South African Medical Association says public health system not ready for NHI

The South African health system is not ready for National Health Insurance (NHI), the South African Medical Association told health minister Dr. Joe Phaahla in Limpopo this week, saying it is just a funding model and does not address various challenges such as a shortage of staff in the public health system.

“We support the objectives of NHI, but the system is not ready for implementation. There is a human resources shortage and as a funding model NHI does not have sufficient funding for staff,” Dr. Mvuyisi Mzukwa, chairperson of the South African Medical Association (SAMA), says.

Professor Malegapuru Makgoba, former health ombud, also said at the meeting that the department of health does not have competent leaders and managers to lead NHI. Mzukwa says this is important because besides money, NHI also needs good governance.

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Is NHI just a big medical aid?

“If NHI does not address these issues, it will just be a big medical aid. NHI will not build infrastructure and address staff shortages, shortages of information technology and the many other issues in health.”

He says government must first capacitate the health department before it can get the funds for the NHI. “Only then can government render the private sector optional, but the system is not ready.”

SAMA is also perturbed that the department of health did not consider its submissions on the NHI, despite the association being part of the NHI journey from the time it was described in a green paper. “We really thought government would call on us, but it did not.”

In addition, SAMA has endeavoured to stay out of politics and Mzukwa says that is why it has refused to join political parties when they marched against NHI.

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What about the unemployed doctors?

SAMA also raised the issue of unemployed young doctors with the minister. “We told the minister we are not pleased that our own South African children, our own trainees, cannot be absorbed in the public health system although we have a dire shortage of doctors, but instead push them into the private sector or to leave the country.”

Mzukwa says government should prioritise employing doctors who completed their community service last year.

“Then government says that young doctors are crazy to leave the country and go work in other countries that also have NHI. But in those countries working conditions are so much better and there are no security issues.”

What about the minister’s promise that all these unemployed doctors will be employed by 1 April? Mzukwa says Phaahla told them at the meeting that he will meet with the provincial health departments in April to find out where they are in absorbing the unemployed doctors.

He thinks these promises are just electioneering. “And the department lies about doctors not wanting to work in rural areas. Some of them come from the rural areas. Why would they not want to work there?”

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Committed overtime and doctors’ salaries

Another issue that SAMA raised with the minister is about committed overtime and salaries for doctors employed in the public health system.

“It is a problem for us that the provinces want to manage it themselves. If you remove committed overtime, it will be a problem because it will affect doctors’ salaries that have already not increased in real time according to a study done last year. Committed overtime cannot be removed if basic salaries are not adjusted.”