In a recent interview with eHealthNews, Spokesperson for Theuns Botha, Minister of Health Western Cape Government, Mrs Hélène Rossouw, described why the Democratic Alliance (DA) run Western Cape Government (WCG) is sceptical of a South African NHI and the way it’s currently being implemented.

While the WCG is not against NHI per se, the Provincial Government is of the opinion that a strict financial management should be in place first – before the NHI is rolled-out. “Initiating an expensive NHI model will solve no problems if bad management continues to be the order of the day, as is the current state in some provinces,” Mrs Rossouw noted.

Mrs Rossouw went on to provide examples of some of the issues the WCG has with the current NHI scheme, such as that it does not address the real problem of inadequate and low-quality healthcare provision in the public sector.

Mrs Rossouw also claims that NHI does not adequately attend to accountability and management structures. “While the Green Paper calls for an Office of Standards Compliance – which we support in principle – its members will be appointed by, and answer to, the National Health Minister. It will not be independent, making it vulnerable to political influence and manipulation.”

It is of the WCG’s belief that the country as a whole lacks the human resources to implement NHI, which demands that they triple the 27,000 doctors that South Africa currently has. Currently only enough doctors are trained each year to keep pace with the numbers who retire, enter private practice or emigrate, as a result the state will be unable to train the necessary number of doctors, amongst other key health professionals, to implement NHI within the envisaged time frame.

The WCG is against the creation of a centralised fund because they believe it will over-bureaucratise the public healthcare system rendering it more inefficient and costly than it already is. Mrs Rossouw explained that the size and scope of a provincial health department will be reduced to that of a de facto branch office of the national department, which in essence means the nationalisation of provincial health services.  “Whilst this is in our view unconstitutional, it will reduce the effectiveness of a health service such as that currently delivered by the WCG and be counter-productive to the objective of a quality health service to all.”

South Africa spends R2 766 on public healthcare per person each year – more than other developing countries and yet, Mrs Rossouw claims, “as a country we have poor health outcomes and inexcusable wastage due to fraud, incompetence and mismanagement in many provinces.”

The WCG believes NHI in its current format will inevitably destroy the important and significant private health care and health insurance industries in South Africa and reduce and subject every citizen to a less than average health service. Mrs Rossouw stated that “in the drive to improve healthcare for all it is my view that this step will reduce the overall standard of health care in South Africa and discourage foreign investment in the country that we so desperately need.”

Mrs Rossouw concluded by saying, “at the end of the day, the ultimate model is a well-functioning system with equal access for all and a qualitative service. Presently we are trying to identify the gaps in our systems. We need to then address those gaps in the context of the funding envelope received.”

eHealthNews will continue to follow and report on the developments of NHI in South Africa.

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