Given the heated ideological divides among political leaders that have characterised SA’s debate over National Health Insurance (NHI), one might assume consensus on healthcare reform is an elusive dream. However, forming the government of national unity (GNU), which has brought together a broad spectrum of political views, has created a window for renewed engagement on the NHI and advancement of universal access to quality healthcare, as mandated by section 27 of the constitution.
The agreement between the political parties stipulates a commitment to expanding employment, economic growth and the constitution. It serves as a basis for renewed engagement on health reform and the mechanisms by which access to universal and quality healthcare can be achieved. Failure to seize this opportunity will result in prolonged legal battles over the NHI Act and again stymie urgently needed health reform.
Despite the political rhetoric, there is substantial common ground among medical practitioners, public health advocates, government and the private sector. Interviews with leaders within these sectors, conducted in the aftermath of the Covid-19 pandemic by Concentric Alliance and Section27, revealed significant opportunities for alignment across these sectors, unanimously agreeing that universal access to quality healthcare remains the overarching goal. This consensus underscores a critical need for healthcare reform that transcends political posturing and prioritises the health needs of all South Africans.
...any opportunities for collaboration are moot unless the deep distrust within the GNU and between the public and private healthcare sectors is addressed
Our research indicated that public discourse has oversimplified opinions into pro-NHI and anti-NHI camps. In reality, many stakeholders support the act’s fundamental principles while expressing valid concern about its implementation and scope. This nuanced perspective challenges the polarising narratives and highlights a spectrum of viewpoints that deserve thoughtful consideration in policy deliberations.
There remains concern about the mechanisms by which NHI will be governed, the powers allocated to the health minister and myriad other contentious issues within the act. Furthermore, the act has failed to address the structural issues within the health system: the huge inequalities in resources between the private and public health sectors and between urban and rural SA, the enormous skills shortages within the health system, the need to strengthen primary healthcare services, and the high costs of medicines and medical care in SA.
Many public health leaders and activists believe there is room for collaboration between the private and public sectors. Our research highlighted opportunities for transfer, leveraging private sector expertise in areas such as ICT, procurement and logistics management to strengthen public healthcare infrastructure. A collaborative approach could enhance efficiency and operational effectiveness within the NHI framework, paving the way for sustainable healthcare improvements nationwide.
However, any opportunities for collaboration are moot unless the deep distrust within the GNU and between the public and private healthcare sectors is addressed. There is an urgent need to establish confidence-building measures to bridge the trust deficit and foster effective partnerships. It is our view this could be achieved through two mechanisms.
In the short and medium term, stakeholders should pursue an objective-driven approach that sets achievable outcomes for the private and public sectors. These could be technical partnerships on specific issues such as logistics challenges within the health system or targeted at improved health outcomes, such as improved postnatal care. Achieving objectives collectively will demonstrate commitment to mutual goals and build trust.
In the longer term we recommend a consensus-building process to reconcile divergent perspectives and foster constructive dialogue without compromising fundamental beliefs. The purpose of such a process should be to address the health system’s structural issues and realise the achievement of section 27 of the constitution. Such a process must be political and technical. Technical leaders should be responsible for developing solutions to structural problems and political leadership reality-testing such solutions to ensure there can be buy-in and support for such solutions.
With the formation of the GNU a pivotal opportunity to advance the objectives laid out in SA’s constitution has emerged. This inclusive governance structure calls for a unified commitment to improving healthcare access — a mandate transcending partisan interests and personal agendas. Amid mounting challenges within the health system there is a palpable sense of urgency for reform. The repercussions of inaction could be profound, underscoring the critical need for stakeholders to engage earnestly and proactively in shaping the future of healthcare in SA.
• Currin is an executive director at Concentric Alliance.
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