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Shopsteward Volume 27: Special Bulletin

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Media Centre  |  Discussion

COSATU and NHI : Provincial Capacity Building Programme 2015

1 July 2015

Political Context: Working Class

- Development must be measured beyond GDP
- Human Development must be prioritized, especially health indicators
- Constitutional Right to quality healthcare: Section 27
- Freedom Charter: “Free medical care and hospitalisation shall be provided for all, with special care for mothers and young children”
- COSATU Resolutions and Growth Path
- ANC Conference and Policy Resolutions 2012
- ANC election manifesto 2014

Socio-economic Context

- SA is rated number 118 out of 187 countries on Human Development Index (2013)
- Health outcomes are very poor when compared to other middle-income countries
- 8.5 % of GDP is spent on health; 5 % services 16% of the population; 3.5% services 84% of the population
- only 10.4 % of the African population had medical insurance and 75 % of the white population was on medical aid ( General Household Survey 2012)
- 63.4 % percent of the Africans used public health services; while 84 % of the white citizens used private facilities
- Commercialization and privatization are destroying the South African health system
- Commercialization= a practice that turns public goods and services into products for the sole purpose of generating profit.

Reasons for Poor Health Outcomes

- Public / Private divide

- Hospicentric health system

- Fragmentation : institutional and financial

- Commercialization

- Solution= National Health Insurance

The Economy and Universal Health Care

- Studies point out that there is a correlation between rise in life expectancy and rise in GDP
- Protects working class from poverty trap caused by high health expenditure
- Enhances financial freedom, working class can use financial resources for other economic purposes
- Comprehensive Social Security contributes to productive economic restructuring

Population Coverage

- All South African citizens and documented permanent foreign nationals qualify for health services provided by NHI

- Tourists, Short-term, and foreign students = compulsory travel insurance

- Refugees Act will guide provision for asylum seekers

New Health Paradigm: Primary Health Care

- Provided by both public and private health providers
- Dangers associated with using private providers: commercialization- Competition Commission Health Inquiry !!!!!!!
- Principles of PHC: preventative health system, decentralization, accountability, responsiveness, local needs
- Based on the following institutional arrangements:
- District Health Teams
- School Health Teams
- Municipal Ward Teams
- Restructuring the Hospital system

Institutions Supporting NHI

- National Health Fund( NHF) and Provincial Offices
- Pool Funds, Purchasing Power and Contract Management
- Office of Health Standards and Compliance ( OHSC)
- Inspections, Setting Norms & Standards, Accreditation, Ombudsman
- District Health Authority supported by NHF office
- Monitoring Contracts and Providers
- National Health Information System
- National Department of Health
- Policy Guidance, Health Services, Human Resource Development Strategy , Infrastructure

The Class Struggle :Financing NHI

- Three Sources: individuals, fiscus and employers
- Cost estimation: 125 billion by 2012; 214 billion by 2020 and 225 billion by 2025 ( NHI Green Paper 2011)
- Main expenditure target= 6.2% of GDP
- In 2010 over 227 billion was spent on health in SA.
- Green Paper (2011) includes: co-payments, investigation into multi-payer system, but silent on VAT. Opposes tax subsidies

COSATU’s View: 2012 Resolutions

- General Revenue financed by taxing:
- high-earning self-employed individuals
- progressive contribution tax,
- high-earning individual taxpayers
- contribution by employers
- There must be no additional levies through VAT
- There must be no co-payments as those who can afford to pay will have paid through employee taxes.
- Tax subsidies to the private sector must be ended.
- The NHI Fund must be publicly-funded and administered with no outsourcing of administration.
- There must be no investigation into multi-payer systems

Key Actions to Support NHI

- Effective State Regulation of Prices in Private Sector = Competition Commission Inquiry
- Rapid introduction of PHC
- Pilot Projects monitoring and evaluation
- Rapid introduction of support system to improve Standards and Quality
- Infrastructure support for NHI
- Human Resource: Revival of Nursing Colleges and Engaging Health Faculties
- Moratorium to be placed on using state funding for private facilities
- Stop outsourcing in the health sector
Centralization of the contracting and license systems.