Ramaphosa takes charge of NHI
President’s office now to lead fight for quality health care for all
● President Cyril Ramaphosa has put the National Health Insurance (NHI) scheme at the top of his list of priorities, telling the health-care industry on Friday that his office will be taking the reins of NHI.
“Leadership is what matters, and that is why I have decided that I am going to, from the president’s office . . . provide leadership on NHI . . . We are going to lead it and we are going to be talking about it all the time because it is important [and] in my view, it is achievable,” Ramaphosa said.
The plan is to implement NHI incrementally from next year, he said. Full implementation has previously been earmarked for 2026. Ramaphosa was speaking during a consultative meeting in Pretoria with healthsector stakeholders, including medical aid schemes, nongovernmental organisations (NGOs), policymakers and health-sector decision makers.
For decades SA has had what Ramaphosa described as a “two-tiered” health-care system where most of the country’s population, which lives in poverty, only has access to public health care, which is characterised by poor infrastructure, a lack of facilities and a skills shortage. The private sector, on the other hand, offers those with more money access to high-quality care.
“We must put behind us the era of quality health care being the exclusive reserve for those with deep pockets,” he said.
Ramaphosa said NHI would be a success but not without all the role players focusing their minds and resources.
Asked about the president taking control of his flagship project, health minister Aaron Motsoaledi said he had requested Ramaphosa’s involvement in NHI to give it the priority it deserves.
“Universal health coverage has become a global movement similar to the right to access to ARVs by people living with HIV and Aids,” said Motsoaledi.
As part of its work towards implementing NHI, the government, the private sector and NGOs have put together the Draft National Quality Improvement Plan, aimed at ensuring that the public health-care sector meets quality standards.
Jacqui Stewart, CEO of the Council for Health Service Accreditation of Southern Africa, who presented the plan to the meeting, said it was meant to pull together work being done by NGOs and the private sector to ensure that there is faster compliance and quality from health-care facilities.
The NHI bill has set out two processes to determine the suitability of health-care providers to provide services under NHI. The first is certification by the Office of the Health Standards Compliance (OHSC) and the second is accreditation by the NHI Fund.
“The OHSC tried to certify all the hospitals against the regulated standards but what they are finding is that the facilities aren’t getting up to speed as quickly as they can. Our concern is that if we wait for that to happen, we are losing ground for getting sustained quality for NHI,” Stewart said.
Part of the proposal includes using facilities which are soon to be identified as centres of excellence as test cases for NHI accreditation. This means that facilities that have been doing well in terms of staff skills, quality of services and infrastructure will assist those not meeting the standards.
The Board of Healthcare Funders of Southern Africa (BHF), which represents medical schemes, administrator and managed care organisations, said it supported the plan, which it was also involved in drafting.
BHF head of benefit and risk Dr Rajesh Patel said the plan was in response to calls for the public sector to be fixed.
“This [plan] is an intention to move in that direction and I am sure a lot will probably be done by the [OHSC],” he said.
Mark Peach, executive head of public affairs at the Hospital Association of SA, said the association supported all the steps that were being taken to improve the performance of the health-care system.
“We welcome the leadership shown by the president for demonstrating the importance to him and the country of finding solutions to the many health-care challenges we face so all South Africans enjoy an effective and efficient health-care system. We are committed to working with him and the national department of health to form effective legislation . . . and action plans,” Peach said.
NHI is important and it is achievable