LETTER: NHI is SA’s path to universal health coverage

Universal health coverage (UHC) as defined by the World Health Organisation “means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care”.

There is no “one size fits all” approach; every country has a different path to achieving UHC based on its unique needs, context and resources. For SA, National Health Insurance (NHI) is the chosen path.

It is intended that the NHI will use a single-payer model to finance healthcare costs. The NHI Fund will be the single payer and a strategic purchaser. It will purchase healthcare services from both private and public healthcare providers to deliver care to all South Africans regardless of socio-economic status.

All healthcare providers will be accredited through the same process to ensure standardised and quality health care in the public and private sectors. Through the NHI SA aims to address the inequity in access to health services, and prevent financial hardship people accessing health care.

The current challenges with the UK’s National Health Service have led to comments such as: “If the UK cannot get universal health coverage right, how will SA fare?” But the NHI is not modelled on the UK’s system. The two nations have different societies and hence cannot have the same approach to health care.

For instance, SA is one of the most unequal countries in the world with a Gini coefficient of 63, compared with the UK’s 35. In addition, the UK has an ageing population with different health needs than SA. An ageing population requires more costly healthcare interventions such as hip replacements, cancer treatment and frail care, compared with those of a younger population.

The disease profile in the two countries aren’t the same, and the range of health services provided would also differ. Both nations aim to achieve universal health coverage, but the systems to deliver this will be significantly different.

The NHI, after a wider health systems comparison with other countries and identifying what worked and what did not, will be context specific in serving the unique health needs of the people of SA.

Dr Vivien Essel
Public health medicine specialist

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