Primary health care – the foundation of NHI
IN his State of the Nation Address last week, President Cyril Ramaphosa told parliament that: “This year, we will take a significant step towards universal access to quality health care for all South Africans.
“After extensive consultation, the NHI Bill will soon be ready for submission to Parliament. The NHI will enable South Africans to receive free services at the point of care in public and private quality-accredited health facilities.
“By applying the principle of social solidarity and cross-subsidisation, we aim to reduce inequality in access to health care.
“Realising the magnitude of the challenges in health care, we have established an NHI and quality improvement War Room in the Presidency consisting of various key departments to address the crisis in the public health system while preparing for the implementation of the NHI.
“We have a funded national quality health improvement plan to improve every clinic and hospital that will be contracted by the NHI. By introducing the NHI together with a multi-pronged quality improvement programme for public health facilities, we are working towards a massive change in the health care experience of South Africans.”
This commitment to the nation, by the highest office in the land, has assured even the doubting Thomases of the government’s commitment to the implementation of the National Health Insurance (NHI).
However, despite our concerted efforts to explain the concept of the NHI, there are sceptics who argue that the plan is unaffordable and that the government should first address the serious challenges in the public health care sector before rolling out the Universal Health Coverage (UHC) plan. by simple things that should have been dealt with at primary health care level.
Many of our tertiary hospitals are over-loaded with work because they are treating too many patients who should not be there in the first place. You find hundreds of patients going to Chris Hani Baragwanath Academic Hospital to get treatment of minor illnesses such as flu. This is certainly not sustainable.
As health professionals, we know that health is not just the absence of disease but a state of good physical, mental social well-being. This has to be extended to everybody and this right cannot only be reserved to those who have the financial means. This is why we have no option but to move with speed to implement the NHI.
The former health minister of Ethiopia, who is the current Director General of the World Health Organisation Dr Tedros Adhanom Ghebreyesus, once shared with me how in his native country they had been achieve much better health outcomes such as reducing maternal mortality than South Africa despite the fact that South Africa has much more advanced hospitals than Ethiopia.
His argument was simple. They used primary health care, deploying community health workers throughout the country.
Our current system is actually sick care not health care. In other words, our approach is taking care of the sick. Those who believe that they are healthy, they are not part of the healthcare system. They first have to be sick first to be part of our system. But when we apply primary health care system, those who consider themselves to be healthy, are part of the system. They have to undergo screening to avoid going to the hospital when they are very sick.
We are encouraged by the words of President Ramaphosa that the NHI bill will be going to parliament soon. We have no option but to deliver on this Constitutional mandate of ensuring that we provide quality and affordable health care to all our people regardless of their economic or social status.