This article was published in the Daily Maverick on March 5, 2020 and written by Dr Sibongiseni Dhlomo.
What stands between our current state of arrested development in the healthcare sector and the achievement of the good intentions of the National Health Insurance (NHI) is fear. Like a crawling child, that first step seems difficult and insurmountable, until taken. Fear, if harnessed carefully can be an advantage, but let loose it has the potential to undermine our power to deal with current challenges, thereby holding us back from our intended progress.
The attainment of universal access to quality healthcare is an ideal that all South Africans should espouse. It is an undeniable fact that 84% of the population is expected to receive quality healthcare from the public healthcare system at a cost of about 4.5% of South Africa’s gross domestic product. Compare this to 16% of the population with medical aid, with spending similar to that received by the 84% of the population. This disproportionate distribution of healthcare resources is immoral and makes no financial sense.
To say the public healthcare system is not operating optimally is an understatement, with communities complaining of lack of medication, a shortage of medical personnel, long queues at clinics and hospitals, and a level of service from personnel that undermines the principles of Batho Pele. We could and should be doing better to serve the people who depend on the public sector for healthcare.
As we reflect on these shortcomings, we must not forget that the ambitious goal of universal healthcare can only be attained if we harness our collective resolve to find solutions to challenges. Otherwise, we will fail to serve our people with the honour and integrity they deserve. This opportunity has been allowed to pass by some, who shout from ivory towers and do not actively participate in the process of ensuring that, when the NHI Bill is finally passed, it is progressive and addresses concerns.
The threats by some doctors that they will emigrate if the NHI is implemented is a case in point. Rather than work together to identify areas of concern and find solutions, some have decided to put a loaded gun to South Africa’s head, more so the poor who yearn for the kind of service that only 16% of the population enjoy.
The endemic corruption in South Africa can scare the staunchest optimist, but fear should not paralyse us. Corruption eats at our moral fibre and should be fought with every weapon in our arsenal. Hence the need to support and participate in the Anti-Corruption Health Forum, launched by President Cyril Ramaphosa. Instead of allowing fear to stop us from taking the first steps towards universal NHI, we should embrace the challenge.
When Parliament held its public hearings on the NHI in the North West, a cancer patient complained that her medical aid was refusing to pay for a lifesaving drug that she needed in her fight against breast cancer. She informed the committee that she has two young children whom she wishes to see grow into adulthood, but she faces imminent death because her medical aid will not relent.
Many more members of the public complained that despite exorbitant monthly medical aid premiums, they find themselves without cover seven months into the year. These experiences bear testimony to the Health Market Inquiry, which found that the South African private healthcare market is characterised by high and rising costs and that medical schemes offer little value for money.
This highlights the need for a comprehensive investigation into healthcare funding to ensure that quality universal access is ensured. The benefits of NHI far outweigh the disadvantages. The question we should be asking is not if we should implement the NHI, but how best to do this to ensure access to healthcare for all.
Healthcare is a moving target, particularly in light of the growing number of people affected by the lifestyle illnesses that ravage South Africa. We do not have the luxury of being able to stop the current public system to fix it and then innovate later on. The fixing and innovation have to happen simultaneously.
The moral question facing South Africans is: how can 16% of the population bask in the luxury of private healthcare, when 84% are subjected to crumbs? Economists across the world advocate cross-subsidisation, where the rich support the poor to improve their quality of life. Why is this a scary thought in South Africa?
The current economic headwinds affecting South Africa and the ever-dwindling tax base have been used to drum up fear about the NHI. In an ideal situation, it would be desirable for the economy to be operating at its maximum to increase the revenue base. However, to use the example of the United Kingdom, a NHI scheme was instituted in that country during the years of economic hardship following World War II and, despite teething problems, continues to offer one of the best models for government-managed and public-funded healthcare. Fear of unfavourable economic conditions did not paralyse the UK and should not immobilise South Africa.
The parliamentary public hearing process has shown that many South Africans yearn for change. The change proposed by the NHI will protect the dignity of all South Africans. The majority of participants in the public hearings have defied their fear of the unknown to voice their support for a better healthcare system.
Let us not allow fear to enslave us or prevent us from delivering on the promise of a better life for all. DM