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Gordhan announced the imminent establishment of a national health insurance fund as he allocated R606bn over the next three years to the ailing health system

National health insurance (NHI) is fast moving towards a reality, with treasury announcing that an NHI fund will be established this year as the country heads towards the next phase of providing universal health coverage.

While the white paper on the NHI is still being revised and finalised, treasury and the health department are working on a sustainable long-term financial framework.

The fund aims to improve access to services such as maternal health care, wheelchair access, family planning and mental health care. Initially it will also serve to expand school health-care programmes.

Finance minister Pravin Gordhan said that, in setting up the fund, treasury will weigh all the options, including possible adjustments to the tax credit on medical scheme contributions.

The private health-care system in SA is utilised by a small percentage of the population, though expenditure in private care is well over 50% of total health-care spend.

Abieyuwa Ohonba, a health economics expert at the University of Johannesburg, says even though public hospitals have considerably lower rates for adults, and free primary health care for children under six and pensioners, private health care is first choice for most people.

“Even the very poor would rather incur outof-pocket expenses to consult with a private doctor,” she says.

Against the background of a disparate and unfair health system, where a greater percentage of the population is serviced by a severely underfunded and deprived public health system, “the NHI is certainly a vital transformation tool in the process of economic growth and development in SA”, Ohonba says. “However, there are many challenges, like the source of funding which is expected to be derived mainly from general taxes.”

Over the next three years, government will spend R606bn on health, concentrating funds primarily on HIV/Aids treatment and prevention programmes, revitalising health-care facilities and providing specialised tertiary services.

Treasury committed R19.1bn more to the health budget than in 2016. Between 2012 and 2018/2019 health expenditure will have grown in real terms by 1.3%.

For the 2017 financial year, R187.5bn is reserved for the health sector and district health services will get the lion’s share of R83.6bn.

Central hospital services will receive R35.9bn, R32.3bn is set aside for provincial hospital services, and other health services will have R25.8bn to spend. R9.9bn is reserved for facilities management and maintenance.

With SA’s shortage of medical personnel and training facilities, higher education & training minister Blade Nzimande has sent thousands of students to Cuba to obtain medical degrees and experience in a country with one of the best health-care systems in the world.

Gordhan said that over the next few months he will work with health minister Aaron Motsoaledi, Nzimande and economic development minister Ebrahim Patel to plan the development of the Limpopo Central Hospital and launch a new medical school in the area.

Prof Laetitia Rispel, who heads the Centre for Health Policy at Wits University, says all categories of medicine need to be developed to ensure a reasonable ratio of practitioners.

Rispel says government also needs to provide incentives to health-care workers across the board. “Our problem is that the majority of doctors are in the private sector and those in the public sector are based mainly in cities,” she explains.

Though the health-care sector faces huge challenges, there have been some gains in the treatment of HIV/Aids. Mother-tochild transmission has been drastically reduced in the country through various interventions.

Gordhan set aside an additional R885m for the implementation of the universal test-andtreat policy for HIV/Aids.

More than 3.5m people are accessing antiretrovirals (ARVs) and the health department expects ARV treatment to reach 5m South Africans by 2018/2019.

Treasury says it has saved about R1.6bn/year through the centralised procurement of medication, but savings have been offset by a weaker rand, which has driven up prices.