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NHI far from reality but progress made in improving public health

One common medical aid for all South Africans, as envisaged by government’s proposed National Health Insurance (NHI) scheme, is many years away, but many of the country’s 10 pilot sites are making progress.

Newly revived school health programmes  have already screened over 280 000 learners for eye, ear, dental and nutritional problems.

Newly revived school health programmes have already screened over 280 000 learners for eye, ear, dental and nutritional problems.

But most of the 10 NHI pilot districts – with the exception of OR Tambo in the Eastern Cape – are making reasonable progress to improve the public health, according to a Health-e News investigation.

The most immediate success is the school health teams, which have already screened over 280 000 learners for eye, ear, dental and nutritional problems.

The pilot districts, covering 20 percent of the population, were set up almost five years ago after Health Minister Aaron Motsoaledi announced the NHI as government policy.

While the White Paper to map out how NHI will be introduced still has not been released, health department spokesperson Popo Maja says “the consultation process and the drafting of the White Paper have reached an advanced stage and it is anticipated that the document will soon be tabled in Cabinet”.

The NHI is revolutionary in its aim to unite public and private healthcare resources into a single healthcare scheme so that all South Africans have equal access to quality healthcare.

Daily horror stories about patients’ experiences in public health facilities led government to concentrate on cleaning its own house before attempting any marriage with the private sector.

NHI gives school health a shot in the arm

”People believe that the NHI is some creature that they must see, like they see when we build a hospital but it’s not like that”

The NHI pilot districts are test-driving new approaches to improve health delivery particularly at primary level in Tshwane (Gauteng), OR Tambo (Eastern Cape), Thabo Mofutsanyane (Free State), Vhembe (Limpopo), Gert Sibande (Mpumalanga), Pixley ka Seme (Northern Cape), Dr Kenneth Kaunda (North West), Eden (Western Cape), and Umzinyathi and Umgungundlovu (KwaZulu-Natal).

Patients living in the pilot districts are starting to experience better health services, thanks mainly to the introduction of:

  • School health teams, including nurses at schools and mobile vans to test pupils’ eyes, ears and teeth;
  • Ward-based outreach teams staffed by nurses and community health workers who go door-to-door, particularly intent on ensuring the health of pregnant women and children under the age of five and educating people about healthy living;
  • District clinical specialist teams, made up of health experts that support health workers, particularly clinic nurses.

Reporting on the screening of learners, Motsoaledi said “about one-third of (learners) had at least one of the three problems – eye sight, hearing, oral hygiene”.

“They need somebody to do something about it but when you check for (specialists) they are not available for them in the public sector, they are all in the private sector for the well-to-do,” Motsoaledi told a recent meeting in Johannesburg.

Before Eden District began piloting the NHI, the Garden Route had no school health staff outside George and no outreach services to rural schools. In their first year, Eden teams screened more than 12 000 students for health problems.

Mpho Modzai (left) used to walk Mamelodi's Nyaope Road looking for a hit, now he walks it as a community health worker trying to bring health out of clinics and into communities.

Mpho Modzai (left) used to walk Mamelodi’s Nyaope Road looking for a hit, now he walks it as a community health worker trying to bring health out of clinics and into communities.

NHI teams take health to the streets

The ward-based outreach teams are trying to find those vulnerable to sickness before they need to be hospitalised and encourage them to go to clinics for check-ups.

In Tshwane, Mpho Modzai and Phillipine Thulare have joined more than 1 000 community health workers in the district’s 75 ward-based outreach teams. The pair criss-cross Mamelodi, including the township’s infamous drug-laden Nyaope Road, educating people about healthy living.

North West recently bought 300 bicycles to assist members of its 78 ward-based outreach teams. In Mpumalanga, 52 ward-based outreach teams have been kitted out with uniforms, name tags and vehicles to reach about 28 000 households.

Meanwhile, the district clinical specialist team is working best in Tshwane, which has been able to employ specialists including a paediatrician and gynaecologist to assist with treatment of more complicated patients.

This team has almost tripled the percentage of mothers seeking early antenatal care, rolled out better infant care and helped to start HIV-positive babies on antiretrovirals, according to the Department of Health.

Chronic medication schemes decongest clinics

Some districts, including Eden and rural Umzinyathi, are piloting a novel scheme of decentralising the delivery of chronic medicine, allowing stable patients, including those on antiretrovirals, to collect their medicine from places more convenient than clinic pharmacies, including schools and private pharmacies.

253 private doctors have also been contracted to work part-time in pilot districts

A total of 253 private doctors have also been contracted to work part-time in the pilot districts, mainly in government clinics. Tshwane is leading the recruitment, with 80 extra doctors on its books.

“The common challenge that many districts continue to face is the availability of health professionals, particularly for the very disadvantaged areas,” Maja tells Health-e News. “Capacity constraints at the district management level also impacts adversely on the performance of some districts.”

Mfowethu Zungu, the NHI KwaZulu-Natal provincial co-ordinator, says changing the mindset of healthworkers is also difficult.

“We think we must get the sick to come to us and we will give them medicine. But we want to change the mindset from curative to preventative health, so we have to go to them,” says Zungu.

Costing a health care revolution

“South Africans believe that this is a short distance run but it’s a long distance one”

While the weak economy means that there is little spare cash for such a massive undertaking, Finance Minister Nhlanhla Nene has promised that Treasury would soon release a “discussion paper on financing options to accompany the NHI White Paper”.

In its 2012 Budget Review, the Treasury estimated that the country would need an extra R6 billion for the roll out this year.

But Maja says “no one can clearly determine what NHI will cost” because it would be “inaccurate and misleading” to “base the costs on the current health system that is hospi-centric and curative”.

The aim of what Motsoaledi calls “the primary healthcare revolution”, is to prevent sickness rather than cure disease by reaching the vulnerable in their homes and at clinics, before they need much more expensive treatment in hospitals.

But Motsoaledi has cautioned that it will take 14 years before South Africans begin to see tangible results of the move to NHI.

“The problem is that people believe that the NHI is some creature that they must see, like they see when we build a hospital but it’s not like that,” he said. “South Africans believe that this is a short distance run but it’s a long distance one.” – Health-e News.

*Reporting by Kerry Cullinan, Sibongile Nkosi, Laura Lopez Gonzalez and Ayanda Mkhwanazi

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