies to achieve better health outcomes.
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South Africa's healthcare system is fragmented, two-tiered and inequitable, with only about 17% of the population receiving medical assistance in 2018 and more than 80% of the population receiving public health services. Much depends on the department. This is according to the Competition Commission's final health market investigation report published in November 2019.
The path to universal health care requires critical actions, including maintaining and strengthening health care infrastructure and implementing strategic initiatives to strengthen the workforce through strong recruitment, retention, and public-private collaboration. It becomes.
However, attention to these important measures has been diverted by the government's focus on a particular funding model (National Health Insurance), and the plan has faced considerable backlash from critics. . The main causes are government inability to provide essential services, theft due to corruption and cadre staffing, and disadvantages for health users. These concerns have been ignored. Rather, the determination to advance national health insurance amid protests from the medical field, academics, and civil society is likely to be driven by politics.
Lessons from Ghana
The failure of Ghana's NHI experiment is a shining example for many countries experimenting with different financing models to deliver UHC. Ghana's attempted national health insurance initiative was removed from the national policy agenda due to public political opposition, weak civil society mobilization, and low trust in the political leadership. This raises the question of whether due diligence was undertaken by the authors of the NHI to establish the viability and sustainability of this model within the South African context.
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Governments need rich cooperation to materialize policy goals. The National Health Insurance Bill has already been passed by Congress, but the success of this policy will depend on people across the political spectrum. Developing and implementing the operational plan for the NHI will require a government approach that demonstrates a willingness and commitment to receive input from all sectors, be open to criticism, and find an approach that integrates all stakeholders within the health sector and finance. you are required to take it. space.
public-private partnership
Well-designed public-private partnership models, with strong monitoring and evaluation processes, may provide an opportunity to build the foundations for medium-term solutions. This will increase the resource capacity of the public health sector, address current health service backlogs, improve health infrastructure and technology, and improve collaboration between the public and private health sectors to collect accurate health data. It is possible to build a functional system. Ultimately, enhanced data collection systems that are inclusive and reflective of all users of the health system are essential to creating a responsive rather than a reactive health system, and thus It will be placed at the center of the system.
Furthermore, structures for community engagement to inform health service delivery, such as clinic committees and hospital boards, are currently poorly functioning or non-existent and need to be strengthened. There is. Including all voices, especially those of the public and clinicians, is critical to establishing a competent health system that provides equitable access to health care for all. This can only be achieved by raising our voices and making a united call for governments to urgently re-evaluate their current approach to implementing the National Health Insurance.
– Mtsago is a health policy analyst, health equity activist and primary health care enthusiast, while Majid is a Global Atlantic Fellow for Health Equity in South Africa and Director of the Public Health Program at civil society group Usawa.
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