LETTER: Why the NHI is important for rural healthcare

Rural communities represent a consequential part of the SA population. Seven of the nine provinces can be classified as rural. These rural communities still do not have access to quality healthcare.

People living in rural areas struggle to get equitable access to healthcare services. The maldistribution of healthcare workers between rural and urban, private and public, is a lived reality for these communities.

In 2015 about 70% of SA doctors worked in the private sector, which is largely based in urban areas. Quality healthcare requires access to multidisciplinary teams of healthcare workers.

The proposed National Health Insurance (NHI) is a fund that will be purchasing healthcare services for the whole population. One of the key NHI features is the purchaser-provider split, which means the fund will be responsible for purchasing healthcare services from accredited healthcare providers.

The providers will be from public sector as we know it, and private providers. This will increase access for rural communities to much-needed resources that are in the private sector. The NHI seeks to provide healthcare services closest to where people live. The NHI fund as a strategic purchaser will not only purchase services from providers, but also medicines, laboratory services and radiological technology.

The contracting unit for public healthcare will be responsible for purchasing services in the districts. The district consists of a hospital that offers district level services, community health centres, clinics and healthcare providers. Well defined referral pathways will ensure patients receive the level of care they need at the appropriate facility.

Primary healthcare re-engineering has reinforced the building blocks for the district system through community healthcare workers, school health, district health management teams at district hospitals and the inclusion of private providers in public facilities. The NHI will ensure sustainable and equitable distribution of the healthcare workers needed to realise public healthcare re-engineering.

As a public health medicine specialist I support the NHI and its objectives to achieve universal health coverage for all South Africans.

Dr Mahlatse Rapholo
Via email

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