Civil Society organisations, Section27 and VillageReach, agree that the National Health Insurance (NHI) Bill has the potential to drive universal health coverage (UHC) in South Africa (SA).
Weighing in on the road to achieving this and reflecting on how this year’s world health day theme “Health for All” relates to SA, the shadow of gaps in the access to healthcare services follows. World Health Day is observed on the 7th of April every year and marks the anniversary of the founding World Health Organisation (WHO).
The WHO describes UHC as an idea that is about ensuring people have access to the healthcare they need when they need it, and without suffering financial hardship.
Introduced in 2012, the NHI is a health financing system that is designed to provide affordable quality personal health services for all South Africans, irrespective of their socio-economic status. It is interpreted as a fitting solution to provide access to health services for people as it breaks the barrier of the financial burden to access.
Claudia Shilumani, Vice President for Partnerships and Impact, from VillageReach, says SA should be focusing on ensuring that rural and under-resourced communities can access healthcare services.
Using the NHI effectively
Shilumani says integrating a community-focused model of care that includes insights from communities in terms of how they want healthcare services to be delivered to them.
“Reengineering primary healthcare and professionalising community healthcare workers (CHW) is one of the things that we need to be looking at – how they get trained and how we equip and accredit them to provide more services.”
She adds the trust established by CHWs in the communities they work in makes them effective tools in identifying disease outbreaks, healthcare needs and gaps in their environments.
Sustained financial commitments by the government to healthcare is an important solution. Shilumani says that in order for healthcare services to be scaled and for new innovations and technology in the medical field to be introduced,
“The NHI can be effectively designed to bring together the public and private sectors. Looking at how the private sector operates is of value, as adopting leadership styles by the CEO, seeing how they manage employees or a shortage thereof. Effectively building private-public partnerships to sustain the public sector.”
Balancing international obligations
South Africa has the obligation to provide access to healthcare for citizens and for non-citizens living in the country.
Domestically, this obligation starts with The Constitution of SA. Section 27 provides entrenches the right to access healthcare services, including the right to reproductive healthcare. And then other sections such as section 28 of the Constitution directly deal with the right to healthcare for children and provides no limitations for that basic health right.
Khanyisa Mapipa, Health Rights Attorney and Activist, from Section27, explained that the main legislation is the National Health Act 61 of 2003 which provides for a variety of rights and responsibilities on behalf of the government.
Internationally, under the International Covenant on Social and Economic Rights officiated by SA in 2015, the country is obliged to ensure that everyone living in its borders enjoys social and economic rights, including the right to health and education. We are also obligated under
The Convention on the Elimination of All Forms of Discrimination Against Women to eliminate discrimination against women and girls in all areas and promote women’s and girls’ equal rights – including the right to health. There are also various other health rights-related obligations, as well as other policies and related instruments that have been incorporated domestically. Mapipa refers to the Joint United Nations Programme on HIV AIDS that was launched in 2014 as an example.
“The established 95-95-95 testing and treatment targets to achieve among children living with HIV are shared by many different countries and is a goal that we also hope to achieve here. We see that many of these have been incorporated domestically into our legislation. Adhering to these domestic and international obligations to provide access to healthcare for all is paramount,” she says.
Concerns about NHI effectiveness
Section27 expressed concerns about how equitable the NHI is and questions whether it can fulfil the country’s domestic and international obligations to healthcare.
The organisation believes that the governance structure in the NHI is flawed because it gives the Minister of Health too much power. The minister would be responsible for appointing the CEO of the fund where the money for NHI would come from and appointing the board members.
“It’s concerning to us that one political figure would have that kind of power and would have that kind of reach into this and knowing that it’s unchecked is problematic.”
The second concern relates to the transparency regarding reporting mechanisms in relation to these governance structures and the ability of civil societies to inform the process.
“We also feel that the bill is a regression in the way that migrants are being treated now. It excludes migrants as it stands, from accessing HIV, and TB healthcare, which is a catastrophe.”
Exclusion risks the whole population
TB burden in the country is high and it thrives in low economic settlements where people experience overcrowding and a lack of resources, communities like these are homes to migrant people. By excluding migrants from getting access to healthcare, the bill essentially places the population it aims to protect at risk.
Mapipa added that it also excludes the right to access maternal health and the health of lactating women. The National Health Act currently covers all pregnant and lactating women and children irrespective of their nationality and document status, “The bill also removes that so it doesn’t cover migrant women who are pregnant or lactating and so it’s in that sense a step back for us.,” she says.
She concludes that the NHI will only achieve UHC if it is equitable and in line with our international obligations, and constitutional obligations.
“And right now, we don’t feel that the bill does that,” she says. – Health-e News
Source:
health-e.org.za
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