Finance minister Enoch Gondongwana is right. It’s time to end the fighting over National Health Insurance (NHI), the ANC’s blueprint for universal health coverage. The protracted wrangling over the reforms proposed by NHI has for far too long deflected time, energy and resources away from fixing South Africa’s health system, leaving patients to pay the price.
More than 30 years after the advent of democracy, citizens’ access to healthcare services still hinges on their socioeconomic status. Public servants and most other people in formal employment belong to medical schemes that enable generally timeous access to decent care in the private sector, while the rest of the population relies on an increasingly overburdened state sector that provides services of wildly variable quality. The evolution of the NHI Act has been tortured from start to finish.
Stakeholders have consistently complained that neither the health department nor the previously ANC-dominated parliament paid any heed to their input during the development of the policy that underpinned the legislation or its passage through parliament. This critique is a common thread in the mounting legal challenges to the NHI Act, which is being contested by organisations representing healthcare professionals, medical schemes, private hospitals, business interests and trade union Solidarity. The finance minister’s call last week for thelitigating partiesto call a truce and negotiate a settlement marks an important shift in tone.
Read Full Article on Business Day
[paywall]
While his comments may be more a sign of his frustration than the harbinger of imminent change, they have nevertheless elicited positive signals from some of the protagonists sparring over NHI. First there is the South African Medical Association (Sama), the country’s biggest doctors’ organisation, which says it hassecured a promisefrom health minister Aaron Motsoaledi to sit down and discuss its concerns about NHI. Like most parties contesting the NHI Act, Sama says it supports universal health coverage, but does not believe NHI is the way to achieve it and maintains it took legal action as a measure of last resort.
Then there is Business Unity South Africa (Busa), which says it finally has a firm commitment from the presidency for a meeting to discuss its ideas, more than a year after it submitted them. These are significant developments, as until now the health minister and the president have appeared impervious to calls for change. The obvious conclusion is that pragmatism has finally trumped ideology and that the health minister and president now fear they may lose in court.
The question is, where to now? The government needs to convince stakeholders that it is actually willing to listen. Seven of the eight organisations challenging the NHI Act in court have understandably expressed scepticism about the likelihood of a settlement, given the extent to which their suggestions previously fell on deaf ears.
A good starting point would be the two alternative plans to the NHI Act that are already on the president’s desk. In addition to Busa’s proposal, there is another from theUniversal Healthcare Access Coalition(UHAC), which represents more than a dozen organisations. Neither Busa nor UHAC are directly involved in the litigation, but many of their members are.
If the president and health minister sit down with these organisations and hear them out it would go a long way to rebuilding relationships with some of the fiercest critics of NHI. Such discussions need to be transparent, so the public knows what trade-offs are on the table. Negotiating health reform behind closed doors is dangerous because it runs the risk that powerful interest groups hold sway, to the detriment of weaker lobby groups or those without an organised voice.
Ending the fight over NHI does not mean retaining the status quo. If the government is truly willing to listen, it offers an opportunity to redirect time, energy and resources to less ambitious and more manageable reforms that will make an immediate difference to patients.
[/paywall]
