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Western Cape warns NHI will bring ‘deep uncertainty’ over provinces’ role

THE Western Cape’s head of health has warned that the National Health Insurance (NHI)Bill introduced deep uncertainty about the role of provincial health departments and could diminish the money available for service delivery. The long-awaited bill unveiled last Thursday by Health Minister Zweli Mkhize is the first piece of enabling legislation for the government’s plans to implement universal health coverage, which promises to provide services to everyone free at the point of care. The government hopes its reforms will resolve the deep-seated problems in the public health service, which is hobbled by corruption, staff shortages, dilapidated infrastructure and weak management, and it intends drawing on private sector resources to create a more equitable system that is used by everyone.

A draft version of the bill was released for public comment a year ago and was approved by the cabinet in July. The bill’s provisions affecting the role of provinces appear to bemuch the same as those set out in the draft version released in June 2018, despite concern previously raised by Western Cape officials and expressed in a Treasury letter toPresident Cyril Ramaphosa’s adviser, Olive Shisana, in November. The bill sets outprofound changes in the role of provincial health departments, by amending chapter 4 of the National Health Act, which states their responsibilities.

It further provides for the removal of many of their functions, diverting most of their budgets to a centralised NHI fund and moving the oversight of specialised hospitals to the national government. Specialised hospitals offer the most sophisticated care and provide training for specialists. The bill specifies that the NHI fund will purchase services from accredited hospitals, and with contracting units for primary healthcare that are to be overseen by a district health management office set up at national level. The units will determine the healthcare needs in their subdistricts.

Western Cape head of health, Beth Engelbrecht, said her concern is that there will be a fragmented system, that accountability will be a challenge and that the complexity of the administrative processes in a province will be very difficult. She said the Premier and provincial government will have much less capability to influence the well-being of local communities, because they will be depending on somebody in Pretoria to buy services. There was no formal consultation with the provinces in the National Health Council (NHC), a structure that includes the top officials from the provincial and national departments, MECs, the Minister and Deputy Health Minister.

However, the Health Minister’s spokesperson, Lwazi Manzi, said the NHI bill was servedbefore the NHC on several occasions where it was discussed during the fifth administration. Provinces were fully aware of the implications of the NHI policy and bill. It is completely untrue that the NHI policy and bill were not discussed with provincial

colleagues. Manzi said the bill had been discussed with the NHC on July 25, and it would be tabled again at its next meeting. Another provincial head of health, who asked to remain anonymous, said the bill was presented to the NHC by Mkhize after it was approved by the Cabinet.

Tamar Kahn: Business Day

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