NHI’s hits and misses

Yay or Nay to NHI
Yay or Nay to NHI

The drive to implement the National Health Insurance (NHI) scheme was boosted with the launch of a report outlining “important lessons”.

Commissioned by the department of health and compiled by consulting firm Genesis Analytics, along with PwC and the Centre for Health Policy, the 192-page Public Health Strengthening Report evaluated the progress of 11 NHI pilot sites across the country.

On Friday, Health Minister Zweli Mkhize said that certain aspects of the assessments were not meant to be read as “a fail or a pass, but for us to strengthen what we can do”.

Dr Saul Johnson, head of health practice at Genesis Analytics, and a member of the evaluation team, agreed, saying: “Overall, the implementation of the pilot interventions had mixed successes across the pilot districts. None of the interventions can be considered failures in and of themselves, as all were implemented at scale and reached lots of people. However, there were important lessons to be learnt.”

Teams often lacked the envisioned composition, with many of them lacking outreach team leaders. Data collection was insufficient to adequately monitor the effectiveness of the referral systems and follow-up processes

Earlier this month, the NHI Bill – which lays the foundation for providing mandatory healthcare services – was adopted by Cabinet.

And on Thursday, the much-anticipated Presidential Health Compact, aimed at repairing the country’s ailing public health system, was signed by President Cyril Ramaphosa.

Speaking at the Board of Healthcare Funders’ 20th annual conference last week, Mkhize also announced other processes under way in getting the NHI off the ground.

These include the establishment of an NHI Implementation Unit and a Health Patient Registration System by the end of this financial year.

In addition, 30 managers at the forefront of NHI will leave the country in the next four weeks to get exposure to, and learn about, universal health coverage in the countries implementing it, including the UK, Japan and France.

The NHI will be implemented in three phases, each lasting five years.

The Public Health Strengthening Report assessed phase 1 of the project, which ended in 2017.

The report, finalised at the end of last year, looked at nine parameters of interventions under the NHI.

These included assessing the municipal ward-based primary healthcare outreach teams, who were responsible for providing and promoting healthcare to households; the integrated school health programme; the contracting of general practitioners (GPs); and the ideal clinic realisation and maintenance model.

Regarding ward-based healthcare, the report states: “Teams often lacked the envisioned composition, with many of them lacking outreach team leaders. Data collection was insufficient to adequately monitor the effectiveness of the referral systems and follow-up processes.”

Regarding the school health programme, the report found that 4.3 million pupils have been screened through the programme since 2012, and that 504 803 of them were found to have various health problems and were referred for treatment.

However, the report also states: “There is a lack of data to support the effectiveness of the referrals and a lack of feedback mechanisms between school teams and facilities. A lack of sufficient equipment, such as measurement scales and transport to travel to schools, often impacted on its success.”

The report also found that 330 GPs were contracted by the end of 2017/2018.

Where this had been done successfully, it was clear that there was improved access to doctors at facilities – and patients reported that the quality of care had improved at facilities because of their presence.

Read: SA's wasted millions could have been spent so much better

But, states the report: “Inadequate monitoring of these GPs caused some challenges during implementation. Unforeseen contractual challenges ... resulted in GPs having substantially higher expense claims than expected.”

With regard to the ideal clinic model, 3 434 clinics were assessed. Of these, 1 507 attained ideal clinic status at the end of 2017/2018.

But the changing manual and frequent change of standards made it difficult for managers to keep up, the report found.

Health director-general Precious Matsoso said the department had followed up with some of the clinics which had dropped in status to see where they needed help, in accordance with the report’s recommendations.

Johnson said the determining factors in those clinics that recorded successes were strong political will, sufficient staff, good coordination and communication, and good monitoring systems.

But these factors were absent in the projects that had performed poorly.

He also attributed their poor performance to a lack of resources and insufficient mechanisms to monitor progress.


What do you make of the pilot phase of NHI? What do you think needs to be done to make it efficient?

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