adminA government paper proposing universal health coverage is due for release. 84% of South Africans do not have health insurance. Pilot schemes in 10 districts across the country are testing the viability of government proposals. WHAT do you do when over half of health sector spending is available to less than a fifth of the population? When only 16% have private health insurance and the 84% who do not are forced to turn to a public sector overstretched and understaffed?
The problems are manifold, the solutions never easy, but South Africa is on the brink of overhauling its health care system – and it’s a plan 70 years in the making.
Universal health coverage in on the horizon, and would bring free at the point of delivery health care to a country blighted by the unequal provision of services.
Dismissed by certain parties as a pipe dream and looked upon with suspicion by others, the plan has been fraught with difficulties.
But with the imminent release of a government white paper outlining a new National Health Insurance (NHI) scheme, there is new hope for millions that they will now be able to access far greater primary health care.
Learning from Obamacare
Health care is a $29 billion dollar industry in South Africa, accounting for 8.5% of the country’s GDP – a figure expected to rise. But for many medical professionals and politicians within the country, the disparity between the services available is problematic.
“The distribution of money between the private and public sectors is very similar to the U.S.,” says Professor Diane McIntyre, founding director of the Health Economics Unit at the University of Cape Town. “Utterly unaffordable” is the way she describes the private sectors of both countries.
In South Africa, private medical schemes offer first class facilities and quality of care, whilst public hospitals, though offering free child and antenatal care, are understaffed and underfunded. More than half of general practitioners engage in private work, says McIntyre. For specialists, the figure is closer to 70%.
Like the U.S., “it’s very much two systems running in parallel,” says Daygan Eagar, program manager at the Rural Health Advocacy Project. He warns that “we don’t want to go where the U.S. is going.”
Policies such as President Obama’s Affordable Care Act “don’t undo the ‘for profit’ elements that make health care so expensive and access so difficult for people.”
Instead, South Africa is going down a different route — one entirely of its own making.
False starts and missed opportunities
Universal health coverage has long been an aspiration for South Africa.
Dreamt up by politicians in the 1940s, scuppered by apartheid and failing to fly in the Mandela years, it has a long narrative of false starts and squandered chances.
In 1945 the Gluckman Report proposed a version of a nationalized health service, one that Eagar argues “informed” the creation of Britain’s NHS in 1948.
However the rise of the National Party – and with it apartheid – precluded its full implementation, and progressive initiatives were almost immediately rolled back, with health care services segregated along racial lines.
When Nelson Mandela became president in 1994 “we missed an opportunity,” says Eagar. Health was at the forefront of ANC policies in the lead up to the election, but despite strong social cohesion and the desire for progressive policies, universal health care failed to materialize.
Then in 2011 the emergence of a government green paper sparked the debate back in to life.
Online Reporter