Monday, August 22, 2011

South Africa's Proposed Health Care Reform

South Africa is spending 8.5% of her GDP on healthcare expenditures and continue to have inequity health system, plagued with inefficiency. Their health care system has been described as "unsustainable, destructive, very costly, and highly curative". They are expected to live seven years shorter than Tanzanians, despite the fact that Tanzania's expenditures in healthcare is much less comparable to SA's. This is not a surprise; the legacy of Apartheid is the creation of one of the most en-equal society in the world.

To that end, it seems like folks in SA Ministry of Health are parting ways with donors influenced disease control programs and are overhauling the entire system. Their plan is ambitious, with some unanswered questions--but it is a bold and much welcomed change. Details of the proposed reforms are outlined in this 59 pager policy paper released by SA-MOH. Quick reforms that stands out--

  • Creation of National Health Insurance (NHI) modelled from UK's NIH (what Americans call socialism ). NHI will be the sole provider and payer of health expenditure in SA. It will make sure everybody has access to a defined "comprehensive package of healthcare services'". NHI will definitely help control the escalation of cost and there will be rationing of care as well. NHI eventually will transform the way health services are provided, managed, and increase priority towards primary health care.
  • Ideally, NIH being the sole funder--will be able to pool and reallocate the funds in a more egalitarian fashion, and revitalize public health sector that will vastly improve access, and will regulate for the higher quality of care.
  • Foreign students, tourists, and visitors will be required to show health insurance prior to entry in SA. (potential impact on tourism industry?)
  • Re-engineered primary healthcare system focusing on community outreach with an eye on health promotion and preventive measures. They need to look at Ethiopia's Health Extension Workers, who are attributed to a revolutionized rural health in Ethiopia.
  • School health services. This is a simple and effective way to improve child hood health.
  • Over 14-year implementation period, the overhaul will cost $17 billion (Same price US spend in Afghanistan in 8 months). It will be funded by taxes--which raise concerns for a country with 24% unemployment. It might be regressive to bombard the tiny middle class with extra taxes. I wonder how rich folks feel about that.
You can check out the rest of the proposal on the link above. I think it is the right direction towards improving health systems in low-mid income countries. We have to get away from the PEPFARs and the Global Funds and tackle the problem at its core--which is the messed up system. Tanzania should pay close attention on how this thing is being implemented, we need our own reform. Besides, healthcare is one of the few industries that continue to add jobs in this economic climate. It makes sense to reform now.

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