NHI IN SOUTH AFRICA

 I have been working in the South African healthcare system for about 9 years. I started as an intern in Thelle Mogoerane Regional Hospital, and did one year of community service at Bara Hospital. I was extremely enthusiastic about my South African medical experience and didn’t mind the overcrowded and short-staffed hospital environment. Every day had a new challenge and new experienceS in clinical medicine.

 Thelle Mogoerane Hospital was recently renovated and had quite a pleasant environment. The government wanted to start the process of making the hospital services paperless in 2015. They started training the staff and distributing laptops, but it was never implemented. We only had access to X-rays over the PAX computer system. This would make hospital record keeping and access to patient’s old files very easy and we also did not have to struggle with various doctor’s handwriting. My Bara maternity experience was different. The department was extremely rundown and old. The post-natal wards were extremely busy, and the hospital did not have warm water and clean toilets. Later on, I had a very pleasant birth experience in one of the private hospitals. The post-natal wards were very clean  with great nursing care. Reflecting back at such a huge discrepancy between the public and the private sector I really feel like something needs to be done in South Africa’s healthcare system.

The NHI is a fund, paid by the taxes from which the government will buy health care services and provide good quality universal health care. This means when we are unwell we can go to our nearest GP or clinic of our choice that has a contract with NHI and not worry about the cost of care. The public sector is providing health care services for 84% of the population and is currently under financial constraint.

The fund will be implemented over phases and over many years. Regulations will be published to address the phased implementation of the NHI Fund and the phased implementation of service benefits as the money is moved to the fund. The business models of the private funders and their business administrators will change over time. Once the NHI covers a benefit, the medical schemes may not cover the same benefits. This means that their membership fees must be reduced and some will be too small to survive so they will consolidate with others to maintain a viable risk pool for the benefits that they will still cover. Administrators of medical schemes no longer manage over 250 options, meaning the complexity of their services will be greatly reduced.