EDITORIAL: NHI not a cure for all SA’s health problems

South Africans don’t need another talkshop about the dire state of the public health system. They need concrete action to fix it.

Try telling that to President Cyril Ramaphosa and his advisers, who convened SA’s second presidential health summit last week. The first, in October 2018, produced little more than a glossy booklet with a long to-do list, signed with much pomp and ceremony nine months later. It sat gathering dust as top government officials directed their energy towards the lofty promise of National Health Insurance (NHI). Meanwhile public hospitals and clinics continued their precipitous decline, and patients paid the price.

Barely a day goes by without a new public health crisis. Last week it emerged SA’s biggest hospital, Chris Hani Baragwanath, had run out of food, and that 900 babies had died from avoidable incidents on its premises between 2020 and 2022. This week it was Dora Ngiza Hospital’s overwhelmed maternity service that made headlines, after pregnant women were left without meals and forced to sleep on the floor before eventually being transferred to other facilities.

The latest summit was positioned as a high-level gathering to assess SA’s readiness to implement NHI, the government’s plan for achieving universal health coverage. Almost 14 years after the ANC adopted the policy, parliament has yet to pass the laws required to bring it into effect, and the whole notion is proving a huge distraction.

No matter the problem, be it overcrowded public clinics or soaring medical scheme premiums, the government would have us believe that NHI will solve it. But this is at best naive and at worst dishonest.

NHI, which aims to provide healthcare services that are free at the point of delivery, is at its heart a set of health financing reforms. It won’t shore up public hospital management, improve the administration of provincial health departments, or end the rampant corruption sucking funds out of the public sector.

Business Unity SA has rightly pointed out that if the government wants to purchase services from private healthcare providers under NHI, it had better be sure the sector remains sustainable. And for that it needs to radically rethink its insistence that medical schemes should fade from view, relegated to providing cover for services not provided under NHI. Busa is sensibly urging the government to implement the Health Market Inquiry’s recommendations for reforming the private healthcare sector, and to extend medical scheme coverage to a greater proportion of SA’s working population with cheaper, pared-down benefits. These measures would not only ensure a stable private health sector that provides a better deal to patients, but will also reduce the load on the state.  

No-one can fault the president’s good intentions. He rightfully recognises that a healthy nation is a productive one, and that access to decent health services should not be determined by one’s wealth, or where one lives. But good intentions are pointless without action.

It is time to stop positioning NHI as the panacea for all ills, tackle the vested interests throttling the public health service, and ensure hospitals and clinics function as they should.