National Health Insurance (NHI) is the key health policy of the South African government. It is aimed at realising everyone’s right to health care as set out in Chapter 2 of the Constitution (the Bill of Rights).
A Government Gazette set out the basic principles of the NHI in 2009:
- it is a Constitutional right that the public has access to affordable and acceptable quality health services;
- it is the responsibility of the State to ensure the progressive realisation of the right to health for all South Africans premised on Universal Health Cover; and
- health services must be funded in an equitable manner that promotes social solidarity’.
It proposed to establish an “integrated, prepayment-based health financing system that effectively promotes the progressive realisation of the right to health care for all’’.
Since then, the Department of Health (DoH) has put out a Green Paper and two White Papers, proposing a National Health Insurance Fund (NHIF) to pay for everyone’s health services. This is known as a single-payer system. In such a system, people who access needed health care don’t have to pay the service providers directly. Instead, the NHIF pays public and private providers to deliver the service.
The money for the NHIF comes mainly from progressive taxation. The rich and healthy (who need the least health care while they are young) make the biggest contribution. In this way, they cross-subsidise health care for the poor. This is the key pillar of social solidarity – one of the foundations of the NHI policy. It is based on the principle that health is a public good and a fundamental human right.
There is good evidence to show that tax-based, single-payer systems and strong government leadership are essential for the implementation of Universal Health Cover.
Progressive civil society organisations and public health experts, including the People’s Health Movement South Africa (PHM-SA) and the Treatment Action Campaign (TAC) responded to the Green and White Papers and expressed support for these government proposals.
However, powerful private sector corporate groupings oppose the principle of health as a fundamental human right. They believe that health care is a profitable commodity to be delivered by markets and they are strongly opposed to the single-payer system.
Unfortunately, the DoH seems to have bowed to these corporate interests. It has set up seven implementation structures with strong representation from corporate interests. One of these structures is tasked with advising on the establishment of five separate finance mechanisms in the NHI.
This amounts to effective corporate capture on our NHI. If we allow this to happen, it will perpetuate inequity in health care for generations to come. Poor people, who need most health care will have the least access, while the rich, who on average need less health care, will get the most. The historic opportunity to promote social solidarity and heal the nation will be lost.
In this context, PHM-SA is campaigning for a “People’s NHI” — an NHI that puts people before profits. Our main partners in this campaign are the Treatment Action Campaign (TAC), SECTION27, Rural Health Advocacy Project (RHAP) and Lawyers for Human Rights (LHR).
Through this campaign, we hope to bring together other civil society groupings and movements to establish a broad social movement for people’s health. For more information, please see the articles below.
If you would like to become involved in the campaign for a People’s NHI, please contact Anneleen de Keukelaere at email@example.com.