South Africa has embarked on a bold and new direction with its National Health System following the publication of its green paper on the Policy on National Health Insurance (NHI) on the 11 August 2011. The NHI intends to ensure that everyone has access to appropriate, efficient and quality health services. It is expected to make public health care more accessible and affordable. Pretoria’s current system is under immense pressure and is in desperate need of improvement. The full implementation of NHI in South Africa is expected to take 14 years before its complete.This will entail major changes in the service delivery structures, administrative and management systems.
Currently, the expenditures in both private and public sectors are roughly the same (about R100 billion each) and together makes up about 8.5% of GDP but the inequity is in the coverage. The private sector serves 16% of the population whilst the public sector serves the rest (84%) of the population who are largely poor and black. The NHI policy green paper contends that the two-tiered system is unsustainable, destructive, very costly and highly curative or hospi-centric.
Furthermore, South Africa also faces a huge burden of disease aptly called the quadruple burden of disease made up of HIV/AIDS and TB, maternal and childhood diseases, non-communicable diseases and violence and injuries. This is further compounded by the problem of a shortage of key human resources in the health sector and in particular the public sector.
Currently South Africa has a two tier system which consists of public health care and private health care. NHI will introduce a one tier system, but there’s still little clarity on how it will work.