Part 1: The NHI, A dream in theory, a nightmare in practice.

In a response to the opinion piece published in the Daily Maverick by Narnia Bohler-Muller and Moremi Nkosi, titled “The NHI Bill is the best way to attain universal health coverage and health equity”, I would like to share my views and comment on the NHI in practice. Although the authors make a good argument when looking at the constitution and the very real inequities within access to healthcare, they fail to acknowledge the practicality of the NHI and how it will be achieved from an implementation level.

There is no doubt that South Africa’s healthcare system is one that is plagued by inequalities and barriers to access. The NHI, if implemented and operated successfully, has the opportunity to create a system that provides for all South Africans. It can create a healthcare system that will take care of the most vulnerable and work towards closing previous inequities, which have far long been apparent in the healthcare system. This, however is a dream. In practice, this Bill will most definitely create a more equal healthcare system, but it will be one that will see poor access to quality healthcare for all, no matter your income level, race, or geographical location. We will all collectively suffer when it comes to healthcare access and below I list the reasons why.

1.????Poor consultation, planning and preparation

It is no secret that public participation within the NHI is a mere box ticking exercise. It holds no power and no matter public inputs, government will continue to push for the Bill. Why? Because it scores the ANC quick political points to the detriment of the populations health, excluding real public concerns on the Bills viability. In public hearings conducted in the beginning of the month, a few major concerns came to light. Firstly, the DoH instructed UCT to conduct a pilot study on the?NHI. A pilot study is ultimately an experiment. It is a small scale preliminary study conducted to evaluate the feasibility, duration, and cost of a project with the aim of improving the design prior to implementation of a full scale project.

In the NHI public hearings conducted on 2 June, the DA posed a question to UCT, asking the institution to provide details on the pilot study and comment on how its results would guide the implementation of the NHI. UCT explained that the pilot study was a ‘misnomer’ as it in fact was ‘not piloting the NHI’. The researchers could not therefore use the pilot study to directly comment on the expected successes or failures of the NHI. The reason for this is that study does not fully encompass the various features of the NHI, which puts into question the relevance of the pilot study to begin with. The various structures within the NHI have not been tested with regards to cost or feasibility – the feature of establishing a fund for example, was not a part of the study. Government will ultimately be blindly implementing a policy, in order to further their ideological agenda.

The risk of this is disastrous. The DA posed a follow-up question asking how the government would ensure the NHI will be successfully implemented without the proper piloted research to support its implementation. Before UCT could answer, the Chairperson of the committee interrupted, excusing UCT from answering the question on the basis that, ‘they (UCT) were not the creator’ of the study. ‘Answers, he continued, ‘must come from elsewhere.’ How the NHI can be successfully implemented without the appropriate research and feasibility planning is baffling. It is one of many questions which have remained, unsurprisingly, unanswered by government.

2.????Negligence and malpractice due to poor monitoring and evaluation

Although Bohler-Muller and Nkosi make a good argument regarding the clear disparities of health access between the public and private sector, they fail to mention the challenges and operational issues of the public sector, which include corruption, negligence, lack of skills, poor monitoring, poor evaluation, fraud, poor and unmaintained infrastructure and lack of medical professionals, to name a few. Yes, Bohler-Muller and Nkosi are correct in saying that access to healthcare is a basic human right. What they fail to mention however, is governments poor track record and its sheer inability to implement so many of its honourable ventures. A failed public healthcare system mired in corruption, as the Covid pandemic clearly highlighted, brings into question the NHI’s viability on a practical level.?

Currently, medical negligence claims against the state have more than tripled over the last four years. The DoH’s legal bills for medical negligence and malpractice is sitting at a whopping R105 billion. Horrific accounts of such medical negligence are easy to find. An infant hospitalised with stomach cramps, for example, shockingly left with an amputated hand. These mistakes are not only devastating to the patients themselves but incur massive legal bills and are a direct result of poor monitoring, quality control and evaluation of health facilities.

In a Portfolio Committee meeting earlier this year we received a presentation from the Office of Health Standards and Compliance. Its mandate is to reduce “avoidable mortality, morbidity and harm within health establishments through reliable and safe health services”. Essentially the entity is responsible for ensuring healthcare safety and quality standards. An entity with such a crucial responsibility only inspected 10 per cent of health establishments in 2020. Their 2021 annual objective is to inspect 8 per cent of health establishments. How will we ensure quality healthcare for all, when we cannot even ensure over 50 per cent compliance with our health facilities?

3.????Corruption

The Covid pandemic has exposed a corrupt and inefficient healthcare sector with leaders exploiting the health pandemic for personal gain. SIU covid corruption investigations are currently sitting at R14.2 billion. Recent corruption allegations against health Minister Dr. Zweli Mhkize,?concerning the R150 million Digital Vibes scandal, certainly suggests that the fish rots from the head. South Africa is a country where political leaders implicated in corruption are not held accountable, where money is looted at the expense of the poor and where leaders make decisions based on ideology rather than public interest.

Conclusion

The questions remains, if government cannot control the mass looting of state coffers, if they cannot control employees being hired on the basis of connections rather than skill, if they cannot control the awarding of dodgy tenders, if they cannot monitor the quality control of public health institutions, if they cannot lower the legal costs due to medical negligence, how will they adequately implement the NHI? Rather than improving the current public health system, which does indeed have the potential to provide universal healthcare, government would rather destroy the private sector, along with medical aid schemes and pool it into a system that is bound to fail.

The NHI, when implemented, means that the healthcare system will be nationalised and fully controlled by government. A government that cannot even get the basics right, which will remove your choice of healthcare and place it in a singular system that has not been properly planned or budgeted for. Negligence bills are in the billions, yet government cannot even monitor half of its health establishments. For these reasons, NHI will most definitely provide equal access to poor quality healthcare for all.