05:30 GMT 8th November 2011
The vast majority of South Africans currently rely on underfunded and overstretched public hospitals as they cannot afford private medical insurance. 'The private sector is held up as an example of good service and quality of care, and this is mostly justified,' South African health minister Aaron Motsoaledi, a doctor by profession, said. What is not justified is the price tag that comes with certain forms of private health care provision. Without NHI, the burden of disease in the country will not be reduced because the majority of the population - and the section suffering the greatest ill-health - will not access good quality health care.'
'The right to obtain healthcare is written into our constitution, but large numbers of our people continue to die prematurely and [many] suffer unnecessarily from poor health,' states the department of health on its 'Treatable conditions are not being treated on time and preventable diseases are not being prevented.' This is expected to change with the introduction of the NHI, which will give every South African, as well as permanent residents, access to affordable healthcare.
The hallmark of the scheme is its universal reach, ensuring the provision of primary healthcare for all- regardless of their employment status or whether they are able to make a direct contribution to the NHI Fund through taxation. Although primary healthcare will form the core of the NHI, the scheme is intended to provide comprehensive coverage - primary, secondary and tertiary, as well as high-care medical services.
The NHI will cover health services at all levels of medical intervention - disease prevention, health promotion, treatment as well as rehabilitation. With the new scheme the stress will fall on disease prevention and health promotion. Treatments that the NHI will not cover include cosmetic surgery and dental procedures for aesthetic purposes.
In anticipation of its implementation, the government has stepped up inspections to ensure that all publicly funded hospitals and health clinics will be ready to comply with the standards of the new scheme. The department of health is undertaking a complete audit of all public health facilities in the country - 4,200 in all - and the process is expected to be completed by May next year. To qualify for the NHI, they will need to meet rigorous standards of availability of medicines, cleanliness, patient safety and infection control. Full compliance with these standards will be an absolute requirement for receiving NHI funding. The government has set aside more than $1bn from the $14bn health department budget for boosting health facilities across the country.
During the initial phase of implementation, the scheme will start in the most under-served areas where the majority of people have difficulty accessing essential treatments. The programme will then be gradually rolled out nationwide over the next 14 years.
The NHI will not herald the end of private healthcare in South Africa as private hospitals may choose to opt out of the scheme. The government intends to work closely with private healthcare providers, particularly in areas where there are no public hospitals. If there is a private doctor operating in an area without a public health facility, the government will sign a contract with the doctor to provide essential treatment to patients who cannot pay the medical bill. Affluent South Africans will also have the option of continuing to use private healthcare at an additional cost.
Implementing the new scheme will entail significant improvement of the country's entire healthcare infrastructure. This will include the building of new hospitals and health clinics as well as refurbishing existing ones. Upgrading medical equipment will be another priority. To overhaul public health facilities in the country, the South African government has teamed up with the Development Bank of Southern Africa (DBSA).
South Africa has experienced significant brain drain over the past couple of decades. Loss of skilled labour, coupled with the devastating impact of the Aids pandemic, has led to a significant human resources crisis in the country, the effects of which have been acutely felt in the health sector. There is a serious shortage of medical manpower - estimated at 80,000 personnel- putting a severe strain on the country's ability to provide quality healthcare.
Training new medical staff - doctors, nurse and midwives as well as medical technicians - and improving the working conditions of healthcare staff will be essential for the scheme's success. At the same time, nonnationals will be brought in to help make up the shortfall.
Inviting public consultation on the new programme, President Jacob Zuma stated that it was 'a national imperative' that the nation had 'to find the resources for'. The cost of setting it up in the first year is expected to be about R128bn. Funding for the NHI is expected to come principally from taxation. South Africans who earn a certain income will be required to make a contribution of the NHI Fund.
South Africa spends just over 8 per cent of its GDP on healthcare, more than any other country in Africa. This is in some cases similar to high-income countries. South Africa is a middle-income nation and boasts the continent's largest economy. But there is still widespread poverty, particularly among the black majority population, and South Africa is ranked among the world's top 10 countries for income inequality - an imbalance inherited from the apartheid era.
As it overhauls the country's entire healthcare system, the government is placing special emphasis on tackling HN / Aids. Zuma's predecessor, Thabo Mbeki, was heavily criticised for failing to grasp the scale of and develop an appropriate response to the Aids crisis in the country. Although it later improved services, according to one estimate, more than five million South Africans, out of a total population of 50.5 million people, were living with the Aids virus in 2009.
Since taking office two years ago, Zuma has increased funding for and widened the scope of treatment. Aids patients now have greater access to anti-retroviral drugs provided through publicly-funded schemes. The government launched a major campaign last year, offering free testing and counselling in public health facilities across the country. With more than five million people tested since the starting date, the campaign has been hailed as a huge success.
The department of health has set a target for the reduction of new infections this year, as well as providing anti-retroviral drugs to at least 80 per cent of patients who need them. Promoting medical male circumcision among men between the ages of 15 and 49 has also been an important part in South Africa's reinvigorated fight against HIV / Aids. Studies have shown that male circumcision reduces the risk of new infections by up to 60 percent.
The government has also made concerted efforts in recent years to improve maternal and child health, including the launching of a massive immunisation programme that was intended to reach three million children and prioritising Aids treatment for pregnant women to reduce the risk of mother-to-child transmission of HIV.
Post-natal home care visits is an important component of the initiative. Although infant mortality has been declining steadily over the past few years, a large number of children continue to die before they reach their fifth birthday. Children in poor and rural communities are particularly vulnerable - dying disproportionately of preventable and treatable conditions such as diarrhoea, pneumonia and measles.
Last month, the UK Department of International Development granted South Africa $26.5m intended for improving maternal and child health. Health minister Aaron Motsoaledi said the grant will greatly enhance the country's chances of meeting the Millennium Development Goal of reducing child and maternal mortality. In an issue devoted to health problems in South Africa, the prestigious British medical journal The Lancet lauded Motsoaledi's efforts as ushering in 'a new and optimistic epoch for the well-being of South Africa's 50 million citizens.'
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