A troubling development following the Department of Health's (DoH) release of the Green Paper on a NHI for South Africa relates to the way in which subsequent health care discourse is so readily, even automatically, channelled to the prospect of the implementation of the proposed system.
The attention that many of the well known problems in the public health sector are now receiving, despite having been explicitly visible to the eyes of government for almost two decades, is being branded under the rubric of the NHI.
For example, on Thursday 22 March Health Minister Dr Aaron Motsoaledi outlined 10 pilot districts that were identified "for the phased piloting of the National Health insurance (NHI) due to start on 1 April." Furthermore, in pointing out its intent to improve hospital management - perhaps the most pressing issue in terms of dealing with the public health sector - the Department released its policy on regulating the management of hospitals (2nd March) while strongly invoking the NHI.
These examples are quite simply marks of government's blatant use of propaganda in an attempt to sell and further entrench the idea of the NHI in the minds of the public as the ideal remedy to the failing health system. Why is it propaganda? Because the NHI does not exist. Identifying pilot sites for improving the health system are one thing; announcing them in the context of the NHI amounts to a crude political tactic aimed at instilling confidence in a system that is animated only in the form of a Green Paper.
It is important to remember that it is not the NHI, or any other theoretical construct in itself, that will change the condition of our health care system, but ultimately better governance, accountability and greater political will within the DoH. Marketing policy is very different from implementing it and take note: the louder the marketing the more suspicious one ought to be of the actual content of the policy.
Certainly, the result of this semantic play poses the risk of diverting attention away from discussing rational solutions to the actual problems of the health system and conflating real action with the passing of an arguably politically motivated policy proposal. This is particularly troubling as it indicates that the debate around health care is being framed by certain assumptions which are, no doubt, testament to the government's success in having essentially reframed the health care debate on its terms.