The NHI in the times of Corona Virus

20 March 2020

It is sometimes tempting to focus on the tree, rather than the forest that is growing. In this instance, the tree would be the Covid-19 and perhaps the forest, the NHI. Before I am accused of writing in parables, let me put it in policy terms.

As everyone is rightly consumed by the immediacy of the Covid-19 crisis, the long-term goals of building a quality healthcare system that restores our collective humanity may be forgotten, at least for a little while. This could be dangerous because as a matter of normal course; healthcare services, especially hospital services, are often offered on an emergency basis.

In Gauteng, we have a clear attitude to the Covid-19: we will tackle it head on with all the skill, might and resources at our disposal. There is no room for failure and we shall win. And yet, there is an important message we must keep alive in the midst of the hustle and bustle of Covid-19: we must continue to work even faster and smarter to improve all the other health outcomes.

The Covid-19 crisis can serve as an opportunity to accelerate the improvements we so desperately need to improve the quality of our health system. Our response therefore must simultaneously address key issues such as funding, pricing, human capital and infrastructure in a manner that helps us get closer to the objectives of section 27 of our Constitution and our Five-Year Plan.

This is what the National Health Insurance (NHI) is about. Stakeholders in the public and private sectors of the health system are provided with a golden opportunity to learn about the principles and practice of NHI as envisaged in policy and the Draft Bill. Among others, the NHI is anchored on principles and features such as solidarity, collaboration, qualitative services, strategic purchasing, access where services are needed, nobody must be exposed to financial hardship and qualitative services.

The emerging spirit and experience so far on Covid-19, sees many of these principles and features of NHI taking root and we should take note and learn. In the first instance, solidarity even goes beyond boarders as countries such as China, Cuba and others; offer assistance in many ways. Our business, labour and civil society sectors have pledged solidarity in the true spirit of the "South African Response". Indeed everybody understands that health is a responsibility of the individual, sectors and the collective that is South Africa. The weak are looking after the strong, the healthy are looking after the sick and the rich after the poor. We are each other's keepers.

In terms of collaboration, a strong sense of working together across the public and private sectors is also emerging. There are deliberations and actions being taken to share resources between private and public facilities. Solutions are being negotiated on appropriate pricing, sharing expertise and skill, cross-referrals (an old practice), laboratory services etc., all of which may produce 'strategic purchasing' outcomes. Even 'panic buying' is being discouraged by all sectors in the true spirit of solidarity.

Access to Covid-19 testing is done at the expense of the state, no matter your income level, nationality, geography and in some cases, the nature of health insurance. What is important is that a patient has a need and the sector must respond to the need. Those who afford private services practically demonstrated 'shared responsibility and costs' and open up space for those who cannot afford to get public services faster. This again is solidarity and collaboration in action during the times of Covid-19.

We all receive qualitative services under the Covid-19 crisis: we have the same protocols, same treatment regime, same basic prescription (except in complicated cases), same expertise and equipment and sometimes; same facilities and health practitioner. Most of these are regulated by guidelines from the World Health Organisation (WHO) which sets the minimum standards of care in this regard. In this way, we ensure qualitative services for all.

Two key lessons are worthy of noting during this crisis: We must not forget to think about the system during the crisis. Let us not wallow in crisis and forget the strategic signposts. In other words, how do we use the crisis to improve the health system as a whole. Let us wake up after the crisis and realise that we have lost valuable time. Secondly, the Covid-19 moment could serve as the first practical on how to implement the NHI and so far, the experience is good. This means that, contrary to doomsayers, the NHI is doable and will be achieved in our lifetime. All we need is the will of Team South Africa which clearly exists abundantly.

Let us not allow narrow sectoral interests to divide and blind us to the fact that we need each other. We are each other's keepers. Covid-19 proves that we do need each other and; we shall win! Let us not only see the tree but; the forest rising. Our heartfelt support goes to our dedicated healthcare workers. Let there be love in the times of Covid-19.

Dr Bandile Masuku, MEC for Heath in Gauteng