'NHI a game-changer for poor, rural areas'

The implementation of the National Health Insurance (NHI) bill changes little for people living in a rural areas. For residents of these areas, they would still have to travel to the same clinic they have been going to that is far away from their homes.

This is according to public interest law centre Section27's Asiphe Funda, who said it was unclear how the NHI will improve access to health for millions of South Africans in remote, rural areas who have to travel long distances, often on foot, to get to healthcare facilities.

Today, President Cyril Ramaphosa will sign the NHI bill into law.

The presidency said the bill “directs the transformation of South Africa's healthcare system to achieve universal coverage for health services and, through this overcome critical socioeconomic imbalances and inequalities of the past”. 

Funda said despite having made two submissions on concerns relating to access and rural healthcare, the bill in its current form does not provide clarity about areas that do not have access to clinics or emergency healthcare services.

Russell Rensburg, director of the Rural Health Advocacy Programme, said the bill would be a game-changer for rural areas. “At the moment there is no GPS in the rural [areas] because there is no medical aid. So this will make it possible for people to practise in rural areas. Right now they can't practise there because there isn't enough medical aid cover.”

Asked if SA was ready for the NHI, Rensburg said the country wouldn't be ready on day one. “That is the whole point of introducing it to start a process to achieve the goals. We can't start a process without a legal framework. I think the NHI provides the legal framework to begin the reform process. It is a good start.

“This is good for rural. This is all about utilising all the different assets within the system so that the working poor, which makes up 55% of the workforce, can also afford to access healthcare. It will take time, but I think that is the goal. It is really about reorganising all these assets that the state has and making it more effective.”

Tinashe Njanji, national coordinator of the People's Health Movement, said NHI was unclear about prioritisation of equity for rural areas. “There is a likelihood that rural facilities, which are under resourced, will be at greater risk of not meeting standards for accreditation under the NHI, leading to a barrier to accessing NHI funds..

“The NHI may, however, motivate some private practitioners, GPs and hospital groups to move into working in poorer and rural areas where previously they were not able to support their practices based on out-of-pocket payments from the community.”

Funda said while South Africans were ready for the transformation of the two-tier healthcare system, the public healthcare system that services most of the population was falling apart. “It [the public healthcare] is collapsing, but it is also an important asset to the country. You can only imagine how the country would be if we did not have a public healthcare system. So the question is if the NHI in its current form is ready to meet the objectives that it is set out to achieve?”

Momentum Health Solutions' Damian McHugh said the intent to enable access to attain more healthcare for more South Africans was positive, but said the implementation of the bill in its current format was not sustainable. “We expect the already documented challenges made by numerous stakeholders to become more vocal, particularly around the constitutionality of the bill. Another key consideration is that the South African economy does not have the required funds to support the implementation thereof.”

Democratic Nursing Organisation of South Africa spokesperson Sibongiseni Delihlazo said they supported the bill. “For NHI to assist people in the rural areas, it means the healthcare facilities nearer where they live must be prepared ... so that they can be accredited by the office of the health standard compliance. 

“We need to fast-track the process of refurbishing healthcare services [in rural areas]. We know NHI will not just [happen overnight]. We must build it gradually and in phases, and everyone should get access and hence we are saying those in the rural areas should not be forgotten.”