Universal Health Coverage: The South African Approach
- Polelo Mawela
- Feb 12, 2023
- 3 min read
Of the many services available in the market, healthcare is the most unique. Unlike other services, healthcare is a basic human right. Section 27 of the South African constitution provides that everyone has a right to access to healthcare services, including reproductive health care services and no one may be refused emergency medical treatment (SAHRC). As part of realising this right for all South Africans, the government drafted the National Health Insurance (NHI) which is meant to be implemented in phases. The NHI is the South African answer to achieving universal health coverage.
Universal health coverage allows for the provision of healthcare to everyone independent of their socio-economic status (WHO). The current landscape of healthcare in South Africa is such that people with a higher socio-economic status have access to quality health care services through the private healthcare sector and their poorer counterparts make use of the an overburdened and under-resourced public health sector. The public health sector is state-funded and caters to the majority – 71% – of the population. The private sector is largely funded through individual contributions to medical aid schemes or health insurance, and serves around 29% of the population.
The public sector is underfunded while most South Africans can’t afford the exorbitant cost of private care (Rensburg, 2021). In this manner, healthcare in South Africa functions the same as other services in the markets where a person’s financial-standing determines their access which contravenes section 27 of the constitution. Because of this discrepancy in the healthcare system, many South African health care workers agree that reform is necessary in particular of the public healthcare system. With regards to the acceptance of the NHI as it is drafted, some groups of healthcare workers particularly those in the private health care sector have raised concerns with regards to how the NHI will affect their work (The big debate, 2019).
In order to achieve universal healthcare, a pool of funds will be created through private health insurance as well as government contribution. This fund will be used to give poor South Africans access to the same healthcare services that their richer counterparts have. Therefore the public and private healthcare systems will be combined (Mukwena & Manyisa, 2022). As part of ensuring access healthcare, the rates that doctors charge will be regulated by the government. One of the major concerns raised by healthcare professionals in the private sector is that the government is responsible for the public health sector which has been plagued by maladministration, lack of resources and poor governance. By being co-opted into the NHI as proposed by the government, private healthcare professionals are of the understanding that they will also be subject to such inefficiencies therefore proposing that ideal path to achieving universal health coverage will be through improving the quality of public health services (The big debate, 2019).
In order to understand how the NHI can work, Mukwena and Manyisa 2022 assessed the preparation for the launch of the NHI scheme at a Johannesburg hospital. They found that even though progress was made to prepare for the NHI implementation, lack of resources, poor infrastructure, lack of participation in training, poor technological advances and management failures pose a challenge to the achievement of universal health coverage through implementation of the NHI. Although the NHI holds great promise for universal healthcare, certain aspects in the delivery of quality healthcare need to be addressed before it is rolled out nationally so that all stakeholders involved are confident and able to champion it.
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Reference
Mukwena, N. V., & Manyisa, Z. M. (2022). Factors influencing the preparedness for the implementation of the national health insurance scheme at a selected hospital in Gauteng Province, South Africa. BMC Health Services Research, 22(1), 1-13.
Rensburg, R. (2021). Healthcare in South Africa: how inequity is contributing to inefficiency. The Conversation.
The big debate season 10 Episode 10: Health https://www.sahrc.org.za/
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