National Health Insurance: Running Before Crawling – The need for objective reassessment of the pilot phase – Part II
4 October 2018
In Part I of the series on health reform and the draft National Health Insurance Bill (NHI Bill), the Centre for Constitutional Rights (CFCR) argued that considering the anticipated costs of the NHI and lack of crucial detail, South Africa needs to urgently assess alternative models to address the healthcare crisis. In Part II, the CFCR assesses the lack of information on the results of the NHI pilot phase, which is supposed to inform the further roll-out of the NHI.
The NHI Bill aims to revolutionise healthcare provision in South Africa by replacing the current two-tiered healthcare financing with the establishment of the NHI fund, which will be the single purchaser and financier of the population’s personal health services. The NHI, according to the NHI Bill, is envisioned to be rolled out in three phases spanning over 14 years, with the first phase extending from 2012 to 2017. The second phase is accordingly from 2017 to 2022. The final phase is from 2022 to 2026.
The 2015 White Paper: National Health Insurance for South Africa (NHI White Paper) furthermore provided that the initial phase, the pilot phase, would focus on strengthening service delivery systems in Primary Healthcare (PHC). This would accordingly be done through Municipal Ward-based PHC Outreach Teams; the Integrated School Health Programme; the District Clinical Specialist Teams and lastly through contracting non-specialist health professionals (general practitioners). Phase One logically provides the springboard from which NHI will develop and the NHI Bill provides that in Phase Two these strengthening initiatives will continue to be implemented. This however begs the question whether the strengthening initiatives for the health system were successful and whether this approach indeed provides the blueprint for the further roll-out of the NHI. The NHI Bill is oddly silent about the need for an objective assessment of Phase One and evidence-based results are not as transparent as one would expect.
The 2011 National Health Insurance in South Africa Policy (NHI Green Paper) stipulated key points with estimated time-frames to be addressed in the initial phase. This included management reforms and designation of hospitals; piloting initial work in 10 districts; the audit of all public health facilities; the establishment of the Office of Health Standards Compliance (OHSC) and focusing on increasing the supply of doctors, nurses and pharmacists.