Dr Aquina Thulare
South Africa’s NHI reforms are intended to transform and re-engineer the health system in South Africa into one that actively benefits the entire population by working towards achieving universal health coverage (UHC).
UHC aims to ensure that all individuals and communities have access to essential health services without facing any financial hardship or encountering catastrophic (poverty-inducing) health care-related expenditure. NHI, as outlined in the White Paper on NHI, seeks to restructure the country's healthcare system to ensure that all citizens have access to needed health-care services without financial barriers, ultimately contributing to the progressive realisation of the right to health as enshrined in the Constitution’s Bill of Rights.
Descriptively, NHI has a number of central features including redistribution of existing health-care resources, pooling of funds into a single payer purchaser of personal healthcare services, and ensuring that the scope of services purchased are comprehensive with a strong focus on Primary Health Care. NHI is a pivotal policy and legislative reform aligned with UHC objectives, working towards equitable access to comprehensive health services, financial protection, and improved health outcomes for all citizens.
Interrelationship between NHI and UHC
The phased implementation of NHI in South Africa is intricately linked to the objectives of UHC, which aims to ensure that everyone has access to essential health services without facing financial hardship. The alignment between the NHI proposals and the achievement of UHC objectives are interrelated as:
a) UHC seeks to ensure equitable access to health care for all. Similarly NHI, by redistributing resources and focusing on primary health care, contributes to narrowing the gaps in access to services, particularly for vulnerable and marginalised populations.
b) UHC emphasises the importance of financial-risk protection, ensuring that individuals do not face financial barriers to accessing needed health services. NHI, through its funding mechanisms and elimination of out-of-pocket expenses, aligns with this UHC objective.
c) UHC aims to provide populations with access to a comprehensive range of health services. NHI, by offering a comprehensive benefit package, supports the objective of ensuring that individuals receive the full spectrum of necessary health interventions.
d) Both UHC and the NHI share the goal of improving the quality of health care. By focusing on primary health care and addressing health system inefficiencies, NHI will contribute to enhancing the overall quality and affordability of healthcare services in South Africa.
Why NHI is important
The NHI Bill that is currently before Parliament involves the creation of a central fund that will be mandated with the pooling of all financial resources for the provision of personal health-care services from various sources, including equitable share allocations, conditional grants and other appropriate funding mechanisms.
The principle that will drive the mobilisation of funding resources for NHI is primarily social solidarity, with tax being the source of funding for NHI. A central tenet to the NHI reforms is the entrenchment of financial risk protection to all South Africans through eliminating out-of-pocket expenses for health-care services, especially at the point of care. This is crucial in preventing catastrophic health expenditures that can lead to financial hardships for individuals and families.
NHI also aims to redistribute healthcare resources (financial and non-financial) more equitably across the country, addressing historical imbalances and ensuring that under-served and particularly vulnerable populations have improved access to quality and affordable health-care services. The reform agenda on achieving UHC through the phased implementation of NHI places a strong emphasis on strengthening access to and use of primary health-care services, ensuring that communities have access to preventive, promotive, palliative, basic curative services and rehabilitation at the first level and point of care.
Importantly, NHI will ensure that all South Africans, irrespective of their socio-economic status, have ongoing and portable access to a comprehensive package of health services, covering a range of interventions, from preventive measures to treatment and rehabilitation so that individuals receive holistic care addressing their diverse health needs.
Benefits of NHI
There are several systemic and population level benefits arising from the planned implementation of NHI in South Africa.
NHI endeavours to rectify discrepancies in health-care access, ensuring that every citizen, irrespective of their socio-economic status, can avail themselves of high-quality health services. By consolidating funds into the NHI Fund, the initiative lessens the financial burden on individuals seeking health-care services, safeguarding them from potential financial hardships arising from catastrophic health expenses.
Additionally, NHI aspires to deliver a comprehensive array of individualised health-care services, encompassing preventive, promotive, curative, and rehabilitative measures for all. This guarantees that individuals and communities receive all-encompassing care addressing their health requirements throughout various life stages.
Given its emphasis on preventive and primary health-care services, NHI places importance on early detection and intervention. This proactive approach is anticipated to diminish the prevalence of diseases, thereby enhancing overall population health management and achieving favourable health outcomes.
NHI seeks to rectify existing health disparities by ensuring an equitable opportunity for all citizens to access health-care services. This is particularly crucial for improving health outcomes, especially among populations that have historically been marginalised and under-served.
The progressive move towards UHC, facilitated by the NHI, contributes to improved health outcomes at the individual and population levels. Furthermore, access to timely and appropriate health-care services enhances the chances of early diagnosis, effective treatment, and better management of chronic conditions. Within this type of health system, there is a focus on public health interventions, including disease prevention and health promotion. This contributes to a healthier population and reduces the burden of preventable diseases.
The implementation of NHI in South Africa will benefit the entire population by promoting equitable access to comprehensive health-care services, reducing financial barriers, and working towards improving health outcomes and addressing health disparities across various demographic groups.