NHI – THE QUEST FOR TRUE UBUNTU

The Star Early Edition - - ADVERTORIAL FEATURE -

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.

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