So Many Questions

Figures obtained from the Office of Health Standards Compliance paint an alarming picture of the state of the national health insurance pilot programme.

Chris Barron asked Health Minister Aaron Motsoaledi ...

Would it be fair to say the NHI pilot programme is a disaster so far?

I reject that with the contempt it deserves. There is no disaster at all.

What about figures from your own regulator showing that only 89 out of 1 427 clinics and hospitals in the pilot districts meet required standards?

To my knowledge the OHSC has never been given the job of assessing the success or failure of the pilot projects.

Isn’t this its job as a regulator?

The OHSC was established by us to inspect health facilities in the country. They are still setting up systems and testing them. You can’t take those figures and use them as a standard for whether the pilots are successful.

Aren’t they the result of inspections over four years?

Mock inspections — they are still finetuning their systems. That’s why they didn’t want to release their findings. They were forced to under the Promotion of Access to Information Act. Everything is still being tested, nothing is final. That is why we have never asked them to assess if the pilots are working or not. That work was given to another independent body.

What body?

The Clinton Health Access Initiative, who put together a group of experts specifically to assess the pilot projects.

So according to them, how are the clinics and hospitals in the pilot districts performing?

NHI pilot districts have got nothing to do with clinics and hospitals only. You pilot the whole area. You pilot primary healthcare. You check school health, you check primary healthcare workers, how many families have they visited . . .

How are the clinics and hospitals doing?

NHI is not only about clinics and hospitals . . .

But standards at the clinics and hospitals are very important?

Precisely.

What does the CHAI assessment say about standards at clinics and hospitals?

We put up a model of what a clinic or hospital should look like to be of an acceptable standard. We call it an ideal clinic.

What score does an ideal clinic need?

There is silver, which is above 60%, then gold, which is beyond 80% . . .

Would your ideal clinic have to be gold?

No, it can be silver. Gold is better, platinum is the best. If it is diamond it is out of this world.

What about doctors and health activists who say there is little to show for the money that has been spent on the NHI pilot districts?

I don’t know what those people were looking for. Totally new clinics, a doctor in every clinic?

Do you agree there needs to be a massive improvement?

Absolutely. For NHI to happen you need a massive reorganisation of the system. We are just beginning.

The pilot projects are in their fifth year, aren’t they?

Yes. So what are you saying?

That’s long enough to show some progress, surely?

Maybe to you.

What are we to make of the OHSC?

They’re on a learning curve.

Isn’t it supposed to be the regulator exercising oversight?

It’s going to be the regulator that exercises oversight.

But they’re still learning how to?

That’s exactly what I’m saying. They’re still establishing themselves.

So they’re in no position to exercise oversight?

No.

How can you expect any improvement if there is no oversight?

No.

I am telling you I am building it. The problem with you people is that you are so impatient.

If after five years you’re still establishing a regulator, how long will it take to roll out NHI?

What is this impatience all about? Many regulators took a long time to be built. This is grossly unfair. It shows a hatred for NHI. You are using any small thing to tell us that this thing is not going to happen.

Why do you accept the findings of CHAI collected over three months but not of your own regulator collected over four years?

They’ve been learning how to inspect in the past four years.

Isn’t it important to have access to regular, reliable figures?

The day the OHSC finalises and finetunes their standards they will publish them in the Government Gazette. It will be a regulation whereby they’ll have the power to go to any hospital . . .

Don’t they already have that?

So how were they able to inspect these NHI facilities?

Because we allowed them to.

What’s the point if you don’t take their figures seriously?

We take them seriously.

So would you agree that they paint an alarming picture of these facilities?

Not in the NHI. It’s an alarming picture of healthcare facilities in the country.