If this is the future of NHI, it looks desperately ill

As the public hearings into the National Health Insurance (NHI) Bill draws closer, the “shambolic” state of access to primary healthcare in the Gert Sibande district in Mpumalanga – one of the 11 NHI scheme pilot sites – could be a hint of things to come.

The pilot phase, conducted between 2012 and 2017 at more than R4 billion, has received a thumbs-down in the district, with patients, residents and community leaders lamenting that the pilot failed to improve access to primary healthcare, which is supposed to be the cornerstone of NHI.

The scheme, which seeks quality universal healthcare for all and to establish a National Health Insurance Fund, places emphasis on preventative and primary healthcare so that most health problems could be diagnosed and treated at this level.

But patients and residents in the district told The Citizen how they dreaded seeking primary healthcare at eMbalenhle’s Extension Four Clinic and Sead Clinic in Bethal.

Patients in both clinics detailed how they continued to be subjected to chronic shortage of medication, rude nursing staff, long waiting hours, as well as a shambolic filing system – despite their clinics being the testing ground for the NHI.

Wendy Masango, of Extension 5 in Bethal, said they have had to fight to be attended to at the local Sead Clinic, where she said nurses all chit-chatted while patients who have arrived as early as 5am sit waiting.

Masango said when they demanded to be attended to, they are ridiculed, demeaned and then ignored.

Masango said in August she had to hire a private vehicle to rush her 17-year-old nephew, a TB patient, to Bethal Hospital in town after the nurses at the clinic allegedly flatly refused to attend to him.

“My nephew is on TB treatment and on that Sunday he became really sick and went to the clinic. The nurses refused to help him because they had knocked off. They have zero empathy. Can you then say it is a clinic? When we complain we are told to go ask the EFF to attend to us,” she said.

A patient, who only identified herself as Sphiwe, said of all healthcare services at the clinic, the shambolic filing system riled her most, because on two occasions she has had to dig up her file herself in the chaotic filing room.

She said the admin staff in the filing room would not even bother to tell them they had misplaced their files.

“On the first occasion, I waited for my file but realised it was not coming. I went to the filing room and found the file myself. Today I was told my file was not there but I found it again,” Sphiwe said.

eMbalenhle resident Bawinile Khoza said she has given up on ever receiving medical assistance for her toothache and has had no other choice but live with excruciating pain after she was turned away twice from the local Extension Four Clinic.

“They take only 15 dental patients a day and I have not been among those lucky ones, despite arriving as early as 4am to increase my chances. I am in pain but it is pointless to go that clinic. I risked being attacked, walking the streets at 3am, only to be told to come tomorrow,” Khoza said.

Thabiso Mofokeng, local EFF leader in the Gert Sibande district, said the state of primary healthcare in the district has not improved one bit and this put the implementation of NHI in jeopardy as primary healthcare was its foundation.

“I receive calls from panicky patients across the district complaining of poor service, shortage of medication and long waiting hours,” he said.

As he was speaking to The Citizen, he received a call from a patient in Bethal telling him there were no shots for contraceptive injection at the local clinic. Patients were referred to private pharmacies because the clinic had been out of stock for months.

Dumisa Malamule, Mpumalanga provincial department of health spokesperson, had not responded to questions at the time of going to press. – siphom@citizen.co.za

How the NHI will work

The National Health Insurance (NHI) Bill was tabled in parliament on August 8, with public hearings scheduled in Mpumalanga from October 25-28 before moving to the Northern Cape between November 1-4.

The Bill, which has been received with both scepticism and optimism, seeks to centralise health services by pooling funds from the national health budget with private healthcare expenditure and various tax revenue streams, including a higher personal income tax.

This would see an additional R162 billion from private healthcare funds added to the R222.6 billion state health budget.

Experts said SA spent 8.1% of its GDP on healthcare but about half of these resources went to the private sector and insurance schemes, which catered for only 16% of the SA population.

A total of 76% of SA’s white population belong to one of these schemes, compared to 10% of the black population, with the remaining 84% depended on the resources of the public sector.

World Health Organisation (WHO) former director-general Gro Brundtland said if implemented in a fiscally responsible, transparent and accountable way, the NHI would turn SA’s crumbling public health system around.

The introduction of the scheme is SA’s response to the WHO’s resolution for access to quality healthcare for everyone by 2030.

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