NHI: key details

Here are the details of the NHI plan. By Mari Hudson.

NHI plan in a nutshell

  1. Every employed South African will have to contribute to NHI.
  2. Members can choose a primary health care provider from a list of accredited providers in the private and public sector in their district.
  3. Members will be allowed about three visits to their chosen clinic/GP per year. Visits to higher health care facilities and providers will have to be authorized, possibly from NHI headquarters in Pretoria. Otherwise members will have to foot the bill themselves.
  4. Private health care providers contracted by the NHIA will earn much less per patient than the medical scheme scale of benefits.
  5. Salaries, working conditions and management skills need to be improved. Expat health and managerial professionals must be attracted back to South Africa.
  6. The Cuban doctors programme will be revived.
  7. The state plans to manufacture its own drugs.

How the ANC wants the NHI to work:

On funding and access

  • The ANC’s NHI task team proposes that a ‘yet-to-be-established’ body called the NHI Authority (NHIA) will pool all funds from general taxes, a new mandatory pay roll levy and medical scheme contributions from GEMS and other public sector medical schemes, into a new government-controlled NHI Fund. This will be used to purchase health care services from the public and private sect
  • The employers’ and employees’ mandatory NHI contribution could initially be at a lower level than their current medical scheme contribution, but will gradually increase to the level of contributions currently paid by medical scheme members.
  • The NHI fund “will promote social solidarity through income and risk cross subsidisation.”
  • All South Africans will have equal access to equal health services – but these services should preferably be public sector clinics and hospitals, including those (more than 50%, according to an official audit) that do not meet the minimum accreditation standards.

On the new structure

  • The NHIA will receive funds from various sources, then pool these resources and purchase services on behalf of the entire population.
  • The NHIA will be run by a CEO who reports directly to the minister of health, and will be supported by an executive management team and specific technical committees (including a technical advisory, auditing, pricing, remuneration and benefits advisory committee).
  • The NHIA will be publicly administrated, will be “a public entity”, and “there will be no role for private intermediaries”.
  • The NHIA will have subnational offices at provincial and district levels. The district health councils and provincial sub-authorities will plan for infrastructure and service provision. The NHIA will then purchase these services on behalf of the districts.
  • “Significant improvement in managerial capacity” at district level will be key to the success of the NHI.

On service providers

  • The first choice in primary health care provision will be accredited community health centres and private GPs. Secondary, tertiary and quaternary levels of care will be provided mainly by public hospitals, but also by private specialists and private hospitals.
  • The ultimate objective is to secure provider payment for all accredited providers; risk-adjusted per capita payments for GPs, community health centres, clinics and others; and case-based payments for hospitals, salaried doctors and specialists.
  • “Given the current capacity constraints in the public sector and the need to reduce the disruption of services, budgets will continue to be used for both primary care and hospital level providers in the public sector, until such time as a facility is accredited,” according to the plan.
  • Out-of-pocket payments will only be made in exceptional circumstance.
  • There may be an element of better payments for increased performance.

On registration for NHI

  • Every South African will be registered for the NHI and assigned to specific health care facilities closest to them.
  • Everyone will receive a NHI card to show when they visited their assigned local primary health care clinic or GP.
  • All patient information will be on electronic patient records so that health authorities can plan according to need.

On the benefit package

  • The benefit package is comprehensive, operating with the current public health services as its benchmark.
  • Members will choose a primary health care provider from the list of accredited providers in the private and public sector in their district. They will be encouraged to use public sector facilities.
  • Members will be allowed about three visits to his/her chosen clinic/GP per year.
  • Members travelling outside their district, might be allowed to visit a facility, but this will be discouraged and only a limited number of visits outside the district will be permitted.
  • A member’s benefit package will comprise “comprehensive out-patient and in-patient care at public and private health facilities”, but it will be capped, and only authorised (possibly only by the NHIA in Pretoria) referrals to secondary, tertiary and quaternary levels of care will be allowed.
  • If a member visits any specialist or private hospital without authorised referral, he will pay out of his own pocket for the treatment.

On auditing and accreditation of facilities

  • The NHI plan proposes that a detailed audit of all public and private facilities in the country be conducted in order to establish the stock and distribution of these facilities.
  • “The credibility of the NHI will rest on the visible improvement in the provision of quality of services for all. All facilities, private and public, will be NHI accredited, based on agreed national norms and standards. The aim is to accredit at least 25% of facilities annually, over a five year phased period, until all facilities are included,” the document states.
  • But all public sector clinics and hospitals will be contracted by the NHI, even if they deliver services below the accreditation standards.

On human resources

  • “Comprehensive strategies for increasing the supply, quality, distribution, and retention of various categories of health workers in the country” should be implemented, the plan states. The funds will be used to fill vacant posts (more than 30% of doctors’ posts and between 36%-56% of current nursing posts are vacant), to create new posts (South Africa immediately needs more than 70 000 more health professionals, according to the Roadmap document) and to create new posts as nurses’ training colleges are re-opened.
  • Working conditions and salaries are to be improved in order to attract South African health and managerial professionals in other countries back to a “more efficient public health care sector”.
  • The Cuban doctors programme is to be revived. A new and large contingent of Cuban doctors is to be imported to fill vacant posts and so allow foreign nationals to practice legally.
  • Although the plan mentions occupation pecific dispensation for public service doctors, and President Zuma said the government was paying “urgent attention to the issues of remuneration of health professionals” to remove uncertainty in our health services, there is no mention of budget allocations for a 50% increase.
  • Private health care providers contracted by the NHIA will earn much less per patient than the medical scheme scale of benefits and these practitioners are expected to adhere to the NHIA’s prescribed treatment protocols.

On the shortage of drugs

  • ”There is also a need to implement the Polokwane Resolution to establish a state company to produce drugs as a means of reducing the cost of medicines,” the plan states.


 This is an edited extract of an article that originally appeared in What's New DOC, the magazine for doctors produced in association with Health24.

Read more:
The ANC's NHI plan

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