National Health Insurance (NHI) Pilot Districts

A Portfolio meeting to receive an update from Minister of Health on National Health Insurance (NHI) Pilot Districts progress meeting was held on 21 August 2015. The Department of Health may have completed its part of the White Paper on NHI, but it is still tied up in Treasury. And until it is finally released, we are going to continue to see mistrust between the public and private sectors.Dr Aaron Motsoaledi, Minister of Health, and department heads working in the Department of Health provided an update about the National Health Insurance (NHI) pilot sites to the Portfolio Committee on Health last week.

This meetings’ focus was on:

  1. The development of infrastructure for primary healthcare facilities;
  2. the recruitment of doctors; and
  3. specialists for clinics.

Minister Motsoaledi emphasised the importance of efficiency in human resources management in building up the public health sector. He explained the Department’s consultations with both the World Health Organisation (WHO) and Harvard University in pursuing the NHI programme. It is such a pity that the Minister and his Executives ignore the many resources that exist within South Africa and who can really add significantly to the NHI programme with much needed local context.

The Department presented the design for an ideal clinic and explained that 106 structures have already been completed in the ten pilot districts. The districts were chosen as representative of the country’s widely diverse demographics, so they therefore vary in size, population, and level of poverty.

The Department is working on construction and budgetary matters in conjunction with the Department of Public Works and the National Treasury. Though it has been challenging for the Department to attract doctors and specialists to work in the clinics, the Department has many methods of recruitment as well as training programmes in place for former or current clinic volunteers. Efforts are also underway to address the critical issues of wait times and school health care services.

The Committee had many questions due to the complexity of creating a national health care system, but generally praised the Minister and his Department’s efforts. Personally the Minister and his team are making great strides in these areas. The general public should be made aware of the good story that can be told.

Members asked general questions about the influence of business on public health, oversight of and budgeting for programme spending, the Department’s ability to build public confidence in the programme, school healthcare services, and doctor recruitment as well as specific questions about x-ray machines in clinics, examples of clinic construction projects being behind schedule, recruiting doctors from SADC countries, and clinic security.

Minister Motsoaledi noted that many funding issues would be clarified in the soon-to-be-released White Paper, pending work by Treasury on the White Paper. He also said that the Department is working with and drawing funding from the private sector for public health initiatives.

The Department will build confidence in the NHI programme over time as the public becomes familiar with the programme. The foreign recruitment of doctors is highly contentious, and Minister Motsoaledi noted that, worldwide, there is a general shortage of doctors.
He told the Committee that the clinics had x-ray machines and proper security measures, and again emphasised the importance of HR structures.

My own view is that there is still a massive mistrust from the Public sector towards the private sector, in spite of the fact that the private sector is able and willing to partner with Government for better health for all our citizens. Our government seems hell bent on getting international help to solve our problems while we have great expertise right here in South Africa – which we are losing to other parts of the world where it is welcomed with open arms. A sad state of affairs and we as a country are on the losing end. Don’t for one second think I don’t see value in obtaining input from international experts but at least use the talent that is in our country.

Until Minister Motsoaledi and his team releases the white paper on NHI and the funding thereof – now years overdue – we will continue operating with the mistrust and great divide between two sectors who can work together and together improve health for all South African citizens.

Maybe we should seriously consider a health CODESA to discuss these matters. The BHF conference in July this year focussed on “Healthcare accountability – a roadmap to a sustainable health system”. Sadly there was almost no input from the Public sector and the conference ended with no real roadmap or plan going forward.


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