NHI – THE QUEST FOR TRUE UBUNTU
THIS year we celebrate the 100th birthday of one of the most revered icons of our revolution, Oliver Reginald Tambo. The year has been accordingly declared the year of Oliver Tambo.
Tambo dedicated his entire life to the creation of a democratic, non-racial, non-sexist and prosperous South Africa where all people regardless of their economic or social status would have equal rights.
The best tribute we can pay to this gallant hero of our liberation Struggle is to ensure that we translate our Constitution into reality - into a living organism.
Only when our people enjoy the health dividends of democracy through the provisions enshrined in the Constitution, shall we say our work is done and Oliver Tambo has indeed been honoured.
The Bill of Rights in Section 27 of the Constitution states unequivocally that healthcare is a right. Subsection (2) then goes on to say: “The State must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.” And subsection (3) says: “No one may be refused emergency medical treatment.”
The most important aspects of these provisions have not yet been operationalised. The time has now eventually arrived for us to do so. In the second phase of our transition to democracy, the phase of radical economic transformation, we have no option but to do so.
It is for this very reason that we have no option but to implement the United Nations programme of Universal Health Coverage which in South Africa we call NHI.
We define NHI as a health financing system that pools funds to provide access to quality health services for all South Africans, based on their health needs and irrespective of their socio-economic status.
This definition may as well fit in very well in the definition of a medical aid scheme. But there are two main very notable exceptions that make NHI and medical aid schemes to look like chalk and cheese.
The first exception is the word “all”. Under NHI we intend to pool funds for all South Africans. In medical aids, the word “all” does not exist. Medical aids are designed for a selected privileged few and pretends the majority of South Africans do not exist.
Yes, the system of medical aids is designed for only 16% of the population. According to this system, 84% of South Africans have no right to access to good quality health services and they can be served through alternative means.
The second notable exception are the words “irrespective of their socioeconomic status”.
Under the medical aid system even the selected privileged few are stratified according to their economic status. The more senior the job you do, the more you earn and the better the quality of health services you get. The more junior your job status, the lesser you earn, the lesser the quality of health services you get.
We can no longer allow this to go on. It is a flagrant disregard of our Constitution because the Constitution does not recognise economic status in the provision of health services. It is also a flagrant disregard of the Constitution because it makes healthcare a condition of service rather than a right.
Contrary to nay sayers, the NHI is the one which is in line with the Constitution because it puts the healthcare of all South Africans on an equal footing. That is why the United Nations used the word “Universal” because nobody should be left behind.
This year, we are at the end of the 5 years, which we regard as a preparatory phase of NHI. Time and again reports have emerged in the media that nothing happened in the NHI pilot districts.
Our 5 year preparatory phase was guided by Section 2 of the NHI White Paper which states that “NHI represents a substantial policy shift that will necessitate a massive reorganisation of the current health system, both public and private .... ”
In this massive reorganisation of the healthcare system, we did what is commonly known as piloting to try and figure out and learn how the healthcare system can be massively reorganised, based on values of justice, fairness and social solidarity.
Let me report on the progress made so far.
Within the 10 pilot districts, we have completed the building of 34 new and replacement clinics and we are busy with 48 others. This will be a total of 82 new and replacement clinics.
Outside the 10 pilot districts, work has also been going on and we have just completed 96 clinics and are still busy with 132 others, to give a total of 228 new and replacement clinics.
Once all are completed, it will be a total of 310 new and replacement clinics.
In the same period within the pilot districts, we have completed the refurbishment of 154 clinics and are still busy with refurbishing 192 others. This will give a total of 346 refurbished clinics in the 10 pilot districts.
Outside the pilot districts, we have completed refurbishing 135 clinics and are busy with 220 others. This will give a total of 355 refurbished clinics.
These figures are based on the work that started in 2012.
We have also separately put up consulting rooms for doctors who visit our clinics on a contract basis. We have completed 142 of them and are still busy with 21 others to give a total of 163 doctor consulting rooms.
There are also new and refurbished hospitals, refurbished nursing colleges within and outside the pilot districts.
Within this preparatory period we have spent a total of R40,342,973,108.00 on infrastructure only. We have spent another R1,706,562,156.00 on all equipment within this preparatory phase.
You may remember the phenomenon of drug or medicine stock-out which used to bedevil the health system. We have, within this preparatory phase, undertaken three 3 initiatives:
SVS or stock visibility system: This is an electronic way of measuring stock at the clinic by scanning the back code on the package or bottle with a specially-supplied cellphone with a special application.
When the nurse scans at the clinic the stock level is automatically and in real time, reported to an electronic map of all clinics in our country at the central tower in Pretoria. We are proud to announce that we have SVS in 3 163 clinics, 658 of which are within the NHI pilots - since we started implementing in July 2014. We did this project in partnership with the Vodacom Foundation and it is very successful in controlling medicine stocks.
Rx Solution and other electronic stock management systems (ESMS): This system has been installed in 80% of our 10 Central Hospitals, in 94% of our 18 Provincial Tertiary Hospitals, 83% of our 47 Regional Hospitals and 71% of our 254 District Hospitals. This system also works by reporting levels of stock electronically from each of these hospitals to the central control tower in Pretoria. If the stock levels are low, it automatically sends in an order.
With the SVS alone, stocks in our clinics have improved as follows: ARVs from 69,5% to 92,5%. TB medication from 65,7% to 88,5% and
Vaccines from 64,5% to 94,5%
Central Chronic Medicines and Dispensing and Distribution Programme: In this programme, patients who are stable on chronic medication do not have to visit our clinics anymore except maybe after 6 months for check-up. They collect their medicines in 401 pickup points around the country and 1,300,000 patients are using this system, relieving congestion in our clinics or hospitals.
Pre or post-apartheid, South Africa has never had a patient information system that allows us to follow a patient from one facility to the other. This means that one patient can visit as many facilities in one day and collect medicine and receive similar services without us knowing because there is no system to detect it.
Working with CSIR, Department of Science and Technology and Department of Home Affairs, I am happy to announce that our preparatory period has gone very well in this regard. We now have a system being implemented that will be ready for NHI. This programme as of 10 May 2017, has now reached 1 859 clinics, 705 of which are in the NHI pilots.
Currently there are 6,355,759 South Africans have registered in this system in preparation for NHI.
We are registering people in these 1 859 facilities at the rate of 80 000 to 100 000 per day.
This Unique Patient Identifier is linked to your ID number in Home Affairs and is a cradle-to-the-grave number. This means as soon as you register, you will keep it until you die. If a newborn baby is registered today, that is their number in our health facilities for the rest of their life.
Each South Africa is going to have their own number and if you visit any one of the 1 855 facilities, you may register. It would take you 5 minutes when you register for the first time. But after having registered, it will take you only 45 seconds, not minutes, to retrieve your file in subsequent visits.
In the massive reorganisation of School Health, we have also completed screening 3,2 million school kids for physical barriers to learning, i.e eyesight, hearing, speech and oral health. We can report that a total of 500 004 school kids specially in the NHI pilots have the following problems:
8 891 have speech problems that will need a Speech Therapist;
34 094 have hearing problems that will need an Audiologist or maybe hearing aids;
119 340 have eyesight problems that will need an Optometrist, Ophthalmologist or maybe spectacles;
337 679 have oral health problems that may need a Dentist, Dental Therapist or Oral Hygienists.
I do not have to point to you how these problems negatively affect their studies.
In putting up solutions to the problems, I have just stated, I wish to first quote from the Budget Speech of the Minister of Finance in February this year:
“The service package financed by the NHI Fund will be progressively expanded. In setting up the Fund, we will look at various funding options, including possible adjustments to the tax credit on medical scheme contributions. Full details will be provided in the adjustments Budget in October this year, and in the course of the legislative programme.
The tax credits mentioned in the February 2017 Budget Speech by Treasury is a whooping R20 billion. Yes, R20 billion that in 2015 and annually will leave the fiscus through SARS back to the pockets of people simply because they are members of a medical aid scheme.
Taking so much money back to rich people is like sending coal back to New Castle when you have a neighbour without a simple fire to cook their food.
How do we as public representatives, honourable ones for that matter, justify this type of thing happening in our country under our watch?
As Honourable Members of the House, we are beneficiaries or recipients of this R20 billion. I am one of them. You are one of them.
This is the worst form of social injustice committed in the name of the cream of the South African society with our full participation.
We are proposing that the 1st step towards implementation of NHI is to pick up those who are outside the system of medical aids and provide services for them through the NHI Fund which must be created from among others the R20 billion tax credits.
Please note, this R20 billion credit given to all who have joined medical schemes is separate from the R26,7 billion which is the total of all medical aid subsidies due to all who work for the State including the MPs.
We have identified the South African who will benefit from the NHI Fund once it is established:
The 500 000 school kids who I have mentioned;
We will provide free ante-natal care in the form of 8 visits to a Doctor to each of the 1,2 million women who fall pregnant annually. We would also provide them with family planning, provide for breast and cervical cancer screening as well as treatment where appropriate;
We will be able to provide better services for mental health users - screening and subsequent services;
We will help the elderly with assistive devices like spectacles, hearing aids and wheel chairs.
We will also deal with the backlog of blindness caused by cataract. The backlog is now 270 000 elderly people who are presently blind and are awaiting cataract removal. We can perform 90 000 operations a year for the next 3 years to clear the backlog;
We will be able to provide assistive devices to people living with disabilities.
The Nation is still in mourning about the terrible events that took place at Life Esidimeni in Gauteng.
Very soon, I will hand over a report to the Speaker's Office to outline progress made so far in implementing the 18 recommendations of the Health Ombud. Some of the recommendations have already been implemented while others are in the process of being implemented.
In addition to dealing with the recommendations, I can also report that I have appointed in terms of Section 88A of the National Health Act, as amended, appointed a Tribunal to hear cases of appeal by those who feel aggrieved by the Ombud's findings.
The 3 persons Tribunal consists of:
Judge Bernard Ngoepe, retired Judge President of North Gauteng High Court;
Professor Hoosen Coovadia and Professor Brian Robertson, both retired Professors from the Universities of KwaZulu-Natal and of Cape Town respectively.
They have been working around the clock exchanging legal documents with the lawyers of the appellants and I can confirm that as of yesterday, one case brought by two NGOs is ready for a hearing - it can take place anytime from now.
Two other cases brought by public servants who have been fingered by the Ombud are about to finalise the exchange of legal documents and those two will also be ready for a hearing in a few weeks or perhaps a few days’ time.