SA is forging ahead with its biggest post-apartheid healthcare reforms despite the lack of evidence from its multibillion-rand pilot programme that the scheme will work, a report obtained by Business Day shows.
National Health Insurance (NHI) is the government’s fiercely contested plan for achieving universal health coverage, which envisages establishing a central fund that will purchase health services on behalf of all patients from public and private sector service providers.
The NHI pilot site evaluation report, commissioned by the department of health from Genesis Analytics, is likely to draw criticism from some quarters including the DA, which has said NHI is being laid on a shaky foundation, and the Free Market Foundation think-tank, which argues that the plan will push up taxes and harm the economy.
Monitoring and evaluation
The government allocated R4.9bn between 2012/2013 and 2016/2017 to 10 NHI pilot sites, which were tasked with improving public health services in some of SA’s most deprived districts. But the project was set up with no clear monitoring and evaluation framework, making it virtually impossible to gauge its effect and determine whether the government got a return on its investment, says the report.
Many of the initiatives that were implemented in the NHI pilot districts — such as the school health programme to screen for hearing and vision problems, a decentralised system for dispensing chronic medicines, and a clinic upgrade programme — were introduced nationwide, making it difficult to determine whether the extra resources poured in to the pilot districts had an effect.
The lack of baseline measures and variation in performance indicators made it difficult to identify trends over time.
It also found that the project had insufficient mechanisms in place to enable the government to monitor progress and correct things as they went wrong, and that it failed to collect vital data.
For example, it found that while the school health programme did a good job identifying children who had faulty eyesight or hearing, no data was collected on referrals, and there was no way of assessing whether children got the spectacles or hearing devices they required.
The department of health’s deputy director-general for the NHI, Anban Pillay, said the pilot was not set up as a randomised clinical trial, and the qualitative feedback provided by the evaluation offered useful insight from the people on the ground. "Such experiences are always helpful in assisting us to reflect on what works and what does not, and for course correction," he said.
The report highlighted underspending of three grants used to direct funds to the NHI pilot districts: only 76% (R380m) of the R502m NHI direct grant was spent; 84% (R2.1bn) of the R2.5bn NHI indirect grant was spent; and 83% (R1.6bn) of the R1.9bn health facility revitalisation grant was spent.
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