South Africa still far from providing equitable healthcare for all, summit reveals

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The summit is the second since 2018, and serves as a platform for government to assess the readiness of the health system to implement the NHI.

"The summit is identifying urgent measures needed to recalibrate the system and accelerate NHI reforms," the national health department said in a statement.

All feedback provided at the summit is based on the nine pillars that feature in the Health Compact signed by the president in July 2019. The Compact lays down a five-year roadmap for health systems strengthening reforms under its nine pillars towards accelerating universal health coverage (UHC) in South Africa.

"The 2018 summit identified areas needing attention to improve financial management including supply chain management. The management of PPEs exposed serious weakness leading to reputational damage," said Minister of Health Joe Phaahla.

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"A number of cases were investigated by the Special Investigating Unit leading to disciplinary processes. Incidents of poor financial management are still occurring, leading to non-delivery of essential goods and services.

"An anti-corruption forum in the health sector was launched in 2019, but its impact still has to be felt. The mode of delivery of infrastructure also needs urgent reform to increase speed and quality, while reducing wastage and high cost. The estimated cost of all infrastructure-needs done in 2019 was R70bn for hospitals and R12.6bn for primary healthcare facilities."

Cutting through the red tape

Barriers to fair and equitable access to medicine also need addressing. Some aspects of the Backlog Clearance Project established in 2019 are still in progress, said President Cyril Ramaphosa's health advisor, Olive Shisana.

With the launch of Sahpra in February 2018, the regulatory authority inherited a backlog of approximately 16,000 new product and variation applications from its predecessor, the Medicines Control Council (MCC).

More than 95% of these applications were generic medicines. Thus, this backlog had an impact on access to safe, cost-effective medicines.

"Some of the pioneering therapies, especially those that were New Chemical Entities held up in the pipeline, were offering hope to terminally ill patients, yet access was delayed by the previous inefficient review practices," Sahpra said in a statement.

"After intensive consultation with both internal and external stakeholders, a project time frame of two years for the clearance of the application backlog was agreed upon."

A dedicated unit with sufficient staff and resources was set up to clear the backlog.

Sahpra's work continues to this end, with the assistance of the National Department of Health, National Treasury, and various funders.

The Health Council is working on a policy to allow one agency to buy medicines for the provinces.

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Iterative learning is the key

Jeanne-Marie Tucker, a technical adviser in the HR department in the National Department of Health, focused on supporting the SA government in accelerating progress towards universal health coverage, stressed that "this is not a one-day event where the NHI will suddenly be switched on".

"There are complex technical issues around health financing [that need to be resolved] and we are navigating a complex environmental, political and economic landscape to find what works for people," she said.

Tucker was speaking at a health congress held in Cape Town in April.

"The NHI Fund is a strategic purchaser funding model for primary healthcare with risk adjustment capitation. Basically what that means is we don't pay for each service, we just pay the providers to keep those patients healthy.

"The task of the NHI Fund - which was developed in 2022 and funded by National Treasury - is to prepare, to test, to learn and to do things small, and learn to get it right, and to scale things up very slowly," Tucker added.

"The idea is to incubate functions of the NHI Fund as we wait for the NHI Bill to get passed to become an Act. It's going to require long sustained efforts over the next five, 10, 20 years of iterative learning," she said. "But what we want you to do is keep that long-term goal in mind: to establish a national health system that delivers universal health coverage."

The NHI Bill is going to the National Council of Provinces and is expected to return to parliament in October, she said.