Читать книгу The Political Economy of the BRICS Countries - Группа авторов - Страница 85

The post-Apartheid period in South Africa saw a number of incremental reforms in the health sector to address the immense inequalities in access and outcome that was the norm during the apartheid regime. This included public health legislation and policies and a unified national health system, increasing infrastructure at the primary care level and removing user fees for maternal and child health services to name a few (Schaay et al., 2011). Despite this, the country saw unprecedented worsening of burden of disease, with HIV and TB wiping out much of the gains achieved through development.

To tackle the worsening health situation, in 2008, the government brought out the Health Sector Road report which resulted in the 10-Point Plan, which was intended ‘to guide government health policy and identify opportunities for coordinated public and private health sector efforts, in order to improve access to affordable, quality health care in South Africa’ (Schaay et al., 2011). A performance agreement between the President and the Minister of Health was signed in October 2010 for the implementation of the Negotiated Service Delivery Agreement (NSDA) for the Health Sector. The NSDA process requires that government departments harmonize the implementation of their respective service delivery agreements so as to facilitate delivery of the 12 key outcomes.

In 2011, the Green Paper on National Health Insurance was brought out which contained the principles for developing National Health Insurance (NHI). The objectives were to improve access to quality healthcare services and provide financial risk protection against health-related catastrophic expenditures. The proposal visualized the development of comprehensive healthcare to be provided through accredited and contracted public and private providers, with a strong focus on health promotion and prevention services at the community and household level. The proposal also contained a realistic target timeline, with the first 5 years to be used to strengthen the public sector in preparation for new NHI systems. The plan was to launch the new central NHI fund in 2014/2015 (National Health Insurance, 2013).

However, the NHI did not quite take off, and in 2015 the government released the White Paper on NHI. The paper proposed that NHI will be made compulsory and will be introduced in three phases over a 14-year period. In Phase I, focus will be on strengthening the public sector. In the second phase, population registration and creation of a transitional fund to purchase non-specialist primary care would be the focus. Finally, in Phase III, the aim will be to operationalize the NHI fund fully and make it a strategic purchaser and single payer of comprehensive health services, including specialist services (Gray and Vawda, 2016).

While it is early to comment on the progress and implementation of the NHI, there is some concern that the necessary homework to make NHI a reality remains to be done. For example, there have been delays in operationalizing the independent Office of Health Standards Compliance, necessary for ensuring compliance with standards laid down for treatment. Some of the changes envisaged in the White paper require far-reaching legislative changes as well, in for example, the National Health Act and the Medical Schemes Act, but details are not laid out in the White paper on how exactly such changes should be brought about (Gray and Vawda, 2016).