NHI row has resulted in another fine mess
SA’s perpetual wrangling over policy orientation, passive austerity, political campaigning and practical realities have yet again been thrust to the fore in the current healthcare debate.
The government’s commitment to rolling out its National Health Insurance (NHI) scheme has resulted in an escalation of tensions between the state, the healthcare industry and big business.
The concept of universal healthcare in a country where so many people’s fate is decided by the mere circumstances of their birth is generally accepted to be a noble pursuit. The constitutional commitment to first-generation rights such as access to healthcare means the state has a binding obligation to create a system that is accessible to all citizens, and anyone else who finds themselves within the country ’ s borders when they experience a healthcare emergency.
Regrettably, like many largescale, critical public initiatives, the system has not been spared the challenges that undermine its intentions. Resource constraints affect the ability to hire practitioners across the healthcare spectrum to ensure the range of healthcare needs of citizens are adequately catered for.
Clinical accidents and errors that lead to medical negligence cases are a common and expensive feature of the public healthcare system. The unpaid liabilities relating to medical negligence claims across the different provinces amount to billions of rand the country hasn’t budgeted for.
Instances of gross corruption uncovered during the Covid-19 pandemic at places such as Thembisa Hospital drain resources from the system. Competing with other public spending priorities means even if we conceptually mapped out what the right resources should be to run the system perfectly, this would not be achievable.
The private healthcare system is far better capacitated but expensive to access. The result of this anomaly is the existence of an overburdened public system and an underutilised private system. The government’s plan is for the NHI to correct the imbalance by treating the entire healthcare system as one national scheme where resource-sharing is a fundamental practice.
Unfortunately, the process of mapping out how it should all be achieved has turned out to be a headache that has escalated the confusion and alienated stakeholders, who seem incapable of reaching consensus.
The progress of the NHI Bill through legislative corridors seemed to be deaf to the sentiments expressed by key healthcare stakeholders regarding various unresolved issues underpinning the model.
The bill’s legislative journey was predictable once the ANC had embraced the bill despite its many apparent flaws, and it has now been left to those who remain opposed to it to directly lobby the president not to sign off on the bill. The problem is that the president is in election campaign mode, and given the centrality of the NHI to the ANC’s policy orientation, his capacity to slam the brakes on the bill is diminishing each day.
While the government may feel the problems that have been identified are mere teething issues that can be resolved post-implementation, the recent fiasco regarding the funding of doctors due to enter the public healthcare system did the state no favours.
Due to the passive austerity programme the National Treasury has implemented to address the public debt crisis, provincial health departments are unable to fund the onboarding of more healthcare workers, who are desperately needed. The consequence of the skills shortage is that all the issues that undermine the system in its current form escalate, and if shortages result in more negligence cases there will be more new liabilities for the future.
A healthcare system is far too important to be subjected to austerity programmes and flawed policy directives.
When it goes wrong, lives are at stake, and given the fact that those who are exclusively dependent on the system are citizens of limited means, messing it all up amounts to an abrogation of the constitutional obligations of the state.