10 districts announced for NHI pilot

Activities in NHI pilots will focus on key elements such as district health services, service delivery, strengthening of health systems and health financing.

The districts are: OR Tambo (Eastern Cape), Gert Sibande (Mpumalanga), Vhembe (Limpopo), Pixley ka Seme (Northern Cape), Eden (Western Cape), Dr K Kaunda (North West), Thabo Mofutsanyane (Free State) and Tshwane (Gauteng).

Due to high population numbers and a high disease burden, two districts have been identified in KwaZulu-Natal - uMzinyathi and uMgungundlovu. However, the province has added a third district, Amajuba, and will be using its own funds to carry out the pilot.

Making the announcement on Thursday in Pretoria, Motsoaledi said the NHI pilots will focus on the most vulnerable sections of society across the country, reduce high maternal and child mortality through district-based health interventions, and strengthen the performance of the public health system in readiness for the full roll-out of NHI.

The pilots will further assess whether the health service package, primary health care (PHC) teams and strengthened referral system will improve access to quality health services, particularly in rural and previously disadvantaged areas of the country.

The objectives of the pilots include testing the ability of the districts to assume greater responsibilities under the NHI, to assess utilisation patterns, and costs and affordability of implementing a PHC service package.

Outlining the selection criteria of the districts, Motsoaledi said 27 indicators in three categories were used to summarise overall performance across districts.

"The districts were ranked from best to worst performance for each indicator and a score from 1 - 52 is given, where 1 is the best performing district and 52 the worst," Motsoaledi explained.

The selection was based on indicators including socio-economic, health service performance and financial and resource management.

Ten indicators were considered under socio-economic indicators including: Deprivation Index District Health Barometer, population with private medical insurance rate (Household Survey), unemployment rate, informal and traditional housing rate, no access to improved sanitation rate, no access to piped water rate, no access to refuse removal rate, no access to electricity for lighting rate, no income or income less than R4 800 rate as well as household head younger than 19 years rate (all Community Survey).

Indicators under health service performance indicators included , amongst others: HIV prevalence, TB cure rate, pneumonia and diarrhoea incidences, antenatal coverage, delivery in facility, whilst indicators in financial and resource management indicators included PHC expenditure per capita, district expenditure, percentage under/over expenditure for PHC, cost poor weighted headcount clinics as well as percentage under/over expenditure for districts.

On financing the pilots, Motsoaledi said it was part of the on-going engagements between the department and National Treasury, which has allocated R1 billion for the project.

An optimistic Motsoaledi said the department was ready for the roll out of the pilot and would be visiting all the identified districts, where he would be interacting with stakeholders including traditional leaders, church leaders, nurses, doctors, explaining the projects ahead of the April launch.

He will also hold a meeting with the medical practitioners from the districts asking them to assist in the clinics for a few hours, where they will be getting paid for services rendered.

"We want to see the presence of doctors in the clinics in the furthest rural in the country," he added.