Detailed NHI plan expected at mid-term budget


According to last year’s mid-term budget address, 132 billion rand was allocated to South Africa’s healthcare sector budget for 2013.

This would include public and private healthcare sector infrastructure and necessary improvements ahead of the implementation of the National Health Insurance (NHI) scheme.

Poor public healthcare services however continue to add strain on the industry, and those seeking private healthcare at the receiving end of significantly high costs.


Minister of Finance Pravin Gordhan’s mid-term budget speech on Wednesday will be just one of the many avenues South Africans will be looking to for answers to the future of the healthcare sector.  

“I don’t think we have a problem in terms of the funding and the amount of money being spent on public healthcare in South Africa. We should be able to provide sufficient care to the majority of the population with the money that’s currently being spent,” Mariné Eramus, head of the Health Economics unit at Econex, told ABN Digital.

“I think the core of the problem is definitely related to infrastructure. The Department of Health is doing a lot to at least determine the extent of what is going on.”

Laying the foundation of the NHI

South Africa’s medical costs are said to be among the highest in the world, and the National Health Insurance plan will be a progressive effort in making healthcare affordable and accessible to all.

Such a large-scale implementation could however take more than 10 years to fully implement and start running.

“It’s truly a very large system that you’re trying to implement. The development and the implementation of the systems that are required to run insurance schemes like the National Health Insurance take years to implement, to train people, to find the right people. These things do take time to develop and to train the appropriate staff that will also be needed,” Erasmus explained.

The World Health Organisation (WHO) recommends that countries spend at least 5 per cent of their GDP on healthcare. South Africa has already spent 8.5 per cent of its GDP on health, which is way above what WHO recommends.

The expenditure is a clear indication of the growing demand for quality healthcare, and the failure of the public healthcare sector to provide adequate medical and health assistance.

The case of South Africa’s poor

Despite free clinic and primary public healthcare access, South Africa’s poor and rural dwellers are among the population in dire need of adequate healthcare that the NHI is expected to provide.

“It will depend on how they [government] implement it. It’s a very necessary project but if we implement it in a certain way, it’s not going to benefit rural areas,” said Rural Doctors Association chairperson Desmond Kegakilwe.

“If you pilot it in urban areas, and take that as if it’s going to work, it’s not necessarily going to work in the rural areas because the challenges aren’t the same.”

According to research commissioned by the department of labour in 2004, the doctor to patient ratio stood at seven per 10,000 patients, an indication of a growing crisis.

Provincially, the Western Cape ranked at the top of the list, with 14 doctors per 10,000 patients, closely followed by Gauteng with roughly 12 doctors per 10,000 patients.

Limpopo and the North West province were among the lowest, with roughly one to two doctors per 10,000 patients.

“In relation to the budget, the rural provinces get less money than the urban provinces, and our observation is that the money doesn’t go to where it’s needed. It goes to the developed provinces,” Kegakilwe explained.

NHI green paper, which was released in 2011, outlined the county’s largest healthcare project to date.

Gordhan’s address on Wednesday is nevertheless expected to shed more light on South Africa’s next step to provide a remedy for those constantly swallowing the bitter pill of difficult access to healthcare.

“We want to know from the budget, is it not going to burden the poor and people living in the rural areas, that are already strained in terms of accessing healthcare?” said Kegakilwe.

“Any strain that you put on them is going to be difficult to access healthcare.”