Navigating healthcare reforms in South Africa’s GNU

Source: @DIRCO_ZA/X

In a Profmed-hosted webinar, Craig Comrie, Profmed chief executive officer, highlighted that the NHI Act which is designed to provide universal healthcare coverage has been a cornerstone of many political campaigns. However, Comrie pointed out that the emphasis on the NHI might have overshadowed other critical aspects of healthcare.

Comrie’s concerns highlight a broader debate around the single-payer model proposed by the NHI. “While this model might address issues of equality, it also raises questions about freedom of choice in healthcare.

"Countries that operate successful universal healthcare models don’t rely on a single-payer, single-funder model as described in Section 33 of the NHI Act, which limits the role of medical schemes. This section infringes on the freedoms of the health consumer and avoids competition between the NHI Fund and medical schemes which remains particularly draconian,” he said.

He said now that the Government of National Unity (GNU) is in power, the future of the NHI hangs in the balance. However, he believes healthcare service delivery will be a critical benchmark for the GNU’s success.

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“The goal is clear: to provide access to all while ensuring high-quality service delivery. We need reforms that deliver better service across South Africa. What we need are well-thought-out, well-researched, evidence-based reforms,” he explained.

Healthcare professionals echoed Comrie’s sentiments in the webinar. Langani Mbodi, president of the South African Medical Association Trade Union (Samatu), emphasised the need for collaboration between private and public healthcare sectors.

“The general population currently lacks access to adequate healthcare, and NHI has the potential to address the inequality,” Mbodi noted. “However, to successfully address the inequality, we need collaboration between private- and public healthcare systems, which is possible, as evidenced by the Covid-19 pandemic.”

Focus on healthcare delivery disparities

Mbodi also highlighted disparities in healthcare delivery while sharing the example that even private patients access pockets of well-functioning public-sector facilities for treatment.

The disparities of the level of services in general are growing. For instance, cancer patients in the private sector receive timely screenings and results, while those in the public system face prolonged waiting periods. He asserted that this stark contrast underscores the need for a more integrated and efficient healthcare system. The use of excess capacity in the private sector can alleviate public-sector queues.

Speaking to the role of medical schemes, Thandi Mabena, chair of the Council for Medical Schemes, asserted that the Medical Schemes Act remains a vital guiding document. “The Act will still be relevant, and there will likely be amendments,” Mabena said.

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“As a country, we need to work together to find solutions that prioritise the interests of our nine million members on medical schemes and those that cannot afford medical schemes.”

When looking at the challenges in the current healthcare workforce, Moratwe Masima, a healthcare practitioner and founder of Your Health, Your Dignity, provided a frontline perspective.

“I have worked in both public- and private sectors. At the start of the year, I was one of the many unemployed medical doctors,” Masima shared. “In the public sector, patients are often referred to different places, which is a huge disservice. We are overworked and understaffed, yet many healthcare professionals are unemployed. Reforming our IT systems is also crucial to avoid losing patient information.”

Overall, all the panellists agreed that as South Africa embarks on this new political chapter, the next few years will be critical for healthcare.

"Preventative care, such as screenings, must be a priority. The GNU’s collaborative approach offers hope, but effective implementation and continuous evaluation will be key to achieving the envisioned healthcare reforms," Masima concluded.