NHI needed to eradicate inequality in the midst of coronavirus

The Covid-19 outbreak is deeply concerning considering that SA's healthcare system was named by the WHO as one of the most expensive in the world.
The Covid-19 outbreak is deeply concerning considering that SA's healthcare system was named by the WHO as one of the most expensive in the world.
Image: REUTERS/Philimon Bulawayo

Quality health care is essential, but according to the World Health Organisation (WHO), only 10% of South Africans can afford it. The proposed National Health Insurance (NHI) might be the solution to this violation of a basic right.

Last month, President Cyril Ramaphosa addressed the issue of the NHI in his state of the nation address, emphasising that the growth of the nation depends on a healthy and productive population that has access to quality and affordable health care.

He said the government has registered more than 44-million people at over 3,000 clinics in the electronic Health Patient Registration System (HPRS) and is now implementing this system in hospitals.

When the UN formed in 1948 and created the Universal Declaration of Human Rights, which is still an integral pillar of the global society, it stated that “everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and medical care and necessary social services.”

Unfortunately, at that time, SA was under the rule of apartheid and nowhere close to fulfilling the basic human rights of all its citizens. When this finally ended, and the constitution was drawn up in 1996, section 27 of the Bill of Rights stated unequivocally that access to health care is a basic human right.

Fast forward 24 years, and though we are a democratic country on paper, the extent of the inequality that still exists contradicts the very notion of democracy.

Data compiled in 2017 showed that just 17% of the country has medical aid. Furthermore, while 72.4% of white people are members of medical aid schemes, in a vast contrast, only 20% of coloured people and 10% of black people have that same access.

The issue of medical aid being a condition of employment is compounded by the fact that our current public health system is ill-equipped for the number of people who require its services.

Hospitals and clinics are overcrowded, resources are limited, and the quality of care is often lacking. Most medical staff tend to go into the private sector once qualified, which leaves the public sector severely understaffed.

The majority of the population being served by a sliver of the available medical professionals in the country, while the comparatively small group who can afford private health care having access to a large pool of doctors and specialists, is a prime example of the unequal distribution of resources that needs to be remedied.

This is where the NHI needs to step in.

The UN listed 17 Sustainable Development Goals (SDG) in 2015, with all member states (including SA) signing on. Their target is to “end poverty, protect the planet and ensure that all people enjoy peace and prosperity by 2030”.

The third SDG is good health and wellbeing, and they state that universal health coverage systems in all countries should be attained to end poverty and reduce inequalities. To take steps towards reaching this universal health care goal, the South African government is implementing the NHI, which aims to pool resources to provide quality health care that is free for all South Africans.

The current outbreak of Covid-19 is a deeply concerning issue for the country, especially considering that the current health care system was named by the WHO as one of the most expensive in the world.

The geographical class divide means that the infection of just a few in the working class — the group that cannot afford good quality health care — could rapidly spread within the same class due to factors such as poor treatment facilities and dense living conditions. This is an urgent example of why the country needs universal health care.

Since the end of apartheid, there has been a constant struggle to redress the injustices of the past and diminish the legacy of the oppressive regime. Unfortunately, with the staggering levels of poverty and unemployment, mostly within the black population, this legacy is still rock solid — and getting worse.

Still, hope is not lost and there are attempts to rebalance. A free and equal health care system is arguably the most vital place to start.

Ultimately, quality health care is a matter of life and death (quite literally, for many South Africans) and those ardently against it need to take a step back and look at it from a humanitarian perspective, rather than focusing on how it will possibly affect their own comfort and finances.

In fact, everyone stands to benefit from the NHI, as it will be available to all South Africans regardless of their socio-economic status.

Everyone should have the right to free health care, and whether one can afford private care or not, they simply shouldn’t have to pay.

Munshi is a lecturer and project manager of the Wits Programme on Social Determinants of Health and Health Inequality at the School of Public Health, University of the Witwatersrand. She holds a Master’s in Public Health focusing on Health Policy and Systems Research from the Centre of Health Policy at Wits.

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