NOMPU SIZIBA: Earlier this month [July] cabinet approved the National Health Insurance Bill. This bill is set to be tabled in parliament before the end of the year. Essentially, the bill seeks to achieve a universal quality healthcare system for all South Africans, regardless of their class or standing in life – a noble intention indeed.
However, a report published by Genesis Analytics on the NHI pilot programme, which began in 2012, suggests that, while close on R5 billion was provided to the project, there were no monitoring and evaluation mechanisms put into place to review progress, and in many instances funding for those special pilot sites was underspent. The report concludes that it would have been difficult for the government to make the assessment of whether there was a return on the investment made.
Well, to discuss the pros and cons of NHI as it gets closer to becoming a reality through the parliamentary process, I’m joined on the line by Dr Anban Pillay, the deputy director-general for NHI in the National Department of Health, and Dr Adrian Saville, chief executive of Cannon Asset Managers, who is also an economist.
Thank you very much, gentlemen, for joining us. Let me start with you, Dr Pillay. Many people are worried that here we have a very noble cause in the NHI, but the economics of our country right now just don’t stack up to being able to support it. What mechanisms are you going to be putting into place as government to make this ambitious project succeed, and what are the implications for private medicine?
ANBAN PILLAY: Good evening to you and to the listeners. I think it’s important to recognise that the National Health Insurance is a project that’s going to be phased in. It’s not anything that will happen within a day. The implementation of the project will happen over months and years. Our estimated time frame is that the project will be completed by 2026.
The idea is to bring the funding from the public and the private health systems into a single pool and, using the state’s ability to procure goods and services at scale, be able to achieve efficiencies in terms of those costs; at the same time to be able to achieve the redistributive efficiencies between rich and poor – so that we are able to allocate resources in a manner that does not differentiate between the wealth of South Africans – and provide them with a basic health package of good quality which will be appropriate for all South Africans.
NOMPU SIZIBA: Dr Saville, as I say, it’s a noble thing, trying to have this universal healthcare for all South Africans, regardless of their standing in life and so on. But when you look at the government’s plan so far, do you think it has a plan in place, and can we afford it?
ADRIAN SAVILLE: There is a plan in place, there is no question about that. Do we have the ability to afford it? I would venture yes, we actually do. Funding is not really the issue at stake here. What is at question is the ability to deliver the service. Here we need to be clear that it is not about the public sector delivering a public service – it’s about making funding available to a service that can deliver what’s promised.
Beyond noble, I think it is in part extraordinarily ambitious but, in the same breath, incredibly important. You can’t possibly build a viable, competitive economy on the back of a society that is not well. That is certainly the diagnosis of South Africa. We have low life expectancy, high infant mortality, high rates of HIV/Aids prevalence, tuberculosis, work absenteeism – high for a country of South Africa’s income status.
NOMPU SIZIBA: Dr Pillay, there are huge concerns about basic human resources in the form of doctors and nurses. I read somewhere that in the next 15 years or so some 50% of the registered nurses we have in the country will have retired, or will be retiring. How do we grapple with this very real human-resource challenge, because it’s a specialised type of skill that we need, especially when many of our health workers continue to be lured by better offers in other parts of the world?
ANBAN PILLAY: It’s important to recognise that in terms of human resources it’s important for us to increase the production of human resources so that we create more people available to deliver services. But, secondly, we also must think more smartly about how we deliver services. In many countries they’ve moved to health systems that are not human-resource intensive. For example, in the UK we have a model where a patient will call into a call centre, and on the other side of the line is a clinician as well as a specialist, if necessary, who go through a series of questions assessing that patient and determining where a patient should go. So, the human resources, the way they are currently structured and delivering services, can be improved in terms of efficiency.
But we agree we need to increase significantly the production of human resources, and so there is a human resource plan to do that exactly. But I do think we also need to embrace artificial intelligence and all the novel ways of delivering healthcare so we can reduce the high reliance on human resources.
NOMPU SIZIBA: Our thanks to Doctors Anban Pillay and Adrian Saville for their time today.