NHI ‘not the solution for access to meaningful healthcare services’

More and more healthcare workers are planning to leave South Africa ahead of the introduction of National Health Insurance (NHI), leaving the country with fewer skilled professionals.

Following warnings from the SA Medical Association (Sama), it seems more doctors and healthcare workers in general are also considering employment in foreign countries as the National Health Service (NHS) in England increases vacancies.

NHI: Doctors planning to emigrate

Sama’s vice-chair Dr Rhulani Ngwenya said while 38% of its members planned to emigrate, and six percent planning to emigrate for other reasons, there were a number of issues continuously convincing the 17% who were unsure whether to jump ship or not.

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“Most people’s feelings regarding the direction of the country, not just as per healthcare, but there are other socioeconomic factors, or rather social determinants, that are driving them away,” he said.

“When one is a healthcare worker like myself, I’m married, I have kids, so you look beyond just a job and you think that life will be lucrative and better for the rest of the family if you emigrate.

“But it’s not only remuneration issues, especially in the public sector, if you look at the availability of infrastructure there tends to be quite a significant frustration.”

Ngwenya said despite the promises the NHI was making, “looking at the current state of public healthcare, nothing about it is promising”.

“The reality is while the NHI seeks to provide more healthcare to a broader group of individuals by reaching out to them, there’s a greater portion for taxpayers to pay,” he said.

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“How is it different from what the current system is? It’s no different; we’re currently paying taxes for service delivery and there’s nothing different because that’s how the public sector is funding.”

‘Not the solution’

The Public Servants Association, which represents more than 235 000 public-sector employees, said it believes that “a single healthcare system, such as the NHI, is not the solution for access to meaningful healthcare services”, according to the association’s Reuben Maleka.

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“Over years, the country has witnessed a decline in the quality of public services owing to various reasons, including human capital flight, poor infrastructure maintenance, a lack of accountability, corruption.

“The question is if the NHI would yield better benefits for public servants and how it would impact on their disposable income, as many of them are already subscribers to a variety of medical aid schemes.

“The notion workers could be expected to pay for private medical insurance and the NHI simultaneously, induces anxiety among public sector employees.”

Maleka said the priority of health reform in SA must be the rehabilitation of the public health sector.

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“This can best be achieved by a competent, nonpartisan public health service, free of corruption and political interference,” he added.

“South Africa’s two-tier healthcare system is not the cause of problems in the sector.”

Current health system not very efficient

However, the senior researcher at the Southern Centre for Inequality Studies at Wits University, Thokozile Madonko, said the current two-tier health system was not very efficient, either.

“We have one very expensive private health system and then one underfunded, overburdened public health system, so the idea with the NHI is to try and bring that into one consolidated health picture where we can get to a more efficient use of health resources across the board, so that everybody benefits from access to healthcare,” she said.

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Madonko said if implemented to the “T” with practicality, the NHI would be one of the best reforms SA would ever have.