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The Congress of South African Trade Unions warmly welcomes the announcement by Zweli Mkhize, chairperson of the ANC's Health sub-committee, that a national health insurance scheme will be implemented for all South Africans from 2012.
The 2009 COSATU 10th National Congress and the ANC 2007 Polokwane Conference passed resolutions calling for urgent implementation of a comprehensive national health insurance scheme, and we are delighted that this is now becoming a reality.
The scheme - to be implemented over 14 years - will guarantee a full range of healthcare services to everyone, regardless of their ability to pay, and is intended to make some private-sector facilities available to people currently denied access to private hospitals.
At last we are about to remove one the biggest barriers to access to health by the poor - money. Apartheid had a fundamental and negative impact on people's health and the organisation of the health system in South Africa. That terrible legacy, despite many achievements in our health care system, continues to this day.
As a result the health profile of the population has deteriorated. The life expectancy of South Africans dropped from 62 years in 1992 to 50 years in 2006. Although we rank 79th globally in terms of GDP per capita, we rank 178th in terms of life expectancy, 130th in terms of infant mortality, and 119th in terms of doctors per 1000 people.
The situation seems to have worsened since 2006. The life expectancy of a black South African stands at 48 years, according to the South African Institute of Race Relations survey in 2009.
Mortality and morbidity rates are unacceptably high; preventable communicable diseases are common, and diseases associated with extreme poverty still occur. The HIV/AIDS epidemic has become the country's most formidable health challenge, with rates of infection among the highest in the world.
At the same time, a wealthy minority suffer from lifestyle-related diseases more typical of developed countries.
At the heart of all these damning statistics is the two-tier, wasteful healthcare system, which consists of:
§ A public health service which treats health as a social need, yet starved of adequate funding and resources. Less than 40% of total health care resources are in this sector, yet it serves 85% of the population, the majority of whom are black and poor.

§ An expanding private sector, which treats private healthcare as a business. It accounts for more than 60% of the total healthcare resources, including majority of health professionals (other than nurses), yet it serves a minority of the population, the majority of whom are white and wealthy.

The private sector creates a market-driven private health care system based on avoiding the sick: medical schemes and private providers compete not so much by increasing quality and lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to the under-funded, under-resourced public health system.
To achieve a universal, comprehensive, free national healthcare system, founded on the primary healthcare approach, requires a well-funded and well resourced funded public health system.
Only within the framework of the NHI will our government and people will have enough capacity to:
§ Build an optimal, unified free and comprehensive health care system;

§ Build on the current government efforts to end racial and geographic inequalities in the current two-tier health care system, through effective planning, rational investments and equal distribution of health resources.

COSATU calls on government not to be distracted by some economists and commentators, driven by the private-sector agenda, who say the NHI won't be affordable. We agree with Comrade Mkhize that "given the financing resources that South Africa commands, NHI is affordable", and as he so rightly says, "given the state of healthcare in South Africa, we cannot afford not to have a national health insurance scheme".
The federation will work with government in order to make sure that workers in the private sector are not affected negatively by the transition to the NHI.