Co-Programme Directors Mabalane Mfundisi & Mukondoleli Muladzi representing the Co-organising Committee of SANAC Civil Society Forum and South African Red Cross Society
Chairperson of the Civil Society Forum Mmapaseka Steve Letsike and the CSF sector leaders and CSF Chairpersons
Youth sector stakeholders led by Lerato Mofokeng
Dan Kekana leading the people with disabilities sector stakeholders
Lauren Pretorius leading Health Users sector stakeholders
Mluleki Zazini leading the Health Users from the People Living with HIV sector stakeholders
Solly Nduku leading the Traditional Health Practitioners sector stakeholders
Kendrah da Silva leading Allied Health Professions sector stakeholders
Leaders of Labour federations led by Ms. Jacqueline Bodibe from COSATU, Masale Selematsela from FEDUSA and Harriet Msikisi from NACTU
UNAIDS represented by SA Country Director Dr. Mbulawa Mugabe
Brian Chirombo: World Health Organisation (WHO) SA Country Office Acting Representative (in absentia) represented by Dr. Rajesh Narwal, the Health Systems Advisor and Cluster Coordinator – Health Systems and Services
Sandile Buthelezi, CEO of SANAC
Angelique Coetzee Chairperson of SAMA (in absentia) leading the Health Professionals sector stakeholders
Olive Shisana (in absentia), Presidential Advisor on Social Policy
It is a great honour and privilege to be given this opportunity to address the forum of Civil Society in preparing South Africa’s input into the Civil Society Engagement Mechanism (CSEM) of the Universal Health Coverage (UHC) 2030 agenda.
This engagement affords me an opportunity to engage with you as I prepare to deliver the first Health Budget Vote of the 6th Democratic Government on the 12 July 2019. I would like to listen attentively to the issues that you raise. This will also shape the upcoming health budget vote.
The South African health system has been described as being in crisis. This is attested to by recent discussions during the Presidential Health Summit held in October 2018 and that was followed by the development of the Presidential Health Compact. Many stakeholders including some amongst yourself present today participated in this process of developing the Health Compact. We have now reached a stage where the Compact is ready to be signed, committing ourselves to collaboratively work together to solve the issues identified.
South Africa is in the process of implementing National Health Insurance (NHI) as our strategy of moving towards Universal Health Coverage (UHC). The implementation of NHI is informed by our effort to address the imbalances of the past and to eliminate current challenges that are still existing within the health system and that have led to what our health system being described as being in a crisis. The implementation of NHI is aimed at addressing this crisis and is line with Section 27 of the Bill of Rights in the Constitution of the Republic.
NHI will have the following benefits to individuals, communities and society:
1. Access to quality health care services
NHI is will ensure that all in the population will have access to quality health care services based on their health needs. every South African will have a right to access comprehensive health care services free of charge at the point of use accessed using a NHI Card. The services will be delivered closest to where they reside or work at an accredited NHI facility. Access to these quality health services is will not be determined by race, gender, geographic location, socioeconomic status and your affiliation to a medical scheme. NHI will cover services based on the health need that a person has.
2. Benefiting from Social Solidarity
NHI will ensure that look after each other during our moments of most need. This is in line with the principle of justice, fairness and equity. We will look after each other based on social solidarity where those that have the means will cross-subsidise those that are less fortunate. We will ensure that those that are more healthy also share with those that are not as healthy. Young people will share health resources wither older persons as their health needs are greater.
These principles are universally applied in health systems that perform well and have reached near universal health coverage such as in the British NHS, Cuba, Canada and Thailand.
3. Providing Financial Risk Protection
NHI is a system of financing and is designed to pool funds received from the general tax and supplemented by a system of mandatory prepayment for revenue generation from sources that have been identified. The funding will be linked to an individual’s ability-to-pay and benefits from health services will be in line with an individual’s need for health care.
NHI will make sustainable progress towards UHC by ensuring that health become a priority when government allocates in resource. This requires political will in government and strong support and advocacy of civil society.
Through NHI we seek to entrench income and risk cross-subsidisation mechanisms so as to ensure that all citizens are provided with adequate financial risk protection. NHI will therefore eliminate out-of pocket payment such as co-payments in the private sector and user-fees in our public health facilities for services that are covered.
4. Services provided under NHI
The health care services that are provided under NHI will be purchased by the pooled funds in the NHI Fund for the entire population based on the principles to provide for universal access to quality, affordable health care services for all South Africans irrespective of their socioeconomic status and not on their ability to pay. This is also in line with our Bill of Rights of the South African Constitution that considers health care as a fundamental human right:
“Everyone has the right to have access to health care services…. The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.” (Section 27 of the Bill of Rights, South African Constitution, 1996)
Using a primary health care (PHC) approach, the services will be delivered as a continuum of care from community-based services, rehabilitative, curative, and palliative to ensure sustainability. This will ensure that we focus on disease prevention, health promotion and the population living long, health and happy lives.
We will work with all partners, including civil society to ensure that our communities are fully engaged in advocating for these services using robust and inclusive communication strategies.
- Improving quality of health care
NHI will ensure that the quality of health care services delivered in our facilities are of a high and acceptable standard. All health facilities designated for NHI are expected to meet the quality standards set by the Office of Health Standards Compliance (OHSC) and be certified and re-certified on a regular basis in line with the requirements of this Office. It is expected that a sizeable number of facilities will be required to achieve and maintain certification by the OHSC and accreditation by the NHI Fund within a specified period.
To achieve the required quality standards in our public health facilities, we will implement the the National Quality Improvement Plan to improve and maintain the quality of the health system. This plan will prepare each of our health facility to meet certification standards that will permit them to be accredited to provide NHI health services. The plan builds on existing quality improvement initiatives to develop local capacity and capability in quality improvement as we prepare each health facility to be accredited to provide NHI health services. This will result in satisfied users, the public and the health workforce.
- Reduction of the Disease burden
Our country continue to face a high burden of disease as a result of Communicable and non-communicable disease, high maternal and child mortality as well as trauma and violence in the face of an increasing population. Although our life expectancy has improved in the past ten year, the burden of communicable disease such as HIV and AIDS, and Tuberculosis remain stubbornly high. This has put a strain on the under-resourced public health system.
Through NHI, we will be able to extend health care coverage to all South Africans and by improving the quality of public health facilities, NHI will contribute to the ability of the health system to address the huge burden of disease that still plagues our country.
By implementing our 90:90:90 policy that states that 90 per cent of all HIV positive persons must be diagnosed, and 90 per cent must be provided with treatment and 90 per cent of those that are diagnosed must be virally suppressed successfully will mean that through a well resourced and capacitated health system, we will be closer to reaching our universal health coverage goals.
7. Benefits of NHI to individuals and communities
NHI will benefit individuals and the population by contributing to the reduction in health care costs that are currently making the health sector unsustainable. NHI will create an efficient, sustainable, accessible and fair health care system that delivers health care services affordably. NHI will also contribute to improved health outcomes, labour productivity and inclusive economic growth and development.
8. Benefits to the Individual, Population, Employers and the Economy
Individuals will benefit as a result of being able to access to health care that are free at the point of use. Individuals and households will have financial protection against catastrophic health care costs. They will have improved quality of care in a well-resourced health system.
Individual health status will improve, and life expectancy will increase. By contributing to raising life expectancy and improving the general health status of the population, NHI will contribute to economic development and growth.
NHI will have a positive impact on social development through: a reduction in inequities to access to quality health services; and improved educational attainment and Labour productivity.
As education levels improve as a result of good population health, this will have a positive impact on the ability of children to learn, especially for children.
NHI will contribute to a caring society and social cohesion by having a positive impact on social development through: a reduction in inequities to access to quality health services; and improved educational attainment and Labour productivity.
A better health status will increase individuals’ capacity for work and earn and will impact the economy positively. The decrease in out of pocket spending to access health service will increase earnings, disposable income and savings for retirement.
A better health status will increase individuals’ capacity for work and earn and will impact the economy positively. The decrease in out of pocket spending to access health service will increase earnings, disposable income and savings for retirement. A productive and effective workforce will support the growth of local businesses, attract foreign investors, and will grow the domestic economy.
Investing in health is an important safety net against poverty, by providing financial protection for the entire population.
As NHI is implemented, there will be a reduction in employer contributions for medical scheme cover and there will be predictability of financing of the health system. The workforce will become healthier and more productive. This will contribute to economic growth and the desirability of the country as an investment destination.
Businesses will be better able to predict the costs of labour, thus contributing to stability in the labour market, and the desirability of South Africa as a destination for investments.
9. Improved Human Resources Productivity in the Public and Private health sectors
Human Resources for Health are a critical component of delivering quality health care services. Under NHI, the working conditions in the public health sector will improve as more resources are mobilised for better human resources, infrastructure, equipment, medicines and supplies, and general quality improvement.
Services will be delivered at appropriate levels of care through a capacitated and competent health workforce as well as by NHI contracted public and private health care providers within safe health infrastructure of acceptable quality.
More jobs will be created under the re-engineering of PHC and overall optimization of human resources for health to address the health needs. In addition, the management of the health system will improve under the revitalized system.
In the private sector, Health practitioners will benefit from improved referral systems, increased pool of empowered users, reduced costs for goods required to provide services, and predictable payment mechanisms.
In general, health care practitioners will benefit from improved working conditions where equipment and supplies will be provided in an environment that is conducive to quality service provision. The requirement of accreditation will ensure that health teams are introduced resulting in the reduction of the workload and more time to dedicate to the patients served.
I would like to conclude by affirming that NHI should not be viewed merely as consumption expenditure but a social investment that is a basis for sustainable and inclusive growth for our economies through a healthy workforce and thus poverty reduction, job creation as employment creators are assured of a health workforce and an increase in the tax-base of the country and fiscal sustainability.
It is through such Forums that we should explore and come mobilising the public support for NHI. I am heartened to know that this forum has declared its support for the implementation of NHI as our strategy for UHC. Let us work together to learn from each other as we go through this journey of implementing NHI. United we prosper and apart we fall and fail.
Let us create strong partnerships between Government and Civil Society as we move on our journey towards Universal Health Coverage.
I wish successful deliberations as we work together to ensure that we move with speed to transform our health systems to be fair, just, and equitable, whilst leaving no one behind.
I THANK YOU