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TOO much emphasis has been placed on the state’s National Health Insurance (NHI) scheme in the ANC’s policy discussion document on health, to the exclusion of other important issues, stakeholders have said.
Contained in the party’s March discussion paper on health and education are details of the implementation of the fund, which was established to ensure universal access to health care for all citizens.
It also seeks to ensure that the poorest people are seen by relevant health practitioners at all levels of the public health system and that their health needs are taken through the structures in a systematic way. This would ensure that no institution was overwhelmed by patients whose illnesses deserved attention at lower levels within the system.
According to public health expert Dr Lillian Alexander, the NHI is being touted as the universal remedy to the country’s public health ills. She said: “The solutions forwarded by the NHI are what should have come naturally for a government which intended to provide quality health care for its citizens.”
Its focus on primary health care should have been long in the pipeline, she said. “Those grand plans to rope doctors in from the private sector so that they lend their time to clinics and community health sectors should not have been blanketed in a plan, but should have been part of the processes that existed,” Alexander said.
Health Minister Aaron Motsoaledi recently embarked on an expedition to convince private doctors to give up some hours from their practices to the public health sector. They would be paid by the department and while the incentives might be right, Pretoria doctor Siya Makgato said the way they were being offered was not right.
He said a well thought out retention plan should have been part of the government’s plan from the onset. “The same doctors who are now being expected to put time in at public health facilities were educated by the state and had every intention of serving the people who deserved their skills. The failure by our government to give them adequate salaries or even pay them on time pushed them out.”
The NHI kicked off in April in 10 districts including Tshwane, with Motsoaledi saying staffing would be adequate by August and only thereafter would any tangible differences be evident. The pilot phase would cover 20 percent of the country’s most vulnerable people.
Teams of experts are being gathered to push the project forward in the institutions and they include gynaecologists, paediatricians, anaesthetists, family-care practitioners, professional midwives, primary health care nurses and paediatric nurses.
The NHI comes with a R1 billion cost tag and, during his budget speech Finance Minister Pravin Gordhan said there would have to be an additional R6bn in 2014/15.
“The money will be sourced from an increase in VAT, a payroll tax on employers or a surcharge on the taxable income of individuals,” economist Sam Mkhokheli said.
The SA Medical Association recently said it was worried that staffing problems would hinder the progress of the NHI because there were no doctors in most public health institutions.
Incentives were also an important aspect if doctors were to heed the call to participate and these included rural allowances, accessibility to malls, shops and schools for doctors working away from cities, the association said.