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Media Centre  |  COSATU Speeches

Opening address by the COSATU 2nd Deputy President Comrade Zingiswa Losi at the NHI Workshop held at Centurion, near Pretoria

19 May 2016

Deputy General Secretary of COSATU, Cde Solly Phetoe
Leadership of the CEC of COSATU
Officials of Unions and Officials from COSATU
Cde Dr Aquina Thulare from the Department of Health
Dr Meshack Mbokota

Our discussion on the National Health Insurance [NHI] must proceed from an understanding that National health Insurance is part of our struggle to ensure decisive state intervention in the economy in favor of the working class.

The discussion about the NHI is therefore a discussion about constructing a developmental state that clearly does so on behalf of the working class and the poor.

The state should establish a pharmaceutical company, to ensure the availability of affordable essential medicines

In the expansion and upgrading of infrastructure, the state should minimize and where possible eliminate the profit motive, build internal capacity and should reverse reliance on Private-Public Partnerships

The state should reverse the process of casualisation of support staff, outsourcing and the use of labour brokers in the healthcare system-these do not support decent work and do not facilitate skills development and career development.

The state should build the capacity of clinics to successfully deal with health problems, as a means to minimize referrals and thereby reduce the burden on hospitals.

The state should ensure that clinics and hospitals have reliable back-up energy support and have a focused renewable energy initiative

This discussion is about responding to the state of health system in South Africa which is currently characterized by high levels of Staff shortages which is a factor that plays a significant role in mortality rates in hospitals

The discussion is about availability of medicines, including improved efficiency in the link between warehouses, hospitals and clinics.

It is about Infrastructure backlogs: The need to extend physical infrastructure, including beds and linen.

It is about inadequate systems including the ICT system, the Management systems and administrative support

This discussion is about availability of equipment because some of our provinces do not have equipment to treat certain conditions.

The fact of the matter is that all these challenges have generated high Maternal mortality and Child mortality.

As a result of these challenges not being addressed there remains a disconnection between national policy and the allocation of resources, management information systems are insufficient for decision-making, and decision-making powers are generally incorrectly located (a hospital CEO doesn't meaningfully control staff, budget or procurement).

Under-regulation of the private health sector and over-concentration of resources

There is clearly insufficient regulation of the private sector, though even this profitable sector is facing serious challenges.

It is for this reason that as COSATU we were amongst those who supported the 10 point plan.

The discussions about the implementation of the NHI must acknowledge that there are huge backlogs in the health system and these require a well-thought out strategy in which the direct creation of decent work to deliver quality health care and to expand access is a priority.

In addition, the strategy should clearly articulate with industrial policy, and thus contribute to the promotion of the industrial structure that is proposed in the new growth path. Specifically, because healthcare is one of the principal human rights and should not be subjected to profiteering, the workshop must explain what will be the role of co-operatives in the implementation of NHI.

We come here worried about some who have sharply raised the issue of the funding of the NHI we think that now the discussion is more about implementations this matter of funding will no longer be an issue.

Conservative and neo-liberal economists have argued that the country does not have adequate financial resources to implement NHI and yet studies have shown that this policy will decrease overall health expenditure from the current 8.5% percent to just above 6% by its full implementation in 2025.

The current health expenditure in the country exceeds the amount required to introduce the policy. The cost estimates in 2011 amounted to R255 billion by 2025.

We hope that the issue of funding as an obstacle will not even arise in this workshop.

Our view as COSATU with regard to the funding of NHI is the following:

a) NHI must be funded via general revenue, taxes on high-earning self-employed individuals, payroll linked progressive contribution tax, tax on high earning individual taxpayers and contribution by employers.
b) There must be no additional levies through VAT
c) There must be no co-payments as those who can afford to pay will have paid through employee taxes.
d) Tax subsidies to the private sector must be ended.
e) The NHI Fund must be publicly-funded and administered with no outsourcing of administration.
f) There must be no investigation into multi-payer systems.

With regard to the human Resources issue as COSATU we have always said that the human resource challenges in the health sector is primarily caused by the skewed public/private divide. The development of a legitimate and efficient national strategy on human resource is integral for the successful implementation of NHI. This strategy must be supported by the following actions.

Firstly, it must prioritize the right to social equity and universal access to health care.

Secondly, it must not be driven by human resource financial considerations only.

Thirdly, it must be based on the ILO definition of decent work. This specifically applies to the status of community health care workers, and other "mid-level" care workers.

Fourthly, all vacancies in the public sector must be filled and outsourcing of services in public health facilities should be halted immediately.

Fifth, the refurbishment and expansion of the nursing training colleges must be a national priority.

It is also important to regulate and exercise oversight over the function of private health professional colleges.

Lastly, the government must improve the status of health faculties in historically black

We are very clear that our overriding drive is to support the government in its drive for a successful implementation of the NHI with public sector health care workers at the forefront of this support;

  • Improve training on NHI through workshops,
  • Continuously engage the department and propose measures for dealing with challenges,
  • Ensuring that our public sector members take full responsibility for the NHI in order to guard against the private sector hijacking it,
  • Educating our members about the benefit of the NHI as means of insuring that they jealously defend it from attacks by those with vested intents in maintaining the status quo,
  • Develop a coherent provincial capacity building programme and to participate in the Competition Commission's inquiry into private health care costs.

We have done almost all of these things what is left is to take the process of the implementation of NHI through to its logical conclusion

We want to see the NHI implemented in our life time.