NHI Bill will soon be ready for submission to Parliament – Aaron Motsoaledi

New system aims to embed principle that access to health care services will be based on clinical need and not ability to pay

Remarks prepared for President Cyril Ramaphosa at the launch of the report on the Presidential Health Summit 

12 February 2019

(As delivered by Minister of Health Dr Aaron Motsoaledi on behalf of President Ramaphosa)

Deputy Minister of Health Dr Joe Phaahla,

Chairperson of the Portfolio Committee on Health, Ms Mary-Ann Dunjwa,

World Health Organization Country Representative, Dr Akpaka Kalu,

Ladies and Gentlemen of the media,

It is a very special moment for me to join all of you for the launch of the Report on the Presidential Health Summit 2018.

The Summit took place in Ekurhuleni on 19 and 20 October 2018 under the leadership of Deputy President David Mabuza, who officiated in my absence.

The theme for the Summit was: “Strengthening the South African health system towards an integrated and unified health system”.

This theme reflects the commitment in the National Development Plan to a sustainable quality health system that provides equal access and care to all South Africans.

The Presidential Health Summit 2018 gave us an opportunity to examine our national health system as a patient in its own right and to arrive at a diagnosis that would allow us to intervene and return this system to good health.

The Health Summit was able to give detailed attention to many of the issues with which I had been presented by various individuals and stakeholders since becoming President at the beginning of last year.

Many people have raised concerns and complaints with me about the poor quality of health care that people experience in our clinics and hospitals during their moments of vulnerability.

Complaints include inadequate access to medicines and equipment; inadequate numbers of staff in our facilities; unprofessional conduct of staff; labour unrest, corruption and theft of hospital property.

South Africans also complain of poor delivery of mental health services and delays in accessing health care.

One of the barriers to access is the unsustainably high cost of private care.

Many users of this care experience above-inflation increases in medical schemes contributions, and the failure of medical schemes to pay for patient services that have been rendered.

Several organisations have raised concerns with me regarding the dysfunction of the health system, to the point that it is clear that the system is in crisis and needs urgent rehabilitation.

These are issues that must be addressed collectively by all stakeholders if we are to prevent a collapse of our health system.

We need a robust, efficient and caring health system in a country where more than seven million people live with HIV, where we are seeing rising rates of diabetes, hypertension and cancer, and where maternal and neonatal death rates must be reduced.

Too many people do not receive quality preventive, promotive, curative and rehabilitative health care services.

As we itemise the challenges we face, we are encouraged by the gains we have made during 25 years of democracy in building a healthier nation.

According to the Medical Research Council’s Rapid Mortality Surveillance Report 2017, which was released a few days ago, average life expectancy in South Africa increased from 61.2 years to 64.2 years in the five years between 2012 and 2017.

The Survey also recorded declines in mortality among children under the age of five and among infants.

Neonatal mortality was unchanged during this five-year period, while maternal mortality declined by close to 30 percent.

In 2009, South Africa became the first country in Africa to introduce pneumococcal and rotavirus vaccines.

Five years later, the South African Medical Journal Reported a 64% reduction in rotavirus diarrhoea hospitalisations and a 46% reduction in hospitalisation for invasive pneumococcal disease in HIV-negative children older than 16 weeks of age.

While we have made much progress, there is much more we need to do.

Our efforts to restore our health system are informed by two of the five national priority tasks I outlined in the State of the Nation Address just a few days ago.

One of the tasks is to improve the conditions of life for all South Africans, especially the poor.

The other is to strengthen the capacity of the state to address the needs of the people.

I indicated in the State of the Nation Address that in 2019 we will take a significant step towards universal health coverage that will bring quality health care to all South Africans.

After extensive consultation, the NHI Bill will soon be ready for submission to Parliament.

The NHI will enable South Africans to receive free services at the point of care in public and private quality-accredited health facilities.

The NHI delivery model will be based on the primary health care approach, which emphasises the importance of providing preventative, promotive, curative, promotive and rehabilitative services.

By applying the principle of social solidarity and cross-subsidisation, we aim to reduce inequality in access to health care. 

Realising the magnitude of the challenges in health care, we have established an NHI and quality improvement ‘war room’ in the Presidency.

This ‘war room’ brings together various key departments to address the crisis in the public health system while preparing for the implementation of the NHI.

We are guided by the insight that improving the health system and introducing NHI are two sides of the same coin and are mutually reinforcing.

Repairing our national health system is an endeavour that requires the input, involvement and innovation of all roleplayers who understand that good health makes for a good life and a good economy.

At a time when we are laying the foundations for increased investment in our economy and we are developing the skills of our people to be active in this economy, it is essential that we build and maintain a healthy nation.

This is not a responsibility that rests only on the shoulders of delegates and partners to the Presidential Health Summit 2018.

This is a responsibility that must be exercised by all South Africans, who are called upon to adopt healthy and active lifestyles and to take care of their physical and mental wellbeing.

Our measure of success should not be rising levels of treatment for highly preventable conditions, but it should be the reduction of the incidence of such conditions in our society.

The Summit adopted the principle of ‘One Country, One Health System’ and welcomed the renewed energy and commitment within government to improve the health system.

The Summit generated unanimous support for National Health Insurance and for the principles of universal quality health coverage, social solidarity and equity in health access.

The NHI aims to embed the principle that health care services will be based on clinical need and not the ability to pay.

Health care will therefore be free at the point of service.

The Summit proposed a centralised, national procurement system, which will achieve economies of scale and assist in addressing corruption.

The success of a quality health system rests on information systems that can generate valid information at the right time and in the right format for decision making and monitoring at all levels of management, taking into account the need for patient confidentiality.

Having identified critical challenges, the Summit called on Government to urgently prioritise the filling of critical vacant posts.

The Summit tasked National Treasury to develop a sustainable financing model, and urged provinces to prioritise their financial resource allocation to ensure the delivery of quality health care is not compromised.

Further proposals relate to the development of expertise and funding to implement government’s health infrastructure plan in a manner that will respond to changing population and clinical dynamics.

This demands stronger coordination between the Department of Health and partners such as the Department of Public Works.

Overall, infrastructure in both the public and private health sectors must meet the requirements of the Office of Health Standards Compliance.

The Summit acknowledged the critical role the private sector has to play in the realisation of universal health coverage and the vision of the NHI, and called for inclusive process started through the Summit to continue.

Most importantly, health care users need to be active engaged in the processes of unifying the health system and Community Health Workers need to serve as a vital link between communities and health facilities.

The Summit derived its historical importance from the fact that this was the first time that such a rich diversity of stakeholders collectively confronted long-standing challenges in health and collectively devised measures that will overcome these challenges.

Through this inclusive and collective approach, the Presidential Health Summit has pointed the way forward not only for health, but for other key sectors where inclusive engagement can make a great difference in the quality of life of South Africans.

The Summit has underlined once more the benefit of working together as a nation and building greater understanding through the involvement of a wide range of persuasions and expertise.

The Report we are launching today serves the dual purpose of documenting the Summit deliberations for the purpose of setting implementation in motion.

At the same time, it provides guidance to the many millions of South Africans who could not attend the Summit and who – in the spirit of Thuma Mina – wish to know what role they can play in our health revolution.

Representatives of the Summit sectors are currently developing a Presidential Health Summit Compact based on the outcomes, which commits sectors to work together to implement identified solutions.

The initial sectors identified are: government, civil society, labour, health services users, business, private providers, funders, statutory councils, academia, health professionals and allied health workers.

Representatives will consult their key constituencies on the interventions to be implemented and craft a plan that includes clear objectives, methods, timelines, indicators and financial resources.

I call on all South Africans to study this report with a better future in mind, and to identify ways in which we can enrich the outcomes of the Summit and set our nation on the road to good and sustainable health.

I wish to thank Deputy President David Mabuza, the Minister of Health, Dr Aaron Motsoaledi, my Special Advisor on Social Policy Dr Olive Shisana and the convenors of the Presidential Health Summit 2018 for creating a platform from which we will launch quality and universal health coverage that will benefit our entire nation.

I wish to thank all the participants for their contributions to the robust debate and the constructive outcomes.

Lastly, I wish to thank the media for covering and commenting on our transformation of the national health system.

Information is a vital part of empowering citizens to contribute to, and benefit from, the change we are realising in our country.

The Presidential Health Summit 2018 has generated a wealth of ideas.

Now we must act on these ideas and together ensure effective implementation.

There is a great deal of work ahead, but if we proceed in the spirit, and with the determination, with which we have started, I am certain that we will succeed.

I thank you.

Issued by The Presidency, 12 February 2019