NHI’s mountain of obstacles before it can be implemented

LOCAL research has identified a number of stumbling blocks to the implementation of National Health Insurance (NHI).

A study conducted by the People’s Health Movement and a mobile health company, Cell Life, found that long waiting times at state clinics and hospitals, staff attitudes and poor training of health workers needed to be addressed before NHI could be rolled out.

According to the study, which canvassed the opinions of South Africans on the proposed NHI, many expressed distrust and lack of confidence in the country’s healthcare system.

The survey, sampling 900 Mxit users who were asked what they would like to see NHI improving in the healthcare system, revealed discrepancies between the lived reality of those who used public healthcare and the intended health policy reform.

The proposed universal scheme, which is currently being piloted in 10 districts, is aimed at bridging the existing health inequalities and offering equal access to affordable, quality health care regardless of socio-economic statuses.

It was hoped NHI would serve all, including the 16 percent who currently make use of private healthcare.

Last week, four years after the NHI green paper was first released, Minister of Health Aaron Motsoaledi announced that the white paper on the scheme would soon be published after the cabinet had deliberated on it.

The white paper is a more detailed outline of how NHI would work, and would detail exactly which health-care services would be offered under the scheme, who would be responsible for delivering them, and how they would be paid for.

But according to the study, which appeared in the Canadian Journal of Medical Internet Research, consumers raised a number of concerns about the country’s public health-care system, including a shortage of health-care workers, a need for better training of doctors and nurses, and the major inequalities in service delivery.

Respondents expressed a lack of confidence in the health system, with some saying the quality of health service they received was “extremely poor” and “the government must improve health conditions in rural areas”.

Others said they were not treated with respect at facilities while some criticised the poor law enforcement they had experienced.

Others demanded that care provided in the public sector should be on par with the private sector.

Patients also claimed care was not centred on patients’ needs. Some patients said medical staff were preoccupied with their own affairs such as “taking long tea breaks”.

They were also concerned about absenteeism and nurses’ attitudes were described as “unethical” and they were “not being empathetic with the patients”.

They suggested that if NHI was implemented, staff would have to receive proper and regular training, and be supervised to avoid the abuse of tea breaks.

Patients also requested easy access to primary health-care services, more free therapies, and longer clinic operating hours.

Also requested were additional services such as mobile ambulances and better logistics management.

Professor Edda Weimann, a lead researcher, medical doctor and public-health specialist at UCT, said the study intended to strengthen health care provision by analysing the consumers’ perspective on the new national health reform.

Weimann said public consultation was often neglected in most health-policy reforms.

“It gives detailed insight of the experiences and expectations of public health-care users in the light of the World Health Organisation building blocks.

“The findings of this study are not only interesting for public health specialists and policy makers, but also for medical staff as they mirror the patients’ experiences and views about current practices of a healthcare system.”