Universal health care must be publicly funded - former Norwegian PM head on NHI

Universal health care can only be achieved with a publicly funded system, the former prime minister of Norway and director-general of the World Health Organisation, Gro Harlem Brundtland, has said.

She and Ricardo Lagos, the former president of Chile, met with President Cyril Ramaphosa in Cape Town to learn more about the National Health Insurance (NHI) Bill currently before Parliament.

The two, who are members of The Elders, also met with National Assembly Speaker Thandi Modise and addressed the portfolio committee on health and select committee on health and social services.

READ: NHI will boost SA's economy, says health minister

The Elders are a group of former world leaders that was brought together by former president Nelson Mandela.

Addressing the committees, Brundtland said not every country in the world had universal health care.

"That is something that is missing in the world today."

She pointed out that nearly 30 years have passed since South Africa became a democracy, yet it does not have universal health care.

"Why not?"

Brundtland said she was therefore encouraged that the NHI Bill was currently before Parliament.

She added to cover everyone, you needed a publicly dominated system, "otherwise the poor will be left behind".

"You should not be forced into poverty because you are sick," Brundtland said. "The thing is, this has been done in many countries. So it is not as if South Africa can't do it."

A concern often raised by the NHI's opponents is that South Africa cannot afford it.

According to Brundtland, countries in a similar economic position as South Africa have managed to do it, using Thailand as an example.

The country spends 3.7% of its GDP on health care, and everyone is covered. South Africa spends around 8.1% of its GDP, but not everyone is covered and the spread is unequal.

Brundtland said the US spent around 20% of its GDP on health care, yet not everyone was covered.

Lagos said he fought against Chilean dictator Augusto Pinochet, and after he was defeated the country had a difficult transition to democracy.

"The neo-liberal system of Pinochet was very difficult to dismantle."

Lagos said the right to health care was written in Chile's constitution, but it was not yet a reality.

So, when he became president in 2000, Chile started on its way to universal health coverage.

Lagos said the inequality in its system was similar to that currently faced in South Africa, where 75% of the population was reliant on public health care and the remainder on private health care.

READ: NHI Bill is constitutional - state law advisers tell Parliament

Currently in South Africa, 84% of the population rely on public health care, and 16% on private.

"There are vested interests. It is very difficult to change things," Lagos said.

He advised South Africans to change to universal health care step by step.

MPs - notably the DA's Siviwe Gwarube and EFF's Naledi Chirwa - spoke of the systemic corruption in South Africa and how this impacts on the provision of health care to the most vulnerable.

Brundtland said in her own country they had little corruption.

"I think you have a bigger problem than many other countries. This cannot be a reason not to [implement] the NHI. It has to be taken seriously. You have to overcome corruption."

Many MPs also mentioned South Africa's triple challenges: poverty, inequality and joblessness.

This, too, was for Brundtland not an argument against the NHI.

"It is a fact that investing in health boosts economic growth," she said.

Addressing the media with Health Minister Zweli Mkhize and Lagos in Tuynhuys after meeting Ramaphosa - who did not attend the media briefing - Brundtland congratulated South Africa on taking up the issue of universal health coverage, and reiterated her earlier point: "Unless you have a publicly funded system, you cannot achieve universal health coverage."

She described Ramaphosa as "very inspired and interested" in the matter.

"The president has to take the lead."

The NHI Bill is currently up for public comment.

The chairperson of the portfolio committee on health, Sibongiseni Dhlomo, said the committee would decide on October 12 when and where it would have public hearings on the bill. 

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