Executive Members of the Board of Health Care Funders, chaired by Dr. Clarence Mini;
The CEO of BHF, Dr. Humphrey Zokufa;
Members of the BHF from South Africa and the region;
Members of the private health sector;
Thank you for inviting me to address the Board of the Healthcare Funders 2012 Annual Southern African Conference which is being held here at the Drakensberg.
This is an important conference because it brings together the private sector industry, and in particular, it gives space to those who administer and manage medical schemes to discuss and debate key issues affecting private health sector as well as its interaction with the public sector. This is crucial given the changing landscape of health service provision and financing in the country.
The disparity in resource distribution between the public and private health sector and consequent inequities in access to care continues unabated. Mechanisms for addressing these disparities have so far not succeeded. A new approach is required to facilitate this and funding is certainly a means for accelerating better resource distribution.
South Africa has embarked on a path that seeks to achieve universal health coverage based on the principle that health is a public good and that social justice, equity and fairness should be the basis upon which health services are provided and financed. I am most certain that all of us gathered here today agree that in pursuit of this goal the State must exercise its Constitutional mandate to progressively realise this right to health care for all.
The continued fragmentation in the health financing system is a risk to universal coverage. This is because it creates unfair barriers to the redistribution of prepaid funds and for public funds it reduces their social protection potential. Evidence indicates that small pools and fragmented pools limit cross subsidy potential creating disparities in access to quality health care. For universal financial protection, the country must consider large and diverse pools that include people from different levels of socio-economic status, different age groups, different geographic areas and so on.
The African National Congress (ANC), as a ruling party, has the responsibility to ensure that barriers to access to quality health care for all are removed. The establishment of National Health Insurance (NHI) is a vehicle to achieve this goal.
At the recent Policy Conference, the ANC, having acknowledged the progress made in moving towards the implementation of NHI, agreed that the state should use state revenue to urgently establish a dedicated NHI Fund. The NHI Fund will be established as a single entity with appropriate governance and accountability systems. Part of this implies that the policy reforms that are implemented are appropriate and are accompanied by sufficiently transparent governance arrangements.
A single Fund will allow for government to exercise strategic control of key resources in the health sector and use them in a way that fairly benefits all South Africans. Evidence from other countries suggests that a single Fund will reduce the costs of administration because it will use its buying power to purchase services at a reasonable cost. This is necessary for the sustainability of NHI.
Furthermore, the Policy conference agreed that the ANC National Executive Committee (NEC) Subcommittee on Education and Health guide and oversee the government process of developing the White Paper and legislation on the NHI to ensure alignment of the governing party and the state.
The ANC has invited the public and stakeholders to contribute to its policies and those inputs were integrated into the policy documents for the conference. This does not imply that the ANC uncritically adopts inputs derived from consultation; where the inputs improve our strategy we do take them into account. For those of you who have given input to our policies, we thank you.
Mr chairperson, government has already made progress towards the implementation of the NHI, including the setting up of pilot sites in the 11 districts covering all provinces. The focus of the pilot districts is to test various components of NHI including the health service delivery platforms, private provider contracting models and improved health facilities management.
I must take the opportunity to emphasise here that the pilots are not conceptualised in an experimental manner where we test the feasibility of NHI. Instead they are being used as a mechanism to strengthen the health system and to create an enabling environment for the eventual establishment of the NHI Fund.
The initial phases of implementation also include the real-life demonstration of the key administrative and technical aspects of the NHI in selected pilot districts. The pilots are designed to be a real-life demonstration of the key administrative and technical aspects of implementing NHI so as to ensure the smooth roll-out of the systems as it matures and new information becomes available.
Furthermore, preparatory work in readiness for the full roll-out of the NHI has already commenced in the 11 pilot districts in the areas of improvement of quality of health services and infrastructure development. Efforts are being made by Government to address shortages of critical health professionals.
KwaZulu-Natal (KZN) has also been ardently implementing key interventions and activities as part of the preparatory work for the implementation of NHI. Taking advantage of the NHI pilot districts that were recently announced, which in KZN are Umzinyathi and Umgungundlovu, the provincial government decided to add a further district to focus on matters pertaining to institutional and organisational arrangements over and above the provisions of the NHI grant framework.
As part of the pilot process, we also have Inkosi Albert Luthuli Hospital and King Edward VIII Academic Hospitals testing components that focus on improving financial management capacity and systems.
Concerns has been raised that the policy is not detailed enough to assess the impact of the NHI policy on the health system. Let me assure you that in line with the Minister of Health's announcement in the government gazette of 2009, the Ministerial Advisory Committee is developing a NHI detailed plan that will provide more concrete information that will serve as a road map for implementation, monitoring and evaluation of the success of this universal coverage policy.
I would like to invite you to join hands with us as we continue to design the NHI plan that will fundamentally change the way services are delivered to ensure the system being developed is robust. Therefore, the theme of this year's event of "The Power of Now - Into the Changing Future", is appropriate in the current stage of health systems reform.
The topics covered in this meeting should help to bring a balance between the public and private sector, a key goal of NHI, We probably all agree that this country cannot continue to spend more than 8.7% of the Gross Domestic Product (GDP), about R258 billion and still fail to provide health care to all. For the public to use the publicly funded NHI services in the public and private sector, the quality of health services must improve. This can happen if we painstakingly improve each facility at a time before it can qualify for providing NHI services.
The private sector providers can play a vital role in improving service provision, provided they are prepared to offer the comprehensive services that NHI will require at a cost the country can afford. I am convinced that there are many here who are committed to making NHI successful.
With these few words, I will like to welcome you to the conference and hope that your deliberations will be fruitful. I also hope that when you leave this meeting you will have reached consensus on the type of private sector that will enable the implementation of NHI.