JOHANNESBURG, 12th DECEMBER 2017– Today the world celebrates Universal Health Coverage Day, but what exactly do people in South African have to celebrate as the public healthcare system is still crumbling, 23 years post democracy? The Treatment Action Campaign (TAC) was born out of the struggle for Universal Health Coverage (UHC). One of our first major victories saw the government forced to provide treatment to prevent transmission of HIV from mothers to their babies during birth. This struggle was waged in the courts, on the streets through protest, marches, pickets and civil disobedience, as we demanded the rights promised to us on paper: health care that embodies quality, equity and financial protection—the three pillars of UHC.
Despite numerous legislations and the Constitution that are meant to guarantee the progressive realization of improved access to quality health care services, TAC remains guarded. Five years into the phased implementation of National Health Insurance (NHI), there is broad scepticism about whether the government can pull this off. Will this ambitious plan that requires financing with billions of rands and restructures our entire health system ensure that we will finally get what we were promised, access to safe and high quality health care services?
The scourge of the quadruple burden of disease (HIV/TB; non-communicable diseases; maternal child health; and, inter-personal violence), the Life Esidimeni tragedy and other examples of serious neglect and crumbling infrastructure do not generate optimism. Notwithstanding many more people starting HIV treatment, new issues like chronic medication adherence and drug resistance are emerging. Similarly, as uncovered by TAC members through our clinic monitoring, problems with shortages of staff, and prolonged waiting times for patients remain serious barriers to accessing basic health services.
Concerned about fidelity to the original underpinnings of NHI, as laid out in the government’s Green Paper (2011), White Paper (2015) and second White Paper (2017), TAC, SECTION27, the Rural Health Advocacy Project (RHAP), the Stop Stockouts Project (SSP) and the People’s Health Movement (PHM) recently co-authored a submission to the National Department of Health on the new Terms of Reference (ToR) of the NHI Implementation Structures, gazette in July 2017. Thirteen other civil society organisations endorsed the submission. The ToR establish seven new committees that will be the responsible drivers of the NHI, structures that require vetting. Put plainly, the ToR seems like back-peddling by the government on their commitment to a single payer and social justice approach to UHC. We have identified two areas where the UHC pillars are at risk:
- The discrepancies between the NHI White Paper (2017) and the final Terms of Reference will lead to a non-progressive, privatised NHI
- The lack of civil society and community member involvement in these implementation structures indicates a bias toward the private sector
These and other issues are further developed in the attached submission. We therefore recommend that:
- The ToR of this structure should be broadened to adopt a whole system perspective, not just the perspective of actors who will sell services or provide curative care for which purchasing will be needed – Community Health Workers (CHW’s), nurses and those with public health competencies must feature
- The terms of reference for the National Health Pricing Advisory Committee should be revised to move away from simply a medical scheme focus to an overall health system focus – solving system wide issues that will strengthen a single purchaser
In order for the NHI to work in this country, health must be regarded intersectionally. Health is not simply a bio-medical problem. Gender, class, race, sexuality, geographical place and space, literacy and identity are all layers that affect an individual’s health and must be taken into account when trying to create a healthy society. We fear that the future of the NHI will not encompass a holistic paradigm.
Our coalition brings a message that is stronger with all of our signatures. Our goal in sounding this cautionary note is to have quality universal health care access for all in South Africa so that on Universal Health Coverage Day, there will something to finally celebrate.
For more information and to arrange interviews contact:
Samara Ragaven | firstname.lastname@example.org | 071 645 7579