UP professors help structure NHI to tackle homeless healthcare

Professors at the University of Pretoria (UP) are assisting government reshape the national health policy.

Profs. Jannie Hugo, Debashis Basu and Stephan de Beer are collaborating with government to formulate part of the national health insurance (NHI) framework, to accommodate homeless people.

NHI is a health financing system that the government wants to implement, designed to pool funds to provide access to quality affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status.

According to government, NHI will ensure that accessing healthcare services does not result in financial hardship for individuals and their families.

NHI will give every South African access to comprehensive healthcare services free of charge at the point of use at accredited health facilities such as clinics, hospitals and private health practitioners, announced the government.

This will be done using an NHI card.

Basu explained that government was setting up a health patient registration system (HPRS), which was an alphanumeric code for everybody who will be accessing the NHI.

“A unique number will identify people when entered into the system.”

Prof. Stephan de Beer said they were integrating the homeless, by capturing personal details and assisting government health facilities with the information.

“Without an electronic database that can identify people, the NHI would not be able to operate. There are many people in the country, both local and foreign being undocumented, so working with an ID alone is not the answer,” De Beer said.

“At a hospital like Steve Biko [currently], the challenge is that if you don’t have an ID, you cannot enter. But we treat anybody who has an emergency, even if you are a homeless person, or are in the country illegally – you have a hospital file number.

“So we have started integrating homeless people into that system. This is a long journey, and we have only started.”

De Beer said the NHI was meant to cover all people in the country, regardless of economic or social status, and, “more specifically, people who are unable to benefit from private medical care”.

He said the homeless were often stigmatised by society and the health sector.

“Clinics and hospitals often treat homeless persons with suspicion and disrespect. We know of many people being turned away at public facilities as a result,” said De Beer.

“During the late 1990s when ARVs were not readily available, homeless persons who had a low CD4 count and were terminally ill with AIDS, were discharged from public hospitals to die on the streets.”

De Beer said the NHI was meant to cover the most vulnerable in society.

He said the NHI project was in its infancy and they were working on creating processes and systems that are set to bring primary healthcare to homeless shelters, housing projects and other areas where a concentration of people lived on the streets.

“We do this through matching medical interns and students, community health workers and public health clinics, to the shelters, housing projects and points of concentration that we are identifying in Tshwane.

“The ideal is that every person who is homeless will have access to a health worker, in the same way many of us have the name and contact details of a family physician we turn to in case of a health matter.”

De Beer said the NHI was still far from addressing homeless health needs, however, through grass-root and local interventions, the policy could benefit the vulnerable.

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