Unpacking NHI

Estella Naicker

While the notion of the National Health Insurance (NHI) is in the process of becoming a concrete reality many are still bewildered about the way in which health care services will change.

The KwaZulu-Natal Department of Health, led my MEC Dr Sibongiseni Dhlomo, hosted a road show at the Fairleigh Community Hall on Tuesday afternoon in order to unpack NHI to medical personnel in public and private practice, traditional healers, coucillors, non-profit organisations and representatives from the Department of Education.

The Amajuba District is one of 11 districts selected nationwide to pilot the NHI. Dr Dhlomo explained at the onset of the meeting that the decision as to which districts would pilot the project was determined according to which area had a more manageable population.

What is NHI and why is it being implemented?

According to the Department of Health, NHI is a financing system that will ensure that all citizens of South Africa are provided with essential health care, regardless of their employment status and ability to make a direct monetary contribution to the NHI fund. The Health Department issued a press release that describes health care as a human right that should not depend on how rich we are or where we happen to live. The guiding principles of NHI, according to Dr Dhlomo, are social solidarity, equity, appropriateness, effectiveness, efficiency, and affordability.

How long before NHI comes into effect?

NHI will be phased in over a period of 14 years and will entail major changes in service delivery structures and in administrative and management systems. At the road show hosted on Tuesday, Dr Dhlomo said that NHI would be implemented in an incremental and staggered manner.

What areas will Health Department have to improve for NHI to be a success?

The Health Department has identified six areas in which public health service facilities are falling short, when compared to private hospitals.

These are: cleanliness, the safety and security of patients and staff, staff attitudes, infections control, long queues and drug stock.

“These six areas are failing in the public sector, but you don’t find these shortcomings in the private sector. Until we can improve these things, it will be difficult to ask South Africa to put their money in a public pot so they can expect the same service no matter which health care facility they visit,” admitted Dr Dhlomo.

He went to say that in a national survey of 800 healthcare facilities, all of the public facilities were marked down on the attitude of the staff.

“There are some instances where a patient will take the time to go to the nurse’s duty station to inform the nurse that the person lying next to them looks very unwell, but instead of thanking that person for bringing this to her attention, the nurse with the bad attitude will ask the patient, ‘Are you a nurse?’ Yet, the same nurse will be completely different in the private sector where she likely to adopt a more caring and pleasant attitude. Why is that?” asked Dr Dhlomo.

Dr Dhlomo further impressed upon the medical personnel present at the road show that he believed that cleanliness was next to godliness.

“I’m not only talking about the cleanliness of the hospital corridors or the cleanliness in the white of the nurse’s uniform, but also in the cleanliness that one should aspire for within,” added Dr Dhlomo.

With regards to shortages in medication, which there have been numerous complaints about in Newcastle, the Health Department will install Drug Supply Management Software for clinics. Furthermore, two qualified post basic pharmacists, two pharmacist’s assistants, and one pharmacist to rove between facilities to assist with drug procurement, management and dispensing of medication, have been appointed.

1?200 prescriptions are now being dispensed in war rooms of Ward 3 and Ward 5.

More than R5.5million has been used to obtain new medical equipment.

“Doctors and nurses must be able to resuscitate patients. I heard one doctor say that you come to the hospital at your own risk because we don’t have tools to assist you, and we are aware that doctors and nurses are resigning because they are tired, frustrated and depressed so we have to ensure they have the equipment they need to save lives,” said Dr Dhlomo.

How much will NHI cost?

A Pricing Commission will be established to regulate the pricing in the private healthcare sector in line with the constitution of the country.

R33million in grant funding was allocated to KwaZulu-Natal for the roll-out of NHI in the 2012/2013 financial year, while R9.7million was allocated to KZN for the 2013/2014 financial year.

What role will private practitioners play in NHI?

General practitioners in private practice will be required to dedicate a minimum of four hours a month to work in a public clinic in order to ensure that every public clinic is visited at least twice a week by doctors in the private sector.