Focus on the potential benefits of the NHI when trying to solve its problems

President Cyril Ramaphosa signed the much-debated National Health Insurance (NHI) into parliament two weeks before South Africa’s crucial May elections.

This move was not only a clear statement of intent that the new political dispensation is unwavering in its commitment to improving the lives of South Africans, but it also brought Africa’s most diversified economy a step closer to implementing universal healthcare.

If implemented effectively, this will be a landmark moment for the Continent. While there are plenty of fears and doubts about the future of the NHI, MANCOSA believes that South Africans should start focusing on the potential benefits of the NHI. “At a conceptual level, the NHI will significantly benefit the country. While there are critical and relevant issues that need to be ironed out, we need to start working together to make universal healthcare a reality in this country,” says Mehnaaz Olla – Manager: MANCOSA School of Healthcare.

Global imperative
In 2015, the United Nations recognized the importance of universal health coverage by including it as one of its key sustainable development goals. This decision underscores the global imperative for healthcare and obligates all UN member states, including South Africa, to work towards implementing these goals.

“As a key African member of the UN, universal health coverage was always going to be a reality in South Africa. While plenty of issues need to be addressed, critics of the NHI should focus on the goal of the Universal Healthcare project rather than its challenges. It is important to note that not every universal healthcare system is perfect. Plenty of lessons need to be learned on the path to perfection,” says Olla, who adds that these lessons should not get in the way of implementation.

Tech can be a significant challenge
A ransomware virus targeted selected points in the National Health Laboratory Systems (NHLS) IT systems, rendering them inaccessible and blocking communication from the laboratory information system and other databases to and from users. Sections of the system were deleted, including from its backup server, and rebuilding the affected parts will be required.

“While the NHLS assured the country that no patient data was impacted in the breach, the incident clearly indicates one of the vulnerabilities the NHI will face. Technology has been a key component of global universal healthcare systems and will play an important role in the NHI. We need to improve the IT infrastructure backbone of the health sector, particularly regarding cyber security. The NHLS is the only body for lab services in the public sector. When rolling out the NHI, we need to improve the building blocks of technology, including data collection, usage, and storage,” says Olla.

The Government is not blind to this challenge. At a June healthcare conference, officials from the Department of Health pointed out that the Government wants to use artificial intelligence increasingly to improve the diagnosis and monitoring of chronic conditions. Their immediate target will be using AI to improve the diagnoses of tuberculosis and silicosis, which are prevalent in South Africa.

“The need for quality data and subsequent interpretation of this data is a high-priority item when it comes to the implementation and usage of AI. There are significant potential hurdles regarding governance, risk, and compliance, which needs to be addressed to mitigate these challenges in practical implementation,” says Olla.

Global benefits
NHI detractors have all said that the system will fail from the outset. However, South Africa is fortunate to have learned the lessons from implementing global universal healthcare systems.

Dr Augusta Dorning – Strategic Advisor: Healthcare Education, MANCOSA School of Healthcare, points out that we should embrace the dynamism of adopting a fit-for-purpose healthcare system that addresses our unique challenges.

“We can learn extensively from international markets and especially from lessons learned in Ghana and Zambia on our Continent. There are exceptional systems worldwide that should provide the blueprint for our own, not least of all, the French and South American versions of universal health care. In the case of France, the system’s design has provided for one health record, which is accessed by the provider with the patient’s permission. This digital system, linked to the patient’s social security number, contains all relevant biographical, diagnostic, and treatment information, preventing duplication and over-servicing. Duplication and over-servicing bring about unnecessary delays as well as wasted expenditure and place a burden on any system. Additionally, in France, patients can access private facilities but at a higher co-payment than the public system, providing the patient with a choice. I use France as an example, given that the population size of France is not dissimilar to that of South Africa. The challenges France faces when providing care in rural areas is also not dissimilar to the changes South Africa faces in the same context,” says Dr Dorning.

Dr Dorning provides further insight into how the NHI will differ from global models. “Most UHC systems involve co-payments. However, South Africa’s unique challenges necessitate that our NHI system be designed to exclude the unemployed and social grant recipients from such co-payments. In all other aspects, our system should align with the best universal healthcare systems, such as those in France, Costa Rica, and Ecuador,” says Dr Dorning.

Taking the lead
MANCOSA is confident that technology will play an essential role in the NHI. Olla points out that the institution has reaffirmed its existing position regarding technology.

“As a leader in distance education, technology has always been a significant value proposition for MANCOSA. Healthcare professionals of the future will be required to possess the transversal skills that MANCOSA students are all too familiar with. Further, our SkillMe platform allows students to upskill and reskill themselves in line with international best practice,” says Olla.

Common good
Olla points out that the NHI’s challenges should not detract from the system’s common good.

“We all envisioned elevating South Africa to greatness in 1994. We need to reevaluate and work towards the ambitions that our democratic founding fathers had for the country. Universal health coverage is a large step in that direction,” says Olla.

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Author: Lola Lazarus from Bullion PR & Communication on behalf of MANCOSA.