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National Health Insurance

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The National Health Insurance (NHI), for which membership will be compulsory, is a funding scheme that aims to address healthcare inequity in South Africa. The scheme will do this by creating a fund that the government will use to buy healthcare services at set fees from accredited public and private health providers. The NHI Bill was passed in the National Assembly in June 2023. It has to go to the National Council of Provinces for approval.

HomeArticlesLonger lives put strain on NHI plans

Longer lives put strain on NHI plans

Successes in the battle against infectious diseases are offset by chronic, noncommunicable illnesses.

Infectious diseases such as HIV and tuberculosis are no longer South Africa’s only major problem. According to health experts, the country now faces a dual epidemic of both infectious and noncommunicable diseases. 

Statistics South Africa’s latest mortality report attributes 40% of deaths in the country to lifestyle diseases such as diabetes, heart disease, lung diseases and cancer. 

The national health director general, Precious Matsoso, said the colliding epidemics were now common in developing countries where people who have one disease are predisposed to more illness. 

“Someone with HIV, for example, has a compromised immune system and is at risk of more infections. They are likely to develop mental health problems and the nature of their medication makes them susceptible to heart disease,” she said.     

Research has shown that lifestyle diseases normally emerge from midlife onwards. Antiretroviral drugs (ARVs) have increased the life expectancy of people with HIV. But these same people have now become more susceptible to noncommunicable diseases. According to the health department, over two million people are on its state-funded HIV treatment programme. 

“Unfortunately, with the  increased life expectancy [South Africans now live six years longer than in 2005, according to Stats SA, mainly due to the impact of ARVs] comes the increased risk of chronic noncommunicable diseases,” said Stephen Tollman of the University of the Witwatersrand’s school of public health.  

Matsoso has warned that the dual epidemic poses a threat to the country’s planned National Health Insurance (NHI) system. 

“Our health services will simply be overrun with people suffering from noncommunicable diseases and our resources will not be able to handle the combinations of both chronic care and HIV,” she said.  

Rural areas hardest hit

Tollman said that the impact of the colliding epidemic is most evident in rural areas where access to health care is limited and the health facilities that are available do not have the resources to provide treatment for people with chronic diseases.   

He said that poor children who have lost their parents and are in the care of grandparents would be hardest hit by South Africa’s high levels of mortality, morbidity and disability. 

“The parental generation has been badly affected by the HIV pandemic so grandparents play a significant role. They are now responsible for the welfare of their families. They are vulnerable to the chronic noninfectious diseases,” he said. 

According to Tollman, addressing factors such as poverty and inequality is important in reducing the high burden of noninfectious diseases in rural and poor areas.

“For example, stroke resulting from hypertension is strongly linked to poverty, mainly due to late diagnosis and poor access to healthcare in rural areas. In addition, poor people have less access to cheap, nutritious foods,” he said. 

However, several studies have shown that noncommunicable diseases are also common among middle-class South Africans. The conditions are strongly linked to lifestyle choices such as how much alcohol they consume or what type of food they eat. 

The South African National Health and Nutrition Examination Survey released last week found that 40% of South African women and 11.6 % of men are obese. 

According to the Heart and Stroke Foundation, 6.3-million people in South Africa have high blood pressure, of which most cases are caused by a high salt diet. The World Health Organisation recommends one teaspoon of salt a day. It estimates that “130 heart attacks and 240 strokes occur daily in South Africa”. 

The National Kidney Foundation has said 60% of kidney failure in South Africa is due to high blood pressure and 20% to 25% due to type 2 diabetes. The International Diabetes Federation estimates that 1.9-million South Africans have the condition.    

Matsoso said the health department is addressing the social norms that contribute to the risk of developing noncommunicable diseases through legislation. 

“We are on the verge of releasing a piece of legislation regulating alcohol advertising. Most recently we have passed regulations about the control of salt content.” 

Matsoso said the health department is also starting to integrate care for people with infectious and lifestyle diseases, which involves regular screening for noninfectious diseases such as hypertension and diabetes for HIV and TB patients or vice versa. She said the “reorganisation of the health system” is part of the preparations for the implementation of NHI.

Ina Skosana was a health reporter at Bhekisisa.