Question NW2332 to the Minister of Health

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24 June 2022 - NW2332

Profile picture: Van Staden, Mr PA

Van Staden, Mr PA to ask the Minister of Health

(1)Whether he will indicate (a) what the current status of availability is of (i) resources and (ii) the capacity to roll out the proposed National Health Insurance (NHI) and (b) if state hospitals and clinics, with their current challenges of shortages of doctors, nurses, medicine, equipment and infrastructure challenges, can indeed be seen as a favourable environment for the implementation of the NHI; if not, why not, in each case; if so, what are the relevant details in each case; (2) whether he will make a statement on the matter?

Reply:

It is important to recognise that reforms of the magnitude anticipated in the NHI Bill need to be phased in over time. For that reason, the transitional arrangements in section 57 of the Bill state:

57(1) (b) National Health Insurance must be gradually phased in using a progressive and programmatic approach based on financial resource availability.

And subsection (2) elaborates that Phase 1 will:

  1. continue with the implementation of health system strengthening initiatives, including alignment of human resources with that which may be required by users of the Fund;
  2. include the development of National Health Insurance legislation and amendments to other legislation;
  3. include the undertaking of initiatives which are aimed at establishing institutions that must be the foundation for a fully functional Fund; and
  4. include the purchasing of personal health care services for vulnerable groups such as children, women, people with disabilities and the elderly;

The NHI Bill (and the Fund that it seeks to establish) will not replace the National Health Act of 2003 although it will amend several sections as listed in the first Schedule.

1. Bearing the context in mind it must be noted that the current status and availability of resources and capacity are only a starting point.

a) (i) The resources available for the establishment of the reformed health system where providers are paid by the Fund are the current resources of the entire public and private health sectors. This includes all health establishments, personnel and technologies currently in use.

(ii) The capacity to roll out the reforms described in the NHI Bill starts with the commitment and stewardship of Parliament to improving the health system for all. The leadership will be provided by the National Department of Health. To this end the Minister of Public Service and Administration has approved a special transitional NHI Branch in the NDOH to serve as the incubator for the Schedule 3A entity. The five clusters, and the nucleus of 44 new posts to be added to the existing 40 posts, are funded through earmarked funding from National Treasury. The reorganisation of the Branch and the preparations for the advertisement of the new posts have commenced.

The remaining Branches in the National Department of Health are all focussed on providing leadership and direction on the anticipated reforms.

In addition to this is provincial management lead by the nine provincial HoDs for Health plus renewed support from many donor partners.

There are many private sector providers that engage with the department and [provide support to various committees and structures involved in the reform.

b) The state of public hospitals and clinics varies widely from immaculate to extremely poor. The department maintains an infrastructure condition assessment and all provinces submit User Asset Management Plans (UAMPS) annually as required by the Government Immoveable Asset Management Act (GIAMA). There is a quality improvement programme in nineteen locations covering over 100 establishments as we have reported to the house in the recent past. Private establishments also vary in their condition.

The health system suffers from shortages of professional personnel in all categories as we have reported to this house. The biggest challenge is the inequitable distribution of personnel but there are nominal shortages. The public sector budgets allocated for Conditions of Employment are fully committed so there is extremely limited room for recruitment of additional personnel. It is for this reason that the NHI envisages a ‘universal’ system for everyone in the country where the NHI Fund purchases services from both public and private providers.

2. Yes, The Minister is prepared to make a statement.

END.

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