The origins of National Health Insurance

The White Paper on National Health Insurance was published on 11 December.

This draft policy has its origins in debates that emerged in the late 1980s.

For those of you interested in the history of these debates, read the publication below that was published by Wits University’s Centre for Health Policy in 2000.

The document talks about the important design features of different policy proposals during the 1990s, as well as the lessons learned during this time with respect to managing the process of policy development.

The document is out of print, but I’ve managed to resurrect it using an old copy.

Doherty J, McIntyre D, Gilson L, Thomas S, Brijlal V, Bowa C, Mbatsha S. 2000. Social health insurance in South Africa: past, present and future. Johannesburg: Centre for Health Policy, for the Centre for Health Policy (University of the Witwatersrand) and the Health Economics Unit (University of Cape Town).

Achieving universal health coverage in South Africa requires higher public sector spending

This article was published in The Conversation on international Universal Health Coverage Day on 12 December:

Doherty J, McIntyre D. 2015. South Africa needs to spend more on health care to achieve universal cover. The Conversation – Africa. 12 December 2015.

Universal health coverage assessment: South Africa

If anyone missed this in an earlier blog, I’ve posted a preliminary assessment of South Africa’s progress towards universal health coverage here.

The purpose of the assessment is to use what data are available to analyse the extent to which South Africans are enjoying financial protection against the costs of using health care services, and accessing the services they need.

Getting South Africa ready for National Health Insurance: critical next steps

Here are the powerpoint slides for a recent presentation I gave about National Health Insurance to a Symposium by Economic Research Southern Africa (ERSA) on 6 February 2014:   ERSA NHI presentation_Jane Doherty 

The theme of the Symposium was “Critical choices regarding universal health coverage” and it was held at the Stellenbosch Institute for Advanced Study.

My presentation was titled “Getting South Africa ready for NHI: critical next steps.” 

If you look on ERSA’s website you will find more details on the Symposium.

NHI Snippets (6): NHI and staff shortages: how can clinical associates help?

South Africa has begun producing a new type of health professional – a clinical associate.

You can read a bit more about clinical associates here but, in brief, they are people ideally suited to working in hospitals, helping doctors carry out some of their tasks – like dealing with emergencies and doing procedures.

Clinical associates don’t replace doctors or nurses  – they work with them, sharing some of their workload, and allowing them to concentrate on the tasks for which only they are qualified.

There is no doubt that more doctors and nurses need to be trained and recruited into the South African health system. But will this alone solve the country’s staff shortages? Realistically, how many decades will it take to fill all the country’s vacant posts? Can the country afford a system exclusively based on doctors and nurses? Is this even necessary?

It takes less time to train a clinical associate. They can become very good at what they do because they focus on a special set of skills and are supervised by doctors. They are recruited from rural and disadvantaged communities. Health workers a bit like them have made an enormous difference to many health systems around the world, especially in Africa but even in the United States.

So clinical associates could do a lot to address staff shortages in the public sector, especially in district hospitals. They could help bring good quality care closer to communities in a way that is affordable for the country. Along with other initiatives – such as strengthening hospital management – they could help produce public services that live up to the aspirations of the NHI policy.

So why isn’t there more excitement about this new category of health professional? Why don’t we hear about them in the press or from government spokespeople?

Clinical associates are noted as a priority in the latest government human resource strategy but the future of clinical associates and the strategy of NHI need to become much more closely intertwined.

NHI Snippets (5): The government’s green paper on NHI

Some of you who have been following my ‘NHI Snippets’ blog may be feeling frustrated because I haven’t yet summarised the government’s NHI proposal or begun to analyse its strengths and weaknesses.

Please be patient! – I’m trying to set down some background information so that we can have an informed discussion. 

In the meantime, if you want to read the National Department of Health’s Green Paper on National Health Insurance in South Africa, you can find it here on the Department’s website.

The same website also has as useful summary of the main implications of the Green paper which can find here.

When discussing a reform as potentially wide-ranging as NHI I think it is important to have read the original documentation!

NHI Snippets (4): Too many women die in South Africa from causes related to childbirth

In NHI Snippets (2) I made the point that health in South Africa is poor, especially when viewed in light of the country’s relative wealth.

I gave some figures on how many women die from causes related to childbirth.  I know these figures can seem very abstract so, as promised, I’ve found a graph (by Jack Langenbrunner) that helps to show how well South Africa does in preventing these deaths compared to other countries. 

Click “MMR relative to other countries” to see the graph and here to see the full presentation which includes additional graphs on other health indicators (the link takes you to the Health Systems Trust page with all the conference presentaitons – you will find Jack Langenbrunner’s presenation on Day 2).

As you can see, South Africa does badly when one considers both its average per capita income and its average per capita spending on health (in the graph, countries in the top right block manage to ‘buy’ much less health for the money they have at their disposal).  In this sense, South Africa is much less ‘efficient’ than some poorer countries that do much better.