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CIVIL SOCIETY AND THE NHI PROCESS – AN OPPORTUNITY FOR ENGAGEMENT

Combinations of poverty, racial and social inequalityand a history of neoliberal policy decisions have contributed to the poor state of the health system in South Africa. For a country that boasts the highest GDP on the continent, we have very poor health indicators and face massive inequalities in access to health care. The HIV/AIDS & TB epidemics, a growing burden of non-communicable diseases, and high rates of injuries and fatalities, mean that South Africa faces a quadruple burden of disease and our health system is in a state of crisis. Close to half of government funding is spent on 16% of the population in the private sector (facilitated through tax credits), whilst the other half of funding is directed towards the remaining 84% of the population in an overburdened public sector.

This crisis has come firmly under the microscope, with the Department of Health proposing a National Health Insurance (NHI) as a potential solution. This proposal has been critiqued from different quarters. For example, civil society groups have sought answers to questions about equity and access, while the private sector has pursued a ‘tax payer narrative’ that heavily criticizes the need for increased resource allocation in the public sector for those who need it most.The prevailingviews in the mainstream mediafocus on the spectre of higher taxes and question the government’s ability to spend efficiently and responsiblywhile casting doubt on the affordability of the NHI.
What should we focus on in a pursuit for a healthier, more productive nation and how can we attain important milestones like the Millennium Development Goals? While government spending, mismanagement and accountability are important in such discussions, what is conspicuously absent in public debate is therecognition of the significant threat to health and development in South Africa if we do not invest in the NHI.
For starters, let’s talk about NHI specifics. While there is a lack of detail in the green paper, there is a much wider research base from around the world to argue for an NHI in South Africa. First and foremost, the proposed NHI is about achieving a universal health system. As Di McIntyre, Health Economist at the University of Cape Town explains, this means two things, 1) everyone enjoys financial protection from high health costs and 2) everyone is able to access good health services when they really need them. Moreover, as the World Health Organisation has repeatedly highlighted, health is not just about the absence of disease, but requires inputs both to health care and to the goods and services needed for good health – what are called the social determinants of health – such as clean water, sanitation and access to nutritious food.
It is undeniable that the political and social conditions in South Africa, questions about corruption, and hostility towards civil society action, have undermined public trust. . These concerns should not be put aside in conversations about the proposed NHI. However, unless we reframe the debate to one about values, vision and goals, as well as how health systems transformation can achieve these goals, we will make no impact on saving lives and improving the quality of life for most South Africans.
As McIntyre, states “The NHI is a process, not an event”. The Department of Health has allocated a long term implementation timeframe to the full realization of NHI related services, meaning that there is ample time for a dialogue as the proposed reforms unfold. The NHI Green Paper is admittedly weak in many areas, including, but not limited to, implementation and structural details. For example, there is no recognition of the complexity of the human resource mix needed to provide equitable access to health care for all South Africans in the policy. This is a model based on expanding access to doctor-based, hospital-centricm curative care, such as that dominant in the USA. This will not work for South Africa; nor is the policy clear on the place of the private sector, or on mechanisms to prevent corruption. Nonetheless, while the DOH has been heavily criticized for these weaknesses, it also must be seen as a positiveopportunity for civil society, concerned citizens and health system workers to contribute, engage and debate the future of South Africa’s health system.
The National Health Insurance Civil Society Coalition (NHICC) is aiming to facilitate public engagement and re frame this discussion around the NHI as a debate about how best to achieve universal coverage. The kind of health system South Africans need in South Africa will be the focus of a National Health Assembly taking place on July 5 and 6 at the University of the Western Cape preceding the third People’s Health Assembly (PHA3) hosted by the People’s Health Movement (PHM), which begins on the evening of July 6th.Participants will include grassroots activists from communities around South Africa, policy makers, interested citizens, government officials and interested delegates from around the Globe who will be in Cape Town to attend the PHA3.
These events are respectively intended to play a catalytic role in rebuilding, re-energizing and unifying health civil society in South Africa, and across the broader global health community. Using the proposed NHI as a platform, the National Health Assembly is an ideal event from which to build momentum and mobilise civil society engagement in the NHI process and towards universal coverage in South Africa.
The overall objectives of the National Health Assembly are to mobilise a mass movement promoting the right to ‘Health for All’ and to foster a progressive, responsive National Health Insurance plan led by civil society.For too long, civil society has been demobilised in the new South Africa – and that passivity is also to blame for the state we are in. By agreeing on an agenda and priorities for building universal access to quality health care among health activists in South Africa, the NHI Coalition will plan a campaign to realize the priorities agreed upon at the NHA and put the initiative back with civil society to hold government to account.
Themes at the assembly include:
Social Determinants of Health ( e.g. food, sanitation, water, reproductive justice, work conditions)
Equitable and Comprehensive Health Care
Political and Economic Implications for Health System Transformation
Addressing health system challenges in both the public and private sectors requires greater co-ordination among stakeholders and between sectors. Encouragingly, dialogue is growing but several crucial conversations and actions have yet to take place, particularly if civil society is to be an active agent in making the right to health real. Without investments in both the health system overall and in government capacity to be accountable, transparent and responsive,South Africa will be unable to tackle our major health challenges. This will continue to have a debilitating impact on the economy, on public trust and on our capacity to achieve our national and global goals in health.It is time that ordinary South Africans took charge of their own destinies in health. Join the debate, join the action for equitable access!
To register for the National Health Assembly visit www.phmovement.org/pha3 or emailcoordinator@phmsouthafrica.org to request registration form before July 5th, 2012.
Registration Fees (Includes Access to Sessions, AGM & Lunch for 2 days):

Standard Fee: R100.00
Student & Unemployed Rate Fee: R60
Katherine Austin-Evelyn
Coordinator of PHM-SA

About Jodi Le Roux