NHI - the only viable plan to ensure quality health care for all
While South Africa has made tremendous progress in the provision of health care, including vaccinating more than 1,9 million girls against cervical cancer, the only sustainable way to give quality health care to all is through the implementation of the NHI, writes Health Minister Dr Aaron Motsoaledi
AS A young medical doctor, I met an elderly woman in my home village of Glen Cowie in Limpopo. The elderly woman knew that I was a medical practitioner and she approached me for help. She pleaded with me that I should assist her to deal with her unending “menstruating” problem.
I knew immediately what the problem was. She had advanced stage of cervical cancer.
For most African women, especially those who live in rural areas, they are only diagnosed with cervical cancer when the disease has advanced to stage 4, when they are basically left with very short time to live. Many of them find it hard to talk about it as they consider it taboo that they could be menstruating when they are in their seventies.
Of course that elderly woman died a short while after our contact.
As tragic as it is, the agony of the elderly villager is not an isolated case. According to 2017 figures, there are 5 743 new cases of cervical cancer that are reported each year in South Africa. Each year, more than 3 000 women die from this disease.
But there is hope. The current generation of young women have a fighting chance to escape this killer disease. Today, girls aged 9 years have the benefit of HPV vaccination that protects them from developing cervical cancer.
Sadly, this protection was not yet available in the eighties, which is why the elderly woman from my village had developed cervical cancer.
Cervical cancer is the second biggest type of cancer that kills women. The biggest cancer killing women is breast cancer.
South Africa started providing HPV vaccination to young girls in 2014.
As part of the prevention of diseases, the Department of Health has been in the forefront of the campaign to ensure that young girls are prevented from suffering the same fate as my elderly relative. From 2014, more than 1,9 million girls have received Dose 1 of HPV vaccination. A total of 1,2 million have received both Dose 1 and Dose 2 HPV vaccination. An individual requires both doses of HPV to prevent her from developing cervical cancer.
The HPV vaccination programme has huge benefits. The obvious one is that it prevents millions of women from developing cervical cancer, thus making them to live long and healthy productive lives. There are also benefits to the economy in that they would not be confined to their hospital beds but would be engaged in productive activities.
The other benefit is that the vaccination program reduces the burden of diseases in the health care facilities. In other words, fewer people would need hospital beds and all the required care associated with hospitalisation.
The other benefit is that the programme has been able to save money for the state. When we started it, we projected, based on the prices of HPV vaccine, that we would spend about R1,2 billion a year on it. Because of the huge number of the girls that require the vaccine, we used our economic of scale to negotiate better prices with the suppliers. This has resulted in huge savings. Instead of spending R1,2 billion, we are spending R200 million.
Our vision is to aggressively fight the spread of cervical cancer in our country so that the next generation of our elderly women would not experience “menstruation” at the advanced age of 75 years.
This is an expensive programme which can only be sustainable in the long term by the implementation of the National Health Insurance (NHI). Many countries around the world have embraced the concept of Universal Health Coverage (UHC). The basic idea behind the concept is that everybody should have access to quality health care regardless of their economic or social status. In other words, nobody should be denied health care because he or she cannot afford to pay.
In our country, our adopted UHC plan is the NHI. The NHI will be implemented in stages because there are many things that should happen before it could be implemented in full. We would need a total overhaul of the health care system because we cannot just super impose the NHI on the current health care system. Even our economic blue-print, the National Development Plan (NDP) has identified two things that should be dealt with to improve the country’s health system. These are the high cost of health care in the private sector and the quality of health care in the public sector. In essence, before we could roll out NHI, we should attend to these main factors that the NDP has identified.
But NHI is not an event that will have a big launch date. It is a long process that that has already started. As we continue to build the foundation of NHI, there are things that we have already started doing.
We have consistently stated that the heartbeat of NHI is Primary Health Care. And Primary Health Care has three major components. The first is prevention of diseases, the second is promotion of a healthy life-style and the third is that when a patient gets sick, the first point of call should be a Primary Health Care facility such as a clinic and not a tertiary hospital.
Our long term vision is to reduce the burden of disease and to contribute in making our people live a longer and healthy life.