EDITORIAL: State must get real on NHI

No rational person can take issue with the government’s desire to improve the nation’s health.  There is no question that a healthier population is a happier and more productive one. And it is simply wrong that 20 years after the end of apartheid the quality of health services available to South Africans still largely depends on the colour of their skin.

The wealthy, who remain largely white, have ready access to private health care, while the poor, who remain mostly black, depend on a corrupt and underresourced public health system lurching from one crisis to another.

The government is right to want to change this dismal state of affairs and institute a system that provides universal health coverage, which it calls National Health Insurance (NHI). But time and time again it has demonstrated that politics trumps all else, to the detriment of the very people it claims to be serving.

The latest egregious example of this is the way it has handled its flagship NHI pilot sites.

The health department poured R4.9bn into 11 of the country’s most deprived districts over a five-year period, directing the money into a host of programmes ostensibly aimed at improving the quality of their health services. But an evaluation report seen by Business Day earlier this week reveals that the project was so poorly conceived that the health department cannot say what worked and what didn’t.

Yet it is forging ahead with NHI regardless.

The big problem with NHI is that it emerged from an ANC party resolution — which will be familiar to those who followed the governing party’s recent approach to land reform and the ownership of the Reserve Bank — rather than a systematic analysis of the problems confronting the health system.

From the outset, every iteration of the policy was published to coincide with a key political event rather than because a rigorous job had been completed. The pilot programme is equally overshadowed by politics.

This explains why instead of carefully devising a pilot programme that would test new ideas systematically, the health department scrambled to retrofit a host of existing ones into the project.

Rather than tackling difficult and unsexy aspects of NHI, such as the governance structure of district health authorities, or figuring out the intricacies of contracting with the private sector, it simply shunted the money into things such as clinic upgrades, dispensing chronic medicines at community sites to reduce the load on hospitals, and a school health programme that screens children for problems with their hearing or vision and called it NHI.

Even its efforts at contracting private sector GPs were hardly new. The state has been paying private sector doctors to do sessions in state facilities for years.

Dressing these programmes up as NHI would not have been the end of the world if there was at least some useful data to inform the next step. But the tragedy is there isn’t.

Hard as it is to believe, even for relatively simple initiatives such as the school health programme, there are no referral records and no information on what proportion of the kids received the hearing aids or glasses that they need. Similarly, no one monitored the patients using the new chronic medicine dispensing services to see whether more convenient access to their pills resulted in better adherence.

It is absolutely scandalous that the health department squandered public funds on a project so flawed it cannot demonstrate the impact of its interventions, let alone report on the return on its investment.

And it is equally disgraceful that the evaluation of this high-profile programme was not made public before the cabinet deliberated on the NHI Bill earlier in July. The bill, which is expected to be tabled in parliament in a matter of weeks, is the first piece of enabling legislation and paves the way for the creation of a fund that will purchase services on behalf of the entire population from public and private sector providers.

The NHI pilot sites are clearly a failure. The government needs to own up to the fact and stop trying to hoodwink the public.