Release of NHI white paper a watershed moment – COSATU

Policy will remove role of profit-driven medical aid administrations, says Federation

COSATU welcomes the release of the National Health Insurance White paper

14 December 2015

The Congress of South African Trade Unions welcomes the release of the long-awaited NHI policy by the Cabinet last Friday. We view it as considered and central intervention that should help define our second radical phase of our national democratic revolution.

The NHI whose objective is to realise universal health coverage is now finally government’s policy. It is the mandate of the government ,as endorsed by the overwhelming majority of the citizens, first in 2009 and again in 2014. It is also a constitutional mandate in terms of Section 27 and an international undertaking and obligation in terms of the United Nations’ Sustainable Development Goals.

This is indeed a watershed moment for us as the organized workers of South Africa and the democratic movement as whole, as this has been one of the key strategic objectives of our struggle outlined in 1943 in the African Claims and in 1955 in the Freedom Charter. 

The establishment of a single payer NHI Fund is what we have been calling for, and it will effectively remove the role of profit-driven medical aid administrations in the system, thereby generating savings from the current wasteful and largely corrupt medical aid industry.

Therefore, with regard to the key question of the health financing system, i.e. the pooling of all existing health insurance and other funds into a single, publicly managed and administered NHI Fund - to ensure social solidarity from the healthy to the sick and the rich to the poor, the debate is now closed. No one will be allowed to opt-out of the NHI Fund, for universal health coverage to be realised.

We believe the fundamental principles of NHI remain upheld by the draft paper but we will study the paper and offer a more comprehensive and coherent response to it. The principles of social solidarity, equality and to right to health care should be the foundation of our new comprehensive health care system that provides for all South Africans.

Health care is social right not a privilege and access to it should be free at the point of services. We are happy that these positions are still deeply embedded in the White Paper.

Of all South Africans, the working class majority, the middle strata and the poor are sure to benefit most out of the National Health Insurance.

The white paper is released on the back of the pilot program, that is about to run its course. The department of health has recently launched the ideal clinic and introduction of ward based primary health care outreach teams ,which in our view will constitute the bedrock upon ,which universal access to health care will be built,

We are however concerned about the failure of our public facilities to absorb all health professionals and Nurses in particular after completing their mandatory community service. This practice will continue to deprive the NHI of the necessary skilled manpower and will potentially undermine the implementation of NHI if it is not dealt with decisively. We are therefore calling upon all provinces to stop the retrenchment of post community service nurses immediately

Implementation must now be the watchword. This is of course only the beginning, as we expect legislation to ensue in terms of the government’s plan to be implemented over 14 years. As COSATU ,we are under no illusions. We know that the private hospital monopolies are gearing themselves to undermine the NHI through the courts. For them health is not a human or citizenship right as our Constitution stipulates. For them health is a business for profit maximisation. Hence, the health system is fundamentally unjust and unsustainable:

- Where spending on each patient in a private health institution is four times spending on each patient in a public institution.

- Where eight out of 10 citizens use public facilities but most health professionals work in the private sector.

Thus, unequal spending means unequal standards of care. Since the 1999, when the private health providers were consolidated – becoming centralized and concentrated into an oligopoly comprising three giant companies i.e. Life Healthcare, Mediclinic and Netcare, medical health care costs escalated and medical inflation consistently shot above general inflation. Indeed, these companies scored phenomenal rates of profits since the creation of this oligopoly.   This is not sustainable, hence since then:

- A number of medical schemes have collapsed and others were placed under curatorship or merged.

- Registered schemes have now been reduced from over 140 in the year 2001 to under 100 since 2010.

To sustain their financial viability, medical schemes regularly tend to increase premiums at rates higher than CPIX, which causes the decline of the depth and breadth of benefits. Yet the principal culprit here is the oligopoly, with what the World Health Organisation calls “uncontrolled commercialism which undermines principles of health as a public good”. Hence, many of our members have increasingly found that they have to pay out-of-pocket or co-payment as if they have no medical insurance.

Therefore COSATU supports the broad thrust of the government’s approach to the transformation of the health system as outlined in the white paper. In particular, we welcome the shift from the current emphasis on the highly costly model of curative service provision, encouraged by this hospi-centric system to a model that is centred on primary health care, emphasising health promotion and prevention.

We support the ongoing primary health care engineering.  Our affiliates will continue to campaign at institutional level in support of the drive to deal with six imperatives as outlined in the policy:

- Cleanliness

- Safety and security of staff and patients

- Long waiting times

- Staff attitudes

- Infection control

- Drug stock-outs

We undertake to mobilise our members and communities in support of the implementation of the NHI. We also send out a message to the oligopoly, that we are going to fight them if they intend to use the courts to derail the implementation of this policy – in defence of their excessive profits. To the government, we are saying that a precondition to a successful implementation of the NHI is an end to tenderprenuering in the public service – outsourcing must be totally eradicated in the health care system and this must be accompanied by the absorption of community care workers and lay councillors into the public service. 

Issued by Sizwe Pamla, National Spokesperson, COSATU, 14 December 2015