Back to basics for NHI programme

Co-operation with the private sector will be crucial to the success of the NHI and the pilot scheme. In the past Motsoaledi has had harsh words for the sector, but he knows he needs private practitioners' help.

"An initial approach will be to call on the private sector to be part of the pilot scheme. The intention is for the administrators in the districts to contact private doctors and ask them to make time available to work in public clinics.

"Many people will be content with a doctor who visits a clinic once or twice a week," says Motsoaledi.

He says the clinics are the weakest link in the public health-care chain.

Already he has met the CEOs of 16 private health companies. "There are many [points on which] we will differ," Motsoaledi says. "But the two areas where the private sector can make a meaningful contribution are [helping to tackle] the combined disease burden of TB and HIV/Aids, and assistance with human resources."

Motsoaledi says the "sector is working with government on a plan, which we shall announce later this year".

Hospital Association of SA chairman Nkaki Matlala says the association and other private health industry players will be part of the initiative. He says an area that has been identified for co-operation is the training of hospital managers, specialists and nurses, and the sponsorship of specialists.

"We are establishing and legalising a structure to formalise the process, and are working towards a unified agreement," he says.

The pilot programme will be rolled out in 11 districts. It will be run for five years, and its main objective is to improve primary health care in public facilities.

Motsoaledi says: "To start with, we are moving people away from hospitals to clinics for [primary care] and the provision of chronic medication."

He says: "I am very worried that people just go to a tertiary hospital; they must be referred to it by a clinic.

"In Britain, where they have had the National Health Service since 1948, people are required to [do it that way]. We need to apply those basics."

Motsoaledi says the health department will initially focus on a few objectives. These include improving the values and attitudes of staff, managers and patients; reducing waiting times; keeping patients safe; providing reliable care; and ensuring medicine and equipment supplies.

He has funding of R1bn from treasury and another R1,26bn pledged by the EU to proceed with his plans. It will be no easy task, as the SA public health system has been allowed to deteriorate.

Funding the pilot may be secure, but Motsoaledi still faces challenges. These include the fact that 70% of SA's doctors work for the private sector, the physically and emotionally dilapidated state of the public health-care system, and critical health-care skills shortages.

As part of the NHI rollout Motsoaledi wants all SA's health institutions to make submissions on infrastructure development and provide equipment logs.

Last year the health department began an audit of SA's 4200 health-care facilities, and the intention is now to tackle some of the issues that the audit revealed.

"They [the auditors] will propose plans for improvement, and there will be no negotiations [about this]," Motsoaledi says.

Genesis Healthcare Consultants MD Clayton Samsodien says the details of the pilot scheme that have been provided were encouraging after the vagueness that followed the release of the NHI green paper last year.

Samsodien says he was surprised by the addition to the scheme of a third district in KwaZulu Natal, Amajuba, to be funded by R110m from the province. But the inclusion makes sense, he says, since KwaZulu Natal is seen as the largest contributor to SA's weak health-care record.

"We will have to wait and see if other provinces are allowed to do the same," Samsodien says.

Source: Financial Mail