Activists from the above mentioned movements, various grassroots organisations and health committees discussed the way in which the proposed national health insurance scheme can be a vehicle towards overcoming the extreme inequality that exists in our health system and for bringing about a single health system based on primary health care principles.
South Africa’s spending on health care amounts to 8.5% of GDP which is higher than even the United Kingdom. Yet, 60% of healthcare expenditure goes to 14.8% of the population who have access to medical aid. Between 2000 and 2006 the medical industry raked in R6.9 billion from its members. 70% of all doctors work in the private sector servicing just 16% of the population and just 30% of doctors that work in the public sector are required to look after the health needs of 40 million South Africans. This situation is even worse for medical specialists, dentists, pharmacists, therapists etc. where the vast majority work in the private sector.
A major issue of concern raised during the course of the seminar was the lack of information and secrecy with which the state is dealing with the NHI. Currently all discussions take place within the ministerial advisory committee and all members have had to sign a confidentiality clause. Participants called for government to immediately make available information on their NHI proposals and to engage with popular movements over an issue which can be regarded in terms of life and death.
Participants called for the end to privatised healthcare for profit. And some suggested that the big healthcare monopoly corporations should be nationalised including the medical aids and their administrators.
After hearing inputs on the terrible conditions of service of community health workers, especially those who undertake home based care, there was a call that these health workers should be regarded as a key component of rebuilding a primary healthcare system and that they be employed by the state with decent wages and conditions.
Another call popular with participants of this seminar was for the unfreezing of all posts in the public health system and for the expansion of training and skilling of health workers including the re-opening of nursing colleges.
An important issue that was highlighted in relation to the NHI was that the social determinants of ill-health, such as housing, access to services, water, sanitation and nutritious food, must be simultaneously dealt with if South Africa was to deal with the quadruple burden of ill-health, namely, under nutrition, infectious diseases affecting young children and maternal health problems; HIV/Aids and TB; non-communicable diseases; accidents and injuries.
In this regard the NHI should not be seen as a panacea but as a first step to rebuilding our health system.
Participants agreed, based on the inputs from Tebogo Phadu from the African National Congress (ANC) and Sheila Barsel of Nehawu/Cosatu that the promise of an single-payer NHI which provided universal access, did away with user fees, provided comprehensive benefits and was funded on the principles of social solidarity where the rich subsidised the poor, would be an important step forward.
The call by TAC general secretary Vuyiseka Dubula for popular movements and organisations to unite in a coalition for an NHI that is part of building a unified national health system on Primary Health Care principles was strongly endorsed by the gathering. AIDC, together with the other organising groups was asked to convene this coalition as soon as possible.