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COVID lessons for South Africa’s National Health Insurance

  • What implementation lessons can we transfer from the country’s COVID vaccine roll-out to universal access to healthcare? We put these questions to our panel of experts for our sixth Bhekisisa webinar. 
  • The National Health Insurance Bill provides the policy mechanisms needed to achieve the rights enshrined in section 27 of South Africa’s constitution: universal access to quality healthcare for all in the country.
  • Partnerships between the public and private healthcare sectors have been at the centre of a successful COVID vaccine roll-out and these partnerships are crucial for the implementation of the NHI Bill.

COVID-19 took centre stage over the past year and half, but work on the country’s NHI Bill, which aims to give everyone in South Africa access to the same quality healthcare, regardless of their income, has continued in the background.

South Africa’s COVID response, particularly its national vaccine roll-out, forced the country to find ways to provide universal access to healthcare to its people — at least as far as COVID health services are concerned.

So are there any COVID lessons that can help South Africa to design a better health system that will give everyone equal access to healthcare?  

We convened a panel of experts to look at this. Our experts included government policymakers working in the engine rooms of the NHI implementation, civil society leaders closely watching the Bill’s developments, business leaders and managers from private healthcare institutions. 

Missed our webinar? Here’s a summary of the key takeaways.

1. What the public thinks of COVID-19 and the NHI: Sibusiso Nkomo

  • Sibusiso Nkomo is Afrobarometer’s head of communications and strategic partnerships. Afrobarometer is a research organisation which conducts surveys and studies on public attitudes on democracy, governance and the economy in Africa.  
  • In July Afrobarometer, together with the Institute for Justice and Reconciliation, released the findings of a survey on public perceptions of COVID-19, the NHI and healthcare in general in South Africa.
  • Nkomo shared findings from the survey which highlight that:
    • Most people surveyed didn’t have health insurance (75%)
    • 45% of those who weren’t insured said this was because medical aid was too expensive to afford
    • The majority of survey respondents believed that the government should make an investment in health emergencies such as COVID, regardless of whether people are insured.

Download the presentation here

2. “The pandemic proved collaboration is possible”: Nicholas Crisp

  • Nicholas Crisp is a deputy director general in South Africa’s national health department heading up both the NHI and the country’s COVID-19 vaccine roll-out.
  • Crisp explained where we currently stand with the NHI Bill, noting that we still have some way to go before the Bill can be enacted. The Bill first needs to be revised and then go back to parliament.
  • Crisp said the health department has learned several lessons from the government’s COVID response that can be applied to the NHI:
    • The different systems at play in the country’s healthcare sector (for example private and public or national and provincial) make it difficult to respond to crises in an agile way. “It was not possible to synchronise any reporting of test results, disease, deaths, beds, availability of space, nothing, everything was captured by nine different provinces, different parts of the private sector, and extremely difficult to integrate,” Crisp explained.
    • “One common database is [therefore] going to be the make or break of a health system we need in order to build a coherent health system to have the data that allows people to move within the system,” Crisp said. This common database will allow patients to have their complete patient history no matter where they go in the country. The Electronic Vaccinations Data System (EVDS), Daily Hospital Surveillance (DATCOV; which keeps track of tests, beds, cases), and Stock Visibility System (SVS) are examples from the COVID response of how a system such as this could work. 
    • Having common dashboards which ask for common data across different systems make collective planning easier.
    • Examples from across the world showed that countries with one national system were able to respond quicker to emergencies like COVID than those with two tier systems such as South Africa.
    • The pandemic proved that collaboration is possible, and not as difficult as had previously been imagined. “You have to put your mind to it, get around the table, agree on the common starting points and build from there, it’s not that difficult to do things together,” Crisp said.

Download the presentation here

3. Open communication, transparency and accountability: Umunyana Rugege

  • Umunyana Rugege is the executive director of the public interest law centre, SECTION27. As part of its work SECTION27 advocates for access to healthcare services, climate justice and people-centred budgeting
  • Rugege noted that greater transparency was needed with both the country’s COVID vaccine roll-out and implementation of the NHI. “[For a long time], there was no access to the ministerial advisory committee’s advisories on which the department [of health] and the government were basing decisions on the COVID response.”
  • “You’ll recall that at the end of last year, we were trying to find out if there had been any negotiations on vaccines. And there was a great deal of public pressure that was brought to bear on the department of health to say what it is they were doing in relation to procuring vaccines that were at that time becoming available and coming online around the world. And South Africa seemed to be lagging and was actually behind the queue because the negotiations clearly had started late.” In instances such as this, decision-makers need to communicate clearly with the public, Rugege cautioned. Open communication, and transparency allow for greater accountability. 
  • People’s voices also need to be prioritised throughout decision-making. “For example, participation of civil society in decision-making [around COVID vaccines] simply wasn’t there.” Rugege said.  

4. A common goal makes working together easier: Tebogo Phaleng

  • Tebogo Phaleng is the chief strategy officer of Discovery Health — the medical aid arm of the Discovery Limited group of financial services. Phaleng is responsible for executive oversight in the areas of health policy, regulatory and strategic industry affairs at Discovery Health. 
  • With a clear common goal established — 40-million adults to be vaccinated — partners across society could work together towards achieving it.
  • Phaleng outlined the role Discovery Health has played in working to help achieve this common goal:
    • This includes supporting the national department of health through various funding mechanisms, Phaleng mentioned, along with helping with how vaccines will be administered and priced.
    • Running statistical models on the effect of mass vaccination sites.
    • Assessing the population risk stratification to help decide which groups should get vaccinated first.

5. The role of business: Stavros Nicolaou

  • Stavros Nicolaou is the senior executive responsible for strategic trade development at the Aspen Pharmacare Group. He spoke at the webinar in his capacity as a member of Business for South Africa (B4SA).
  • B4SA is a voluntary alliance representing the business community in South Africa. B4SA works with government and other social organisations “to mobilise business resources and capacity to combat the Covid-19 pandemic”.
  • The vaccine roll-out programme illustrates how business and government can work together to achieve a shared goal.
  • When the national roll-out was launched on May 17 the vaccination rate was 0.025 jabs per 100 people Nicolaou noted. By 23 July this rate had increased to 3 jabs per 100 people. “So you can work out a 15 fold increase, over roughly a 10 week period is quite an aggressive ramp up.”
  • This increased rate was achieved during a time when vaccine supply was constrained, but government and business worked together, Nicolaou said.