South Africa’s health system is facing immense pressure as lower-income people continue to receive insufficient care, while middle-class South Africans are concerned about the changes that will be introduced through the incoming National Health Insurance (NHI) scheme, say health experts.

Speaking to the City Press, Sasha Stevenson, head of the health rights programme at non-profit group Section27, said health system reform efforts in South Africa appeared to have effectively ground to a halt.

This comes after more than a decade of discussions and debate, so stakeholders were weary and did not trust each other’s motives and opinions, she said.

“This stagnation is fatal. South Africa’s health system is under immense strain and its inequities are well known. Some people continue to receive insufficient care, while others are over-serviced in the interests of profits. Healthcare workers are burning out.

“Uncertainty about changes that may never come is causing jitters in the middle class and impatience among those who can’t imagine a changed system leaving them worse off,” said Stevenson.

The government is currently grappling with budget cuts, freezing of posts and pressure to increase the number of nurses and doctors, says Dr Nicholas Crisp, deputy director-general in the department of health.

He added that the current constraints on government are ‘huge’ and that it’s an ‘extremely rigid and extremely difficult place to work’.

“Our budgets have been cut and the illusion that there’s new money being provided for the Covid-19 vaccine is nonsense. More and more posts are frozen every year and the public sector has no chance at all of improving to the extent that people think it’s possible,” he said.

The NHI split

One of the stated goals of the NHI is that it will help even the playing field and give all South Africans access to adequate healthcare.

However, a report published by professional services firm PwC this week shows that discussions around the proposed NHI are still split. The report considered responses from 31 C-suite leaders of South African healthcare organisations across all sectors, and featured both in-depth interviews and online digital surveys.

The report shows that 100% of the surveyed executives support the intent of NHI and the model of universal health coverage, however, just 50% of respondents believe it will be fully or partially successful. The respondents were particularly concerned about:

  • The coverage and range of benefits to be provided,
  • Governance structures,
  • The risk of corruption,
  • Healthcare worker capacity,
  • The impact on the private sector

More than half of the respondents thought that the NHI would likely not improve South Africa’s health outcomes in its early phases. Similarly, half felt that it will achieve or partially achieve its objectives.

However, public trust in the healthcare system and the NHI governance has to be achieved first and considerable change management across the public and private sectors will be required.

Respondents also felt that unless stakeholder relationships are managed carefully and well before the rollout, there may be hesitation from all stakeholders due to a lack of transparency and communication.

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