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Towards a People’s National Health Insurance!

On 5 March 2018, the People’s Health Movement South Africa (PHM-SA), Treatment Action Campaign (TAC), SECTION27 and Rural Health Advocacy Project (RHAP) met for a workshop to learn more about National Health Insurance (NHI) financing and to set up a national People’s NHI campaign. The first part of the workshop discussed the different options for NHI financing and organisation to develop a shared understanding of the key issues.

The NHI is an attempt to achieve Universal Health Coverage (UHC) in South Africa. There are two important underlying principles:

  • Universality (for everyone – entitlement of health care)
  • Social solidarity (building of finance pool for health care based on income and making use of health care services based on need)

The key issue in the South African context is that there are different understandings of universality. Medical schemes’ understanding of universality is that all should have some common basic access to health care but if one wants to pay more, one should be able to get more and better services. For others, universality means that all should have access to quality health services independent of one’s ability to pay. The Sustainable Development Goals (SDGs) support the latter interpretation with a strong equity component.

In a Government Gazette last year, it was announced that the transition to an NHI will be through implementing five different pools for different categories of the population. Each of these five groups (formal sector employees in large companies, formal sector small companies, the self-employed, government employees, and the unemployed) are likely to start off having different health care benefits under the NHI. This goes directly against the idea of universality. Once these different tiers are established, it will be impossible to undo them and the idea of social solidarity becomes impossible in this scenario.

During the meeting, it was recognised that there was a big gap between where the health system is currently and where the NHI would like to take it, so a staged transition is necessary. But it was emphasised that such a transition should not put in place structures completely against the principles of UHC, or structures that will be difficult to integrate in the idea of a comprehensive NHI at a later stage.

At the end of the meeting, it was agreed to embark on a People’s NHI campaign, including provincial NHI awareness trainings, while exploring an alternative transition for the NHI towards true social solidarity and universality!

About Estian Smit