Treasury officials have criticised the health department’s lack of detail about how it aims to transform public hospitals in preparation for the National Health Insurance (NHI) scheme.
“It is of concern that the NHI documents did not provide sufficient detail on a credible strategy for public hospital reform, with the exception of the important Office of Health Standards Compliance (OHSC),” according to Treasury officials Mark Blecher, Aparna Kollipara, Nomkhosi Zulu and academic Pieter de Jager.
The OHSC will set norms and standards for hospitals.
“It is important that government finds ways to deal with key flow blockages in public hospitals that lead to lengthy delays,” said Blecher and colleagues, writing in the latest SA Health Review.
Launched by the health minister in Pretoria yesterday (Thurs), the SAHR is an annual analysis of the state of the country’s health produced by Health Systems Trust.
Blecher and colleagues also said it was important for the health department to start exploring how to draw private providers, including GPs and pharmacies, into district health delivery – a critical part of the proposed NHI system.
District health authorities would have to be “strengthened” as they would be “budget holders in the new arrangement”, they add.
The NHI, which is to be introduced over the next 14 years in South Africa, aims to radically transform health services by bringing public and private services much closer together.
All taxpayers will make a common contribution to an NHI Fund that will enable them to claim “a comprehensive package of healthcare”.
Primary healthcare, rather than hospitals, are to be the foundation of the health services.
However, the Green Paper on the NHI has been widely criticised for its lack of detail on exactly how the NHI will be implemented.
Blecher and colleagues said a conditional grant from Treasury was likely to channel funds to the health department until an independent NHI Fund could be established.
Treasury would also release a discussion document “in due course” that would “lay out some options” for how the NHI could be paid for, including “payroll tax, personal income tax, surcharge, VAT”.
Although South Africa spends a significant amount on health, the country’s health system provides “low value for money”, argue Tracey Naledi, Peter Barron and Helen Schneider in another chapter in the SAHR 2011.
South Africa spends 8.6 percent of gross domestic product on health services, roughly the same percentage as Brazil, England and Italy – all who have better health outcomes.
“But this investment has not been translated into improved health outcomes,” argue the authors.
In fact, health outcomes such as infant mortality in South Africa have deteriorated in the past decade. The HIV epidemic and a weak primary healthcare system are largely to blame, according to the authors.
Many patients bypass clinics for basic health care and go straight to hospitals, which wastes money.
Staff levels at clinics have declined although spending on health personnel has doubled over the five years.
Last year, government launched its plan to “re-engineer” primary healthcare as part of its plan to bring healthcare closer to the people that is also cheaper to deliver.
PHC outreach teams are to be set up in each municipal ward in the country, made up of six community health workers per team, supported by a professional nurse and a staff nurse, and keeping an eye on the health of 1 500 households.
Nurses are also going to be reintroduced in schools as government tries to move from curing illness to preventing it.