The NHI enforces the constitutional principle of health care as a public good, says the writer. File photo: THE HERALD/EUGENE COETZEE
The NHI enforces the constitutional principle of health care as a public good, says the writer. File photo: THE HERALD/EUGENE COETZEE

Every parent in this country has had their fair share of tending to a sick child, but the worst nightmare is when a parent realises that a very sick child does not respond to basic treatment.

The comfort of knowing your child can be rushed to a nearby hospital or clinic for professional medical treatment is, unfortunately, not enjoyed by all our citizens.

While some know they will immediately receive professional and high standards of medical care, others know they will have to wait in endless queues, either to receive substandard treatment or, worse still, be turned away after patiently waiting for hours.

The untenable reality that access to decent and quality health-care services is determined by one’s ability to pay for them is one of the greatest travesties of our time. Access to health care, regardless of one’s socioeconomic circumstances, is a fundamental right enshrined in the constitution of 1996.  

A people-centred health system is also one of the core pillars of the National Development Plan. The Reconstruction and Development Programme expounded the importance of community participation in government policy, planning, managing, delivery, monitoring and evaluation of health services in their areas.

This inclusive approach is not only aligned to our constitutional democracy but is also an integral part of good governance, owing to its potential to ensure government accountability and responsiveness.

The National Health Insurance (NHI) war room in the presidency, an intergovernmental co-ordinating mechanism, has noted the recent call by parliament’s portfolio committee on health to the public to make submissions through the participatory public hearings process. 

Since the dawn of democracy in 1994, our vibrant parliament has passed a significant number of impactful and far-reaching laws that have advanced the course of social transformation in the country. These progressive laws include those dealing with issues of gender equality, traditional marriages, employment equity, BEE, reproductive rights, a national minimum wage and access to basic services. 

Recently, a panel led by former president Kgalema Motlanthe surveyed the laws passed by the democratic parliament and concluded that the majority were indeed transformative and served to undo the legacy of colonialism and apartheid. 

This parliament of the people is now facilitating dialogue across different socioeconomic classes and diverse interest groups to usher in one of the most revolutionary instruments to advance social equity yet — the NHI. 

We cannot build a prosperous nation if a small minority of our workforce is healthy while the majority is vulnerable to ill health and disease.

All communities will be afforded the opportunity to meaningfully influence the direction of the NHI, especially because it affects their lives. Public engagements on issues related to universal health coverage in SA are not new. Over the years, several reforms were attempted with varying rates of success.

Arguably, apart from the constitution and the national minimum wage legislation, the NHI is the most far-reaching act of social transformation this country has witnessed since 1994. For the first time in our history, all citizens will have access to quality health care regardless of their socioeconomic background.

The health-financing system will be implemented through the creation of a single fund that is financed and administered by the public. Through the pooled funds, the state will be able to actively buy services to enable all South Africans to access quality and affordable health services.

This will alter current reimbursement models in the private sector, including budgeting within the public sector, with the expectation being value-based delivery and reimbursement.

Based on the need to tackle structural imbalances in the health system and reduce the burden of disease for all — and not just for the privileged few — the NHI will provide free services at the point of care and also offer a mechanism for improving cross-subsidisation in the entire health system.

Since it is rooted in the principle of social solidarity, the NHI will provide financial risk pooling to enable cross-subsidisation between the young and old, rich and poor, as well as the healthy and the sick.

The presentation of the NHI Bill to parliament represents a significant step in addressing fragmented financing and service delivery in the national health system since the dawn of democracy.

The NHI is not just about improving equity in access to health care, but it is also about ensuring our parents, grandparents and children receive proper treatment in well-run facilities operated by professionals regardless of where we live and how much or how little we have.

The NHI enforces the constitutional principle of health care as a public good — and that it should not be treated like any other commodity of trade, but as a social investment.

It is premised on affordability, as health services will be procured at reasonable cost that recognises the need for sustainability within the context of the country’s limited resources. It places a premium on quality of care and efficiency.

It is about ensuring the R493bn being spent annually on health care in both the public and private sectors results in better levels of health care and standardised services for all citizens. 

A strict referral system from primary health care will be implemented to significantly alter health-seeking behaviour for most of the population, especially those who are used to accessing higher levels of health care for basic ailments.

Under the NHI, available resources will be allocated and used efficiently to promote health interventions that must result in improved health outcomes.

The NHI will ensure the health system meets acceptable standards of quality and achieves positive health outcomes, and that innovative service-delivery models are tailored to the needs of the local population.

Though the NHI Bill has ambivalent support, and fierce contestation, from groups with vested financial and ideological interests, we believe that popular participation by the public will settle the matter and help the country move forward.

Parliament will be mediating key areas of contestation, such as changes in the role of provinces when the national health department delegates functions to manage the provision of health-care services, changes to the role of medical schemes, and the mooted reallocation of funding for medical scheme tax credits.

Universal health coverage is neither a fight of the poor against the rich nor an encroachment on the profits of the private sector. We cannot build a prosperous and economically thriving nation if a small minority of our workforce is healthy while the majority is vulnerable to ill health and disease.

All South Africans are encouraged to join the parliament of the people and be part of the public participation process. The fundamental right to an equal standard of health care is good for social cohesion and nation-building, and a healthier population will inevitably contribute to economic growth and socioeconomic stability in SA.

• Ngcaweni is head of the policy unit in the presidency. Khumalo is on secondment as health economist in the NHI war room in the presidency.