Covid-19 reveals how far SA is from implementing a national health scheme
NHI doesn’t just face a governance hurdle — there’s the rather more pressing problem of where, in a Covid-ravaged economy with a looming R500bn deficit, will SA find the R256bn in spare change needed to make it happen, writes Rob Rose
What planet, you wonder, do our politicians live on?
Last weekend, City Press quoted an unnamed official as saying the success of SA’s Covid-19 response shows just how well National Health Insurance (NHI) would work.
“This thing was a serious dry run for our NHI ... the ability to scale up those facilities such as the Nasrec [field hospital] in Johannesburg shows that if there is a will, the government could scale up the requisite NHI facilities,” he said.
It’s a stupefying conclusion to draw from SA’s Covid-19 experience — studded as it was with generous theft of relief funds, politicians’ families lapping up tenders, and officials hoarding food parcels for themselves or, worse, trying to sell them to the people they were meant for in the first place.
Intuitively, you’d be more inclined to conclude that, if there’s one thing Covid-19 has taught South Africans, it’s that even when it comes to life-or-death health care, government appointees just can’t seem to stop themselves from looting — which should rather be a flashing red light for NHI.
Corruption Watch’s Kavisha Pillay agrees that Covid-19 most certainly was a dry run for NHI — and SA failed dismally.
“This was a time when the country could have shown that NHI would work, and that we have a responsible government. Instead, we had looting, and this only eroded public trust — so you’ll likely see huge pushback on NHI.”
Pillay says while everyone supports the idea of universal health care, Corruption Watch has flagged corruption “as the biggest threat to the realisation of this”.
NHI doesn’t just face a governance hurdle — there’s the rather more pressing problem of where, in a Covid-ravaged economy with a looming R500bn deficit, SA will find the R256bn in spare change needed to make it happen.
But even if SA were able to find this cash, Covid-19 has taught us there would have to be a radical overhaul of government buying systems. For a start, we’d need an open contracting system where every step, from budgeting to scoring, is publicly available.
Alex van den Heever, adjunct professor at Wits University’s School of Governance, says many in government are arguing that NHI is now more urgent, since Covid-19 taught us a lot about the weaknesses in the health system.
“The problem is, the reverse is true. Covid19 demonstrated what a couple of decades of institutional corruption can do to a health system. NHI’s proposals do exactly nothing to fix that core problem.”
Funding NHI now, with a brittle economy, would be entirely inconceivable, he says. “Fiscally, it’s a non-starter. During the level 5 lockdown, SA was losing R13bn per day, so we’re not in a position to raise more money for NHI from taxes, and we can’t borrow more,” he says.
It also seems odd to argue, as the official did in the City Press article, that the government has shown it can work well with the private sector on health care.
Van den Heever says the public health system and the National Health Laboratory Service weren’t up to the task.
“Initially, the government said the public sector would deliver 36,000 tests per day by April. It never got close. By contrast, the private sector is now exceeding 40,000 tests per day. It illustrates the credibility gap on anything the government says.”
Aslam Dasoo, a doctor who co-convened the Progressive Health Forum and is a member of the ANC stalwarts and veterans group, agrees.
“Covid-19 has pushed the idea of NHI further away than we can imagine. But there’s still a political commitment to it, which is why we still hear all the talk — even though they’ve never been able to answer the cogent rebuttals about where we’ll get the money.”
As Dasoo puts it, the fact that SA’s economy is now in a crisis means there’s no way to finance NHI without raising taxes. “And you try [telling] taxpayers this right now, and see what kind of response you get,” he says.
The problem, he says, is that the very people who have overseen the demise of the public health care system for more than a decade are the ones now calling for NHI, and who want to run it. Dasoo says the government should forget NHI and focus on implementing the recommendations of the health market inquiry from last year, including “measures to appropriately regulate” private health care.
“Some say people are paying through the nose for private medical aid because of ‘middle class fear’. As a physician, I can tell you it’s not just ‘middle class fear ’— it’s because of the real decline in quality and accessibility of public health care,” he says.
This decay, of course, isn’t unrelated to the shoddy mismanagement and corruption in public health care — something which Covid-19 laid bare in Technicolor.
Dr Johann Serfontein, a health-care consultant at HealthMan, wrote in June: “It’s probably not unreasonable for health-care professionals to view the current management of Covid-19 by the government as an example of how NHI might be managed.”
He says the government simply failed to speak to doctors about how to handle and pay for Covid-19.
“There was a take-it-or-leave-it approach to pricing,” he says.
Van den Heever is convinced NHI was never about fixing health care; rather, it was to implement a system that centralises patronage, so that corrupt politicians could benefit.
“Look at what happened with food parcels under Covid-19. The government suddenly prohibited anyone else from distributing parcels, creating a single avenue for tenders. And then look at the looting,” he says.
That is now a real concern with NHI. If Covid-19 is indeed the precedent, as some clearly believe, how long before taxpayers end up enriching medical facilities run by ANC politicians and their families.