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NHI: a far removal from reality?

It doesn't take a huge leap of imagination to understand the connection between jobs and health; likewise, the connection between one's living environment and health. In fact, just about every part of an individual's day to day experience has an impact on one's health.

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The debates around the NHI (National Health Insurance) are far removed from reality. They deal with the more extreme aspects of treating ill health and ignore the basic requirements that would improve the physical and mental health of all individuals.

The Bill explains at length the financial, executive and management structures that would be put in place, the committees, the oversight mechanisms, how decisions will be made on treatments and by whom, who will pay who and how much. But all these details have little to do with health, and much more to do with State control over the individual and removing individual choice over one’s own healthcare.

We need to get back to basics and to understand the responsibility of every individual for their own and their family’s state of health. It is our personal duty to protect and nurture our physical conditions by leading healthy lifestyles. This requires a good knowledge of the benefits of nutrition, an understanding of appropriate types and frequency of exercise, and the harm that follows from the consumption of excess quantities of alcohol and drugs.

Health education imperative


To achieve optimal health, individuals firstly require two things – education about bodily health, and the means to maintain it.

This brings us to the starting point of the connection between employment and health. If there was a greater synergy between government portfolios, there might be a greater realisation of the importance of creating a vibrant climate for investment and job creation, to improve the general health of the population.

While so many families are merely existing on a pitiful hand-out from the State, it is almost impossible for them to fulfil the nutritional needs of their families. This leads to a range of problems which include, but are not limited to, childhood stunting, poor school performance and stress within the family. Cheap and accessible foods are often high in carbohydrates and sugar and low in nutritional value, hence the high incidence of obesity and diabetes in our communities. These lifestyle conditions are the precursors of many other health problems which include heart disease, high blood pressure, osteoporosis, dental problems, and many more.

Nutrition and exercise are of paramount importance to achieving and maintaining good health, but an additional aspect that needs attention are the living conditions of those living in informal housing conditions. The lack of running water, efficient sanitation, and the added problem of cramped living quarters provides a breeding ground for contagious diseases. Children often run and play barefoot through areas contaminated by both human and animal faeces.

Informal housing a hotbed of unhealthy living conditions


It is proving impossible for the State to provide every family with a house, particularly around the larger cities and towns where people tend to congregate in the hope of finding meaningful employment. As stated, this urban and uncontrolled sprawl results in unhealthy and often dangerous living conditions especially for children. Because of insufficient clinics situated in these areas, there is no easy access to health services. Patients are often expected to wait all day to collect medication, be treated for anything from a minor problem to a possibly serious or life-threatening condition.


What is really needed, are more frontline doctors and nurses in strategically placed locations who are able to provide patients with the personal advice and treatment they need. The role of primary healthcare is being overlooked in favour of high-end hospitals, unwieldly management structures, impersonal decision making and excessive funding.

The employed can afford private medical care


Another benefit for those in full-time employment is that they can more easily access cheaper medical-aid options or are able to pay cash for treatments. This immediately reduces the pressure on the public -health system. Jobs provide people with more choices and greater personal responsibility for their health outcomes.

South Africa does not require the NHI to provide healthcare for its population. There is already an extensive budget that is badly managed. The State should ensure these funds are more efficiently utilised, that vacant positions are filled, hospitals fixed up and maintained at acceptable standards, and that nursing colleges are re-established to address the shortage of nurses. More neighbourhood clinics should be established. Hospitals would then be able to provide the service for which they are designed such as emergencies, operations, and serious illness.

Most importantly, the Minister of Health should understand the connection between jobs and health outcomes. He needs to urge his colleagues to create a vibrant and growing investment and employment environment, instead of implementing plans to place all healthcare under the control of the State.

About Gail Daus-van Wyk

Gail Daus-van Wyk writes for the Free Market Foundation.

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