NHI supporters should not ignore SA’s healthcare realities

This article was first published by Daily Friend on 9 September 2023 

Three key questions seem largely to have been ignored in the current debate over healthcare reform.

What are the main problems with our current free public health sector? How will the proposed National Health Insurance (NHI) correct these? And is a bigger budget, managed centrally, the solution?

There have been many new developments in the medical field during the last decade. Private affordable clinics and services have been established and huge advances have been made in medical technology.

We have witnessed a serious decline in the quality of the healthcare provided by the public sector over this period. Crumbling infrastructure, overstretched medical personnel and mind-numbing shortages of medicines, hospital supplies and food for patients have become the norm.

And yet the NHI Bill does not explain how any of these basic problems will be fixed. It does not allow for changing conditions, nor does it seem to take account of how new technology will be incorporated into the system. And most importantly, it does not include realistic estimates of the budget required or explanations as to where the money will come from. Instead, proponents of the Bill simply make sweeping ideological statements about how South Africa ‘needs’ an NHI to provide universal healthcare.

There is an existing ‘free at point of delivery’ public health system that, if managed correctly, could be delivering a vastly better service than is the current reality.

It may well be that only 16% of the population is covered by medical schemes, but it is unlikely that the remaining 84% rely on the public sector. Many citizens with the means choose to pay ‘out of pocket’ for their basic healthcare needs. Affordable Hospital Plan insurance packages cater for major emergencies. If iniquitous laws preventing the establishment of low-cost benefit schemes were repealed, this would allow many more young people and lower income earners to provide for their own medical needs.

Affordable clinics have sprung up in major centres and in retail outlets such as Shoprite, Dis-Chem, Clicks and large pharmacies. Private day clinics have emerged in densely populated areas such as  Diepsloot (Unjani) and Soweto, operated by entrepreneurial doctors and dentists. Most of these facilities provide a ‘no appointment’, ’fixed fee’ service.

Where is the current data on these innovative services and the numbers of patients that utilise them? Does the Department of Health even acknowledge the role they play in the private sector?

The structure of the NHI is modelled on traditional, outdated treatment protocols. Technology is moving rapidly, changing the character of the doctor/patient face-to-face consultation model. Virtual consultations are going to become more common for primary healthcare, reducing the need for personnel based in hospitals and clinics. These on-line services are already available to both private and ‘pay as you go’ patients.

Affordable and mobile

Advanced handheld diagnostic tools will become increasingly affordable and mobile. Personal mobile phones already have health monitoring software. All these devices will reduce the need for time-consuming and costly tests and X-Rays. Qualified doctors will be able to move between facilities with ease, enabling them to assist many more patients in remote areas. Medication is already being delivered by drones in rural areas.

Hospitals and clinics will then be able to focus their resources on emergencies, surgeries, post-operative, chronic and maternity care.

We need to reduce the burden of disease in South Africa.

Education on diet, exercise and healthy lifestyle choices is needed to reduce the incidence of type 2 diabetes, heart disease and other self-induced illnesses. ‘Prevention is better than cure’ is an old maxim that still holds true.

Greater personal responsibility to protect one’s health should be encouraged. Many informed and health-conscious individuals already supplement their diet with vitamins and natural products. These efforts should be encouraged, not regulated against by SAHPRA, which frequently frustrates the import, local manufacture and sale of many of these products.

The NHI proposals illustrate a lack of foresight about the future of healthcare. This should be of concern to everyone and especially those who faithfully support the legislation.

What are the problems with the current public healthcare sector? Have the existing pockets of excellence been analysed to provide examples of best practice? What does the Department of Health have to say about partnerships with the private sector and how they improve the quality of service at state hospitals?

Medical practitioners provide pro bono assistance for operations and emergency treatment at public facilities. Benefactors raise funds to provide for additional staff, resources and infrastructure. This assistance should be acknowledged and welcomed by the public sector.

Raise the quality of healthcare

But ultimately, the single, most important way to raise the quality of healthcare in South Africa is for the economy to grow and employment to increase. The general nutrition of the population would improve, living conditions and sanitation would be upgraded, many mental health conditions would diminish and more personal responsibility for health would be possible. The government can then take care of the most vulnerable in society, the indigent, the disabled and the elderly.

South Africa has an existing public health system that is in intensive care, but it is not without hope. With the right management, elimination of corruption and use of modern technology, it is possible to provide quality care and treatment within the current system without implementing the massive calamity that will be the NHI.


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The views expressed in the article are the author’s and are not necessarily shared by the members of the Foundation. This article may be republished without prior consent but with acknowledgement to the author.




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