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BUSINESS DAY The South African Medical Association Sama says the National Health Insurance NHI Bill and other parallel reform process do not seem to have the interests of health providers at heart. In its September 2018 submission to the National Department of Health in respect of the NHI Bill, Sama says regrettably NHI is being implemented in an environment riddled with chronic shortcomings in the public health sector. "Evaluation reports of the NHI pilot programme show that many pilot facilities fell short on a range of issues, typifying the severe challenges in the public healthcare system. Challenges identified in the pilot sites include PHC re-engineering still incomplete; district clinical specialist, ward based outreach and school health teams not fully constituted; insufficient staff; lack of capacity; supply chain hurdles; delays in getting information on budget codes; limited delegations; lack of support and inability to spend on infrastructure. "Moreover, some essential aspects of NHI that were not piloted are to be 'experimented with' in the real NHI. The failures of the NHI pilot programmes have been widely reported. Sama questions the rationale of proceeding with implementing NHI when the public health system is in crisis and in the absence of adequate governance and accountable structures, particularly on quality of care received by citizens. "Government interventions to improve the state of public health systems have been insufficient to bring about the required change and, given the lack of progress and the level of the economy, it is impossible for the government to put in place the infrastructure required for an effective NHI within the proposed time frames. Is it the intention that the NH! Fund is to be responsible for infrastructure improvement? For the NHI to be successful, the current state of the public health system cannot remain." Sama says the bill does not define the concept of "quality of care", nor does it clearly spell out how the different dimensions of quality will be measured. Improvement of quality of healthcare should be a key priority in NHI. The World Health Organisation recognises the urgent need to place quality care at the centre of country, regional and global action, and notes "the success and value of universal health coverage depends on its ability to provide quality services to all people". Sama is concerned by the limited quantity and quality of consultation of health professionals on NH!, which the association says is unacceptable and counterproductive. Sama is concerned about lack of medical professionals representation in platforms such as the NHI implementation bodies. Therefore, it calls for a re-opening of NHI consultations with doctors and the wider society, to allow the profession to register its concerns and propound its ideal NHI model. These consultations, which Sama says must be instituted by Parliament, should resemble the ongoing land appropriation hearings, and must be at provincial level provincial NHI workshops or imbizos, Sama says a "Codesa" for NHI should be instituted to allow exhaustive debate. "Such consultations will also enable the government to hear views and concerns at grassroots level (i.e. from patients and the community) , many of whom do not, or have struggled to, understand NH!." Sama says it is unwelcome that much of the NHI detail will be in the regulations; more details are needed on contracting, accreditation and reimbursement; and there is a need to get participation by the private sector expertise on board to improve the management, quality and efficiency of care in government hospitals.
Created at 2018/10/23 03:28 PM by Mediclinic
Last modified at 2018/10/23 03:28 PM by Mediclinic