National Health Insurance (NHI) introduction must be the start of radical review
South Africa is in a daunting phase of fiscal austerity which began globally in 2008 and will prevail in the short and medium term, but the situation presents an ideal opportunity for the country to reorganise its skewed healthcare provision to make it more equitable – particularly for rural communities.
Rural communities comprise about 40% of the country’s population of 57.8 million but, historically, these areas are the last to be considered when it comes to health provision by national, provincial and local authorities. This means that the 20 million people in rural areas are generally out of sight, so out of mind.
The authoritative Rural Health Advocacy Project (RHAP), an apolitical body dedicated to promoting health for the country’s rural communities, has produced the Protecting Healthcare in Times of Economic Crisis Report. It outlines the health, economic and political imperatives of addressing traditional deficiencies in delivering adequate, affordable and sustainable healthcare to rural areas, and presents a basic blueprint for rolling out a solution. The findings are based on research over a three-year period and not entirely gloomy.
The United Nation’s 2030 Sustainable Development Goals (SDGs) pledge to achieve a better and more sustainable future for all, commit to ‘leave no one behind’ and to fast track reaching ‘the furthest behind’.
“In addition to the SDGs, any South African government is obliged to provide its citizens with basic universal healthcare. It is a human right in terms of the Constitution. The number of people affected presents a significant voting constituency in the build up to elections. Surely it will pay a political dividend if potential voters benefit from the provision of quality healthcare,” says Russell Rensburg, Director at RHAP.
The Protecting Healthcare in Times of Economic Crisis Report draws on empirical research to establish how other countries with a similar socio-demographic profile to South Africa have turned harsh austerity into a positive force by using existing fiscus allocated to health more effectively, to improve the health of rural communities. These countries include Brazil, Colombia and Rwanda.
“What is patently obvious is that solutions can be found to maximise the return on diminished health spend in rural areas if there is creative thinking strong, sustained political will and consistent policies. South Africa is at a crossroads with the introduction of the NHI which will have to be funded. Built into its rollout and operational structure must be an adequate focus on facilitating the rightful equitable provision of healthcare to rural areas,” adds Rensburg.
The model proposed by RHAP, which it intends to advocate to stakeholders such as government and non-government, business and international donors, will require close co-operation between relevant government departments if they are to fulfil their roles in achieving equitable rural healthcare.
Rensburg concedes that this will not be easy as each government department has its own constraints to meet its obligations. However, the provision of healthcare will have a major positive impact on many health elements: longer and healthier living, better cognitive development of children (particularly in the critical ‘first 1 000 days’ of life), avoiding or timeously treating potentially deadly illnesses such as tuberculosis, high blood pressure, diabetes, and even HIV and Aids.
“Any health initiative that promotes all of these positives will mean simple but vital advantageous outcomes over the medium and long term – healthy and happier communities, fewer non-communicable diseases, reduced employee absenteeism, better infrastructure such as roads and provision of water services which will promote economic activity in rural areas and create employment, better telecommunications and IT spread.
“Overall, there is much to gain by learning how to manage our existing austere circumstances in the interests of all and we call on future South African governments to put in place sustainable rural healthcare with the NHI as a catalyst for this radical but achievable shift,” concludes Rensburg.