South Africa’s Health Minister Aaron Motsoaledi has finally gazetted
the bill detailing an ambitious plan to roll out universal health care
in the country through a National Health Insurance. The bill responds
to a global campaign spearheaded by the World Health Organisation and
linked to the UN’s sustainable development goals to make sure that
no-one is left behind in accessing quality health care. There’s no
dispute that South Africa’s health care system needs major reforms.
There are considerable inequities in health care between urban and
rural areas; between public and private health sectors and between
primary health care and hospital care. And the country has a complex
disease burden with heavy caseloads of HIV, TB and non-communicable
diseases. South Africa has poor health outcomes compared to other
middle-income countries such as Brazil with similar health spending as
a percentage of GDP. It spends more than R300 billion – or around 8.5%
of its gross domestic product – on health care. But half is spent in
the private sector catering for people who are well off while the
remaining 84% of the population, which carries a far greater burden of
disease, depends on the under-resourced public sector. The health
system performs poorly due to a combination of factors including the
poor management of public sector hospitals, health professional
shortages (particularly in rural areas), low productivity levels among
staff, escalating private health care costs and poor quality of care.
But in its current form the proposed legislation won’t be a silver
bullet. There are still too many inconsistencies and unanswered
questions for it to be the final roadmap to universal health care in
the country. For example, the bill focuses on curative services,
missing an opportunity to take a public health approach that focuses
on disease prevention, health promotion and health protection. In
addition, it doesn’t address the relationship between the public and
private health sectors which is seen as a major impediment to
fundamental change.

No Comments

Leave a Comment