Question NW342 to the Minister of Health

Reply:

1. The 2017 White Paper on NHI states that NHI will cover comprehensive health care services that are determined by The Benefits Advisory Committee. These services will be delivered through certified and accredited health care providers located closest to the covered population. South Africans will be able to access personal health care services to achieve allocative efficiency, affordability and sustainability using a Primary Health Care (PHC) Approach. Currently there is no package of benefits that is being offered through NHI to intended beneficiaries. The reasons for this are as follows:

a) The package of health care benefits must first be determined by the Benefits Advisory Committee as outlined in Clauses 4(1) and 7(1) of the NHI Bill. The NHI Fund, in consultation with the Minister must purchase health care services, determined by the Benefits Advisory Committee, for the benefit of users. Clause 6 (a) further outlines that intended beneficiaries can receive necessary quality health care services free at the point of care from an accredited health care provider or health establishment upon proof of registration with the Fund. Clause 25(5)(a) of the Bill further outlines that the Benefits Advisory Committee must determine and review the health care service benefits and types of services to be reimbursed at each level of care at primary health care facilities and at district, regional and tertiary hospitals.

b) The intended beneficiaries of NHI are yet to be concluded but as outlined in Clause 4 (4) of the Bill, must be registered as a user of the Fund as provided for in Section 5 of the Bill, and must present proof of such registration to the health care service provider or health establishment in order to secure the health care service benefits to which he or she is entitled. Currently this has not materialised as it is still awaiting the approval of the Bill by Parliament;

Therefore, the package of benefits can only be determined and offered once the Benefits Advisory Committee has been established for intended beneficiaries that have been registered with the NHI Fund.

2. The National Department of Health is undertaking preparatory work with specific reference the development of the NHI Information Platform as outlined in section 40 of the NHI Bill and section 57 (2) (iii) on transitional arrangements. This is also guided by section 74 (1) and (2) of the National Health Act, that stipulates how coordination of the Health Information Systems must be undertaken. Further to the above the integration of existing and future health records of all patients will take into account the provision of the Protection of Personal Information Act number 4 of 2013.

The integration of patient records will require a digital platform that uses a Health Normative Standards Framework for Interoperability supported by a Health Information Exchange. Interventions to achieve this are outlined in Pillar 9 of the Presidential Health Compact and include:

(a) The development of procedures and systems for the identity verification of users of the health system.

(b) Establishment of a patient registry through the implementation of a Master Patient Index.

3. The preamble of the NHI Bill states that the objective of NHI is to ensure continuity and portability of financing and services throughout the Republic.

Section 40 (6) (b) of the NHI Bill states that the information platform and architecture must facilitate the portability and continuity of health care available to users. This will be facilitated by the development and implementation of a shared Electronic Health Record (EHR).

The key components of a shared Electronic Health Record, that also include accurate medicine records, are the Master Patient Index, Interoperability Norms and Standards and the Health Information Exchange as referred to in the response( 2) above.

4. The country will achieve the integration of records by the creation and implementation of a digital platform and architecture for a shared Electronic Health Record.

The Department has published the Digital Health Strategy 2019-2024 which guides intervention towards the integration of Health Records. The focus areas include:

• a complete Electronic Health Record, which will improve patient management
• the digitisation of health systems business processes
• establishing an integrated platform and architecture for the health sector information system, which will ensure interoperability and linkage of existing patient-based information systems
• the development of digital health knowledge workers

END.