26 February 2013

South Africa: Minister - Slow Start to NHI

Progress in the 10 districts designated as National Health Insurance (NHI) pilots has been slower than expected, and dismal in the Eastern Cape’s OR Tambo district. Speaking last week health minister Dr Aaron Motsoaledi likened it to building a house, and that they were busy digging the trenches while in the Eastern Cape “we are still designing the house”.

But by April, an extra 600 doctors in private practice will have been contracted to bolster services at 533 clinics in the pilots (excluding OR Tambo in the Eastern Cape).

Motsoaledi will this week start to pay a second-round of visits to the pilots to introduce the newly formed district clinical specialist teams, as well as to address the newly contracted private doctors.

The clinical specialist teams are to act as health advisors in each district particularly for maternal and child health, and consist of a family physician, gynaecologist, paediatrician and anaesthetist plus three nursing professionals.

Motsoaledi said he would pay special attention to OR Tambo district, situated in one of the poorest areas in the country incorporating Mthatha, from April once the other districts were on a solid footing.

Last week the Minister pleaded with Parliament’s Standing Committee on Appropriations to “please assess us after April” after it became clear that the majority of the NHI conditional grant had not been spent in the districts. “It took me nine months to get to this point and I was met by problems I had not anticipated,” said Mosoaledi.

The Minister is also in the process of appointing provincial co-ordinators for the pilot districts, who will be responsible for managing the pilots including ensuring that the private doctors deliver the services they are contracted to do.

“These posts are at Deputy Director-General level, and they will sit in the head of department’s offices in each province,” said Motsoaledi.

‘They are three-year contract posts paid for by the European Union.”

The Eastern Cape’s health service is plagued by problems and according to insiders the Minister is resisting invoking Section 100 of the Constitution, which would involve the national government assuming control of service delivery.

It is understood that the Minister is concerned with his department’s ability to take over the running of another province’s health department, despite pleas from some in the Eastern Cape for him to intervene. Limpopo and Gauteng are already under Section 100.

Addressing the Standing Committee on Appropriations, Treasury’s Dr Mark Blecher cautioned that the establishment of the NHI in full would be “extremely expensive”.

“We will need many, many, many more billions for many, many, many years,” he said, adding that in order to prepare for NHI implementation government had to learn “what the right direction is”.

Blecher said the current NHI money had to be used to test various components and once it has been determined which works well, to put a lot of money and effort into rolling it out.

He added that it was well understood they the current public health system was not “strong enough” to cope with an NHI.

Blecher said he was particularly concerned that “they (health department) are not testing innovations in the way that we thought.

“In a thorough way with strong external evaluation”.

However, Primary Health Care Director-General Jeanette Hunter took issue with Blecher, stating that they were planning at all levels, “something that has never happened in the health department”.

She said the department was jacking up its information systems “as today we do not even know what our vacancy rate is”.

She said the department had a monitoring and evaluation system in place.

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