Elections 2024: What political parties are prescribing to fix SA’s sick health system

With the recent signing of the National Health Insurance (NHI) Bill into law, the issue of health has again shot into politicians’ pre-election speeches.

President Cyril Ramaphosa signed the controversial Act on Wednesday to much applause and criticism.

The Act aims to provide free universal healthcare to all South Africans. It has been slammed by some who claim it will collapse private medical care and worsen healthcare services.

It comes amid reports of dilapidation, neglect, and days-long waits at state hospitals and clinics.

ALSO READ: Health minister says NHI will be implemented over next four years

As analysts predict the health system sits on the verge of collapse, political parties have promised several reforms.

This is what the three biggest parties in the country say they will implement if elected, or re-elected:

ANC: NHI, AI and one medical record

Among the ruling party’s key priorities is to “ensure healthcare for all”.

It said this would be achieved by implementing the NHI within five years.

“Over the next five years, the ANC will strengthen youth health services, including access to sanitary
towels for girls and young women, including making them available in schools, universities and other public spaces,” its manifesto added.

It will also create a single electronic health record so healthcare workers can get information about patients wherever the person goes for help.

The ANC said it will collaborate with other countries on the research and development of traditional medicine, and use new technologies like telemedicine and artificial intelligence in healthcare.

Watch President Cyril Ramaphosa sign the NHI into law:

DA: Universal medical care and reformed medical schemes

The official opposition Democratic Alliance (DA) said it “will rescue South Africans from a failing public health system” by “ensuring quality healthcare for all, irrespective of economic status”.

It called for universal healthcare but said the NHI was not the way to do it.

“Despite decades of failure, the national government’s proposed solution to deliver quality public healthcare for millions of South Africans is based on the misguided belief that the only way to ensure quality healthcare is by centralising all healthcare system functions through its National Health Insurance (NHI) plan.

“State control opens the door to maladministration and wholesale corruption, which has characterised almost all state-controlled schemes. The populist proposals contained in the NHI risk bankrupting the fiscus and deepening the healthcare system crisis.

“The DA is committed to universal access to healthcare for all citizens. The key to achieving this over the next five years is to make the current district management model work through governance reform. We argue that by leveraging the strengths of the private sector in partnership with the public sector, we can improve health facilities and the quality of care for all,” its manifesto reads.

It aims to introduce social reinsurance for medical schemes.

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“The solution to pooling problems in private health insurance markets is to establish schemes that can transfer the risks that individual insurers find difficult to cover. Instead of relying on private companies for this (reinsurance), a publicly run programme will be established. All primary insurers (medical schemes) would need to be a part of this programme.

“This method ensures that we maintain the regular insurance market but still achieve the goal of bringing together risks into one larger insurance fund. This will function as a public secondary insurer. Social reinsurance works by reimbursing actual expenses for expensive medical claims after they occur.

It also aims to introduce a risk-equalisation strategy for medical schemes.

“Risk equalisation plans involve transferring funds between different health insurance plans to adjust for the expected costs of medical care. This is done in advance and is based on the average costs for a set of essential services for a population. The goal is to treat all insurance plans as if they are part of one large fund.

“This helps prevent individual plans from favouring healthier individuals over those with higher health risks. Instead, it encourages insurers to focus on managing costs and providing quality coverage to compete with other plans.

“This means that high-risk customers will have more benefits at a reduced cost, and medical schemes will still be profitable.”

It also plans to create post-retirement protection for pensioners to get life-long coverage and an income cross-subsidy based on a person’s income.

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It aims to create investigation units and watchdogs to eradicate corruption in the healthcare system, while also “developing a national health workers plan to identify skill shortages and to ensure that we have sufficient doctors, nurses and administrators in the system”.

It also wants to create a national prescription registry to give patients access to their prescription
medications nationwide.

EFF: 24-hour clinics, cannabis and traditional medicine

Health is also a majority priority for the Economic Freedom Fighters (EFF).

Among its plans is for all clinics in South Africa be open 24 hours a day, and healthcare facilities in all schools and varsity residences.

It has a 70-point plan on health in its manifesto, based on three pillars.

“The EFF government’s approach to healthcare will be based on the pillars of prevention, promotion and education on healthcare,” it said.

Among the key promises are vaccinations for all citizens, more and better ambulance services, international collaboration on healthcare, and exploring the usage of cannabis for pharmaceutical and
medical purposes.

“The EFF will also pursue the integration of African medicine in primary healthcare that will include the rich bio flora which can be explored for research and product development,” it added.

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To accompany this aim, the EFF plans to create a fund to support traditional health practitioners and build consulting rooms for traditional and indigenous health workers, including traditional healers and herbalists, in all district hospitals.

It said it will work with the SABC to produce health education programmes and create a health profile database for all citizens.

Post-sexual trauma units will be in all hospitals and run 24 hours a day.

“The EFF government will upgrade hospitals such that each district in South Africa has a specialist hospital with a minimum of 450 beds, open 24 hours a day, with internal medicine, paediatrics, obstetrics, gynaecology and general surgeons, trauma teams, mental health and drug detox and rehabilitation centres, LGBTIQA specific healthcare, and palliative health services.

“The EFF government will build specialised hospitals for the following disease categories: paediatric hospital, dental hospital, and multi-drug resistant tuberculosis (MDR TB) and tuberculosis (TB) hospital. It will also establish specialised units for the following conditions: diabetes, mellitus, cerebrovascular diseases, heart disease, hypertensive diseases, chronic lower respiratory diseases, oncology, rare diseases, sexual and reproductive health, and chronic renal failure.”

It added it would increase the amount of doctors and nurses, and fight racism and discrimination in the system.