From Green Paper to Final Policy: Has there been a change in how rural is considered in relation to the National Health Insurance process in South Africa

From Green Paper to Final Policy: Has there been a change in how rural is considered in relation to the National Health Insurance process in South Africa

Download RHAP’s review here: NHI From Green to White Paper_ Review_RHAP_July2017

Since the publication of the NHI Green Paper in 2011, the Rural Health Advocacy Project (RHAP) and its rural health partners have engaged extensively with the NHI policy development and review process. This engagement has included providing comment on various components of various versions of the draft policy as well as providing substantive input on specific work areas such as the Ward Based Outreach Team (WBOT) policy[1], GP contracting, human resources for health[2], and financing[3]. This work has been done with a view to ensuring that the NHI fully accounts for the needs and complexities of health care reform in rural settings.

The recent publication of the final NHI Policy (July 2017) by the Minister of Health suggests that legislative and regulatory work of NHI implementation is about to begin. While the NHI Policy itself is only the roadmap for more complex regulatory and systemic change that will continue, it does commit to the foundational principles of the NHI and the priority areas that are likely to receive attention going forward. This is important for rural health as it is an indication of if rural health is being given sufficient priority in the framing of the NHI.

In this review, we do not detail our position on every aspect of position or work on the NHI, its associated reforms and the implications for rural health. This has been done extensively in our NHI Green Paper[4] and White Paper[5] submissions. We have also produced extensive input on various aspects of health system policy, reform and service delivery that are likely to influence implementation. In this review, we simply look at how the NDoH has, or has not, addressed the main concerns we have raised through our submissions and advocacy work over the past five years and then outline critical issues that will need priority going forward.

The content of this work is summarised in Table 1in the attached review.

[1] See for example http://www.rhap.org.za/rhap-position-community-health-workers/ and more recently our work on the costing of WBOT http://www.mrc.ac.za/healthsystems/CBCReport.pdf

[2] See http://www.rhap.org.za/category/goal-03/

[3] See http://www.rhap.org.za/category/goal-02/

[4] Available here http://www.rhap.org.za/wp-content/uploads/2014/03/NHI_GreenPaper-RuDASA-and-partners_11-December-2011.pdf

[5] Available here http://rhap.org.za/wp-content/uploads/2016/06/Rural-Health-Advocacy-Project-and-Partners-Submission-on-National-Health…-6.pdf