Read the Conversation

EF: In your opinion, what do you think 2022 is going to be a year of?  

NC: A year of reform and seriousness on healthcare matters. It is time we start treating COVID as an endemic disease, by integrating vaccines and care patterns in the current healthcare system. We must leverage on the lessons learnt during the pandemic, especially for Africa and strive to stabilise our health care systems, cut our dependency on the west, and hopefully head towards normalcy.  

EF: What direction is healthcare in South Africa taking, and what are the challenges?

NC: Though faced with challenges, we have been able to administer over 37m COVID-19 vaccine doses. South Africa is an unequal society, and this is reflected in the healthcare system as well. It is important for the public to practice caution and we’re looking forward to accommodating Covid-19 vaccination, like all other vaccines into the healthcare service routine. This is a route that should maintain the awakened need for collaboration and accommodation of stakeholders in the healthcare sector in countering repetitive endemic diseases such as measles and polio.  

EF: How has the pandemic impacted the roadmap to implementation of the NHI?  

NC: Firstly, no man is an island, and we need to recognise everyone’s role in the health system. We have allowed a rift to develop between the private and public sectors over the years. One of the biggest lessons of the pandemic is finding a definitive avenue to accommodate each other from both health sectors and work together against a common enemy, the pandemic.  

Second, we are very behind digitally. We had to repurpose our architecturally comprehensive digital systems into a vaccines system, a move that has enabled us to vaccinate over 36 million doses and record everything on a single system. This is proof that teamwork between the private and public sectors can be productive.  

EF: Will the private and public collaboration last?  

NC: This is a collaboration that would yield returns despite there being some scepticism cutting across the two fronts of the public and private sectors. Fiscal federalism is another aspect where interpretation of our constitution has created a barrier to moving patients between provinces, making it difficult to get equity in the public sector.  

Around 20% of the population relies on the private sector but many are unable to sustain their healthcare in that space. many patients end up scrambling to raise funds to pay for care, including selling property to accommodate themselves in that space before reverting to the public sector, an instance we want to stop. About 16% of the population is routinely dependent on the private sector, spending half of the country’s healthcare expenditure whereas the Lion’s share is paid for through prepaid care.

However, 80% of the population is dependent on the public sector. During the pandemic, it was estimated that over 500,000 people lost their jobs, and this meant losing medical scheme cover. Violence and HIV are further challenges to the already constrained public sector whose budget was cut by 1.5%. The private sector is looking after general care using specialist resources, raising the cost of healthcare, and limiting access to these specialists for public-dependent patients who need their care.  

EF: What are the biggest factors affecting the transition to more service to the public?  

NC: First, our national health expenditure is 8.5% of GDP on healthcare which is a lot for a developing and transitioning country. It is therefore important to spend what we can efficiently as this is all we can afford. We need a reform that allows us to work together. Second, revenue being spent on duplication of services also creates a route to unnecessary expenditure.  

Third, we need to embrace digitalization to avoid the loss of patients’ records, medical information, and history. In the private sector, a lot is spent on the administration of 76 medical schemes that utilizes over 250 different packages, which complexity raises the cost of medication, something replaceable with a handful of medical schemes that should fund what cannot be provided by our constrained public service.  

Healthcare is not an industry but an equal contributor to the economy and if not invested in, healthy educated people, you will not have growth. Health is a public good.

EF: How will the NHI benefit society and the economy in the long term?

NC: NHI will reform the health system by registering every person to their nearest primary healthcare space within a contracting unit for primary healthcare. Since we will know geographically where you live it will be possible to monitor access and equitable spending on benefits for all. The aim is equity in access to services for everyone regardless of who you are or where you get treated. If each person’s data can be collected and viewed in their constituents’ capitation area it becomes easier to use strategic purchasing to achieve equity.  

There are at least 40 countries globally busy with massive transformations equivalent to ours which are aimed at universal health coverage. We have a gap to fill and a journey to segue towards productivity and healthcare systems strengthening; TB, HIV, GP contracting, and infrastructure strengthening.  

EF: What are some policies that will complement fundamental changes needed in the future?

NC: Basic education is the avenue to better chances of participating in the economy. As we purpose to craft a future of hard-working, skilled, individuals, we need to deregulate and make the envelope of the small economy bigger. We also need to narrow the gap in what people earn between the rich, the lower middle class and the poor.  Many drivers of the economy were hit hard by the pandemic, but it is an inequity that will destroy our country.  

We must digitalize the way we manage the health system and reduce manual activities to halve the burden on our scarce professionals. We need to embrace innovation in the products that we make. We can use the magnificent, powerful arms industry that we used to have and repurpose those capabilities for health and find our own solutions instead of copying the way other people practice their endeavours.

June 2022
South Africa