We are determined to prove that the NHI is affordable – Cyril Ramaphosa – DOCUMENTS

President says the government is determined to work together to overcome our dual health system



24 AUGUST 2018

(Check at delivery)

Program director, Minister Michael Masutha,

Minister of Health, Dr. Aaron Motsoaledi,

Ministers and Deputy Ministers,

Prime Minister of Gauteng, Mr David Makhura,

MECs and members of legislature,

Health professionals,

Leaders of trade unions,

Leaders of civil society organizations,

Leaders of community organizations,

All major stakeholders in the health sector,

Ladies and gentlemen,

I greet you and I'm glad I'm here

We have convened this important national health insurance meeting with you, as representatives of various stakeholders in our healthcare, to engage in a dialogue about the current health situation in our country.

More importantly, we want to emerge from this meeting, in which we have jointly reflected on and exchanged ideas about the proposed reforms in the legal and regulatory framework of our healthcare system.

Finally, this meeting offers us the opportunity to broaden the consensus on the core principles that the NHI will define.

We have achieved a lot in ensuring access to health care for our people since the beginning of democracy in 1994.

We abolished the apartheid structures of the health care system, rolled out facilities for primary health care in areas where they were most needed, and carried out an effective fight against HIV and AIDS.

We have also done a lot to drastically improve the social and political determinants of health care – including the almost universal supply of clean water to millions of poor people, decent education and the provision of social subsidies to poor households.

The global community marked the end of the Millennium Development Goals era with the adoption of sustainable development goals in 2015.

The SDG goal for health clearly indicates that we have the responsibility to:

"Achieve universal health insurance, including financial risk protection, access to essential essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for everyone."

It is inconceivable that anyone could claim that every South African does not have access to health services based on need and not on their ability to pay.

It is therefore the duty of a democratic and progressive government to develop a policy that ensures that every South African has access to high-quality healthcare – and not just the rich.

This is particularly important in our country with a leveraged two-tier health system that is supported by unequal distribution of resources.

The National Health Insurance is meant to ensure that all our people, black and white, rich and poor, receive the quality health services they need without having to face financial hardship.

Our people must have access to an extensive range of health services, including prevention, treatment, rehabilitation and others.

These services – regardless of who they deliver – must be of good quality.

More recently, the Office of Health Standards Compliance submitted a shocking report to the Portfolio Committee on Health in the parliament, which indicated that the health facilities inspected on average satisfied less than 50% of the required quality health standards.

This is completely unacceptable.

To address the challenges in this report, we need to use this meeting to exchange ideas on how we can address the serious shortage of key workers, such as doctors and nurses, and support staff such as radiographers, carriers and others.

Our health professionals, who are the backbone of public health care, have often indicated that they are overworked and exploited as a result of staff shortages due to the exodus of their colleagues to the private sector.

We must accept the reality that the quality of service can not be improved by a tired and demoralized workforce.

The challenges related to the shortage of medical equipment and the beds of the theater and intensive care units in our public hospitals also require urgent attention.

The massive backlog of operations in our hospitals due to the dysfunctionality of our operating rooms must also be addressed.

Our doctors should not be put in the cruel position of having to fight with each other, trying to convince each other who should be operated first, and implicitly, who should die.

We have to change this situation.

We need to be clear that the resources needed to provide high-quality health care represent investments rather than consumption, especially if you consider the benefits of a healthy population and a productive workforce.

When the NHI was brought to the table ten years ago, some were quick to reject it as a "priceless dream".

But Nobel Laureate Amartya Sen strongly agreed.

He stated that the NHI, if well designed and managed, is affordable.

This is an opinion with which we agree and we are determined to prove it.

Achieving universal health coverage is not just about spending more money.

We must ensure that these resources are used efficiently and fairly to scale up the provision of quality health services for all, with adequately trained and motivated health professionals, and to transform the health care system to meet the needs of all our people.

We provide a transformed health system that will not only have better health outcomes, but also one that will save money for individuals, households and the country as a whole.

We must leave behind the age of quality care and be the exclusive domain of those of us with deep pockets.

The NHI therefore also fundamentally talks about social justice.

Providing universal and high-quality health care for everyone is not just a matter of moral principle.

It is also a financially responsible decision that will save a lot of money and at the same time keep our people healthier.

We need to build on the strengths of the public health system that, in spite of the ongoing challenges, helped to improve the life expectancy of our people, turned the tide in our fight against HIV and AIDS successfully, and rolled out the massive health infrastructure we now have in the whole country.

The NHI can and will be a success.

We are a country that spends R420 billion or 8.5 percent of domestic health care funding.

This is more than any other country with an average middle income and it is very close to advanced economies such as the United Kingdom and Canada.

We have decided to cover the whole country incrementally.

This means that from 2019, once the bill has been adopted, we will start implementing the NHI step-by-step and by 2025 everyone will be covered.

We are determined to work together to overcome our dual health system, which is the main obstacle to achieving a universal health system.

Finally, I would urge all our health professionals and general employees in the health sector to understand that the provision of high-quality health care – and thus the success of the NHI – is literally in their hands.

I urge all attendees to do our utmost to encourage South Africans to adopt a healthier lifestyle and prevent them from becoming ill.

We must emphasize that basic health care starts with individuals at household level.

Our collective approach to healthcare as a society must be preventive rather than curative.

I hope that this consultation meeting will facilitate the necessary partnerships between the various sectors of our society vis-à-vis the NHI.

Without all sectors of society that work together, we will not be able to build a healthy and successful society.

Let's build a social compact for access to high-quality healthcare for everyone.

Let's build the NHI.

Thank you.

Published by the Presidency, 25 August 2018

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