NHI Bill: Challenges faced are enormous

Growing up, I was exposed to many nefarious stories about Cecilia Makiwane Hospital. These came from family, friends and the community and they all seemingly held a common thread of bad to worse in healthcare services.

That said, the storytelling was not immune from the “broken telephone” effect. In that the more these stories were told, the more colourful they became.

Public healthcare system fears

It was in that mist of colour that I developed a genuine fear for public healthcare systems and what they had come to represent in my mind.

To be fair, however, my conventional assumption about Makiwane was determined by the privilege of having access to private healthcare.

Consequently, my privilege ensured that I was never in the position to explore alternative narratives pertaining to public healthcare services.

Until now, that is. The professionalism – from the security personnel and administrative to medical staff – was impeccable.

Administrative process

The administrative process of opening a folder only took 15 minutes. After which I was assisted with directions at each junction.

Immediately, after leaving the hospital premises, my mind was struck with the conundrum of attempting to reconcile what I had come to accept as the conventional “truth” versus my lived experience.

As inconsequential as my experience might be within the broader ideological, structural and economic debate, herein lies the crux of the contention in the proposed National Health Insurance (NHI) Bill.

The contestation in ideology that informs “how things ought to be” directly contradicts the existing structural political economy of our healthcare system.

Irrespective of the contradictions, they simultaneously frame the parameters and limitations to the political and economic arena of what is possible.

NHI Bill challenges

Frankly speaking, the challenges faced by the NHI Bill are enormous and the only way it will gain traction is if transparency is at the forefront of its public discourse and engagement.

READ MORE: NHI Bill is almost ready to go to parliament

What do I mean? Research indicates that the implementation of the NHI system has traditionally been skewed towards developed countries.

However, that is not to say its implementation has been in the absence of challenges. Contrary to what some proNHI lobbyists might argue, the UK case study continues to highlight structural and systemic challenges that, at times, have threatened the resiliency of the national healthcare system.

Therefore, SA as a developing country must clearly articulate how it aims to resolve the identified sectoral bottlenecks in other countries while simultaneously responding to the contextual structural and systemic challenges facing our healthcare system.

These proposals must speak to the reform of the healthcare structural political economy, its sustainability and economic efficiency.

The NHI Bill is a vision that is worth fighting for but it must be done right.

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-Maqwelane is a PhD candidate at Rhodes University