The National Health Insurance as a vehicle for Radical Socio-economic Transformation
3 February 2020
In the ANC January 8th Statement President Cyril Ramaphosa declared that the year 2020 is the year of unity, socio-economic renewal and nation building. Embedded in this declaration is the commitment to the values enshrined in the Freedom Charter and the rehashing of the Charter as a lodestar for the development of South Africa – a democratic country, underpinned by equality for all without discrimination of anyone based on their race, gender or class positioning.
The African National Congress and the Mass Democratic Movement have over the years maintained the commitment to democracy, equality and an unequivocal bias towards the working class, women, youth and those in rural areas. It is in this context therefore that the call for Universal Health Coverage in South Africa is made.
In Echoing the commitment towards multilateralism and building a united Africa for all, it is our responsibility as leaders to advocate for the reign of freedom in the continent – consolidating efforts towards the strengthening of the public health sector is one of the ways we can build a secure foundation for a united and prosperous Africa that we want and are dedicated to.
The time for deepening the agenda of access to quality healthcare is now, in order to meet the Sustainable Development Goals on health, it is imperative that the status quo in the provision of health services is not maintained. A business as usual approach on the political economy of health will not radically transform the socio-economic positions of most of the people in South Africa.
While discourse on the National Health Insurance was more advanced in the past few years, it is worthwhile to note that, the changes that are being presented through theNHI Bill are not new, and the process towards achieving Universal Health Coverage by 2030 has been ongoing. In December 2012, the international community through the United Nations General Assembly endorsed the resolution on Global Health and Foreign Policy which encouraged countries to commit to accelerating progress towards achieving Universal Health Coverage.
This endorsement being informed by a recognition that national health systems need to be both elaborate and specific in their targets and approaches to improving healthcare. In this regard, the required approach must be grounded in a shift towards broadening Primary Health Care and nurturing a culture that fosters social protection as a vehicle for making inroads in the health sector, and transforming the lives of many, specifically the poor and most vulnerable.
It is from this perspective that we ought to better understand the relationship between radical socio-economic transformation and the NHI. The key theme that is captured in the Freedom Charter is that of equality and an equal chance at success at life irrespective of one’s socio-economic background.
It is important to recognise that achieving the kind of society that we envisage through the Charter requires that government, all its stakeholders and citizens of South Africa accept that the level of transformation needed must be radical. In its radicalism, it is expected that it will unnerve and challenge the comfort and privilege that few in this country enjoy. This being so, it remains a necessary radicalism.
At this conjuncture, the Freedom Charter offers a vantage point that which we can use to further develop a case for Universal Health Coverage in South Africa. An approach that prioritises using a public health lens to understand the Freedom Charter and the call to radical socio-economic transformation is crucial because it acknowledges that a good quality of life, that is anchored on the principles of equality and justice for all relies on access to quality healthcare services.
The Freedom Charter through one of its clause’s advocates that ‘There Shall Be Houses, Security and Comfort for All’, it is under this clause that the notion of access to quality health services arises. The inaccessibility of quality healthcare has a direct impact on the quality of life, and the security and comfort that is envisaged in the Charter.
The relationship between the Freedom Charter, the call to radical socio-economic transformation and achieving Universal Health Coverage through the NHI is therefore worth exploring. The point of departure being that the National Health Insurance should be seen as a vehicle for radical socio-economic transformation.
The NHI firstly offers the opportunity to close the economic disparity that exists in access to healthcare services in the country. It is in part, an appeal to the moral duty and conscience of South Africans genuinely committed to equality and justice. It is also an opportunity to step up the rainbow nation rhetoric through actionable commitments towards health justice.
Secondly, the NHI echoes the view that radical transformation cannot take place in a business as usual context, it is the business of radicalism to challenge the way in which the market operates. In the health sector, there is evidence that the private sector works in an unequal, and unsustainable way that not only excludes the majority, but that also exploits even those that are included.
The reality that the private sector remains an oligopoly itself is a case for transformation of the sector. Lastly, the NHI as presented prioritises an approach that empowers the health user to take full responsibility of their health.
The idea of strengthening Primary Health Care is in itself a way of entrenching a culture of preventative care and approaches to treatment that empower communities. The NHI is a radical shift in health policy, it is the backdrop upon which a more equitable healthcare system can be ushered in. It is also the revolutionary responsibility of all South Africans to commit to this call till the end.
Bandile Masuku, Gauteng MEC for Health.
