No confidence in NHI

Health Minister Dr Aaron Motsoaledi may be punting that "primary healthcare will be the foundation and heartbeat of the country's health system," but without getting SA's medical professionals on board he's missing one of the most important cogs in the wheel.

Medical Chronicle, 16 November 2015

As the promised White Paper remains elusive, it appears most medical practitioners are still doubtful over the implementation of the proposed National Health Insurance (NHI) scheme.

According to a survey conducted by PPS among almost 400 medical professionals, only 19% of the respondents indicated that they had started taking the necessary steps to ensure ease of integration into the new NHI model once implemented.

Certificate of need
The proposed Certificate of Need (CoN) is at the top of the list of respondents concerns. Macy Seperepere, Manager: Professional Associations at PPS said that 87% of respondents agreed that the implementation of the CoN would impact negatively on the medical profession.

Commenting on the survey results, Dr Mark Sonderup, Vice-Chairman of the South African Medical Association (SAMA), said that the CoN in its original form disregards medical professionals' right to choose their place of work. "The CoN will essentially strip medical professionals of rights that are freely enjoyed by the rest of the nation, as they will be directed to work in an area as instructed by the legislation and policy."

A KwaZulu-Natal paediatrician, currently employed at a public hospital, expressed her concerns over the fact that the CoN essentially takes away a doctor's autonomy. "Having studied and specialised for over 10 years I really should have the freedom to choose where I want to work.

As a wife and mother, two of the biggest problems that come into play when you're forced to work somewhere in particular, is the challenge your spouse can face in finding a job, and of finding the kind of school you want your children to attend. This is a particular issue when you're sent to a rural area."

NHI white paper ready for government
In September Dr Motsoaledi announced the White Paper was ready to be presented to Cabinet. Addressing the Hospital Association of South Africa he spoke about how the South African health system will be overhauled and what health reforms will be implemented over the next few years.

Slow progress
Metropolitan Health CEO Dylan Garnett believes it's time to find a faster track to deliver universal health coverage.

The government first published a broad outline of its plans in a green paper in August 2011, but has failed to publish a more detailed policy despite repeated announcements of it being imminent.

Difficulties in contracting private doctors due to poor working conditions have been raised as the main cause of slow spending within the NHI rollout. "Attracting general practitioners to work for clinics, especially in rural areas, proved challenging," said Dr Motsoaledi.

A doctor recruited in Mpumalanga has commented that she quit public healthcare after a few months as she could not work efficiently in a place that had broken equipment and medicine shortages.

Key to the success of the NHI, resources and management are both currently lacking in SA. We are not producing enough doctors and nurses to meet our needs and those we do produce are in demand given the global shortage of medical staff.

So, despite some progress it seems the public may have a long wait ahead of them before the NHI is rolled out nationally.

The private sector
Responding to concerns of the private sector, Dr Motsoaledi has been quoted as saying the White Paper envisages a future role for the private sector, as services would be purchased from both public- and private-sector providers.

"The NHI is not about abolishing private healthcare, but about making quality healthcare more affordable. People don't trust the concept of NHI because it is still new, but it is not about doing away with the private sector."

Confidence in the future
When asked how confident medical professionals are in the future of their profession in the PPS survey, the confidence levels dropped two percentage points from the first quarter to 69% in the second quarter.

"The respondents' confidence in the future of the healthcare system over the next five years remained unchanged at 44%," said Seperepere.

While the majority of the results from the survey reveal a negative sentiment in the medical profession this quarter, Seperepere says that respondents' confidence about remaining in the country for the foreseeable future remained unchanged at 74%.

"It is somewhat concerning that the majority of South African medical professionals who took part in the survey are still not supportive of the NHI-model, seeing that the Minister of Health is confident that the release of the NHI white paper is imminent."

With speculative and sketchy details at best, Dr Sonderup is adamant that medical professionals will remain sceptical of the NHI-model as long as the NHI White Paper is held back.