Understanding NHI Pilot and
review of achievements so far
27-02-2014
Presenter: Dr. Uma Nagpal
unagpal@nwpg.gov.za
NHI and what it means to common man
• To provide improved access to quality health services
for all South Africans irrespective of their capacity to
contribute.
• To pool risks and funds so that equity and social
solidarity will be achieved through the creation of a
single fund.
• To procure services on behalf of the entire population
and efficiently mobilize and control key financial
resources. This will obviate the weak purchasing power
that has been demonstrated to have been a major
limitation of some of the medical schemes resulting in
spiralling costs.
• To strengthen the under-resourced and strained public
sector so as to improve health systems performance.”
Understanding what is being piloted
Objectives relating to service delivery
• Reduce high maternal and child mortality
• Strengthen the performance of the public health
system
• Strengthen the District Health System
• To assess whether the District health service
package, PHC teams and strengthened referral
system will improve access to quality health
services - particularly in rural areas
• To assess ways of engaging private sector resources
for public purpose.
Understanding what is being piloted
Objectives related to pooling and purchasing, with
implications for future funding of PHC:
• To examine extent to which communities are
protected from financial risks by introducing a district
mechanism of funding
• To test ability of districts to assume greater
responsibilities - the purchaser-provider split
• To assess the costs of District Health Authority as
contracting agency
• Implications for scaling-up throughout the country
• To assess utilization patterns, costs and affordability
of implementing a PHC service package.
prerequisites to success of NHI
• Improving the quality of public health care,
• Lowering the relative cost of private care
• Recruiting more professionals in both the public
and private sectors, and
• Developing a health information system that
spans public and private health providers.
• These reforms will take time, require cooperation
between the public and private sectors, and
demand significant resources.
BACK TO BASICS
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WHAT NEEDS TO BE PILOTED
A defined service package of PHC services
Ward-based PHC outreach teams(WBOT)
District Clinical Specialist Support teams(DCST)
School health services
Sessional General Practitioners
Linkages to Emergency Medical Services.
A referral system to and from the district hospital.
Gate-keeping and compliance with the referral
system need to be piloted.
BACK TO BASICS
Twelve principles with which planners must comply in the
development of the District Health System:
• Overcoming fragmentation
• Equity
• Comprehensive services
• Effectiveness
• Efficiency
• Quality
• Access to services
• Local accountability
• Community participation
• Decentralisation
• Developmental and inter sectoral approach
• Sustainability
CHALLENGES
There are insufficient professional nurses, trained
midwives and PHC trained nurses in the public
health service to implement the re-engineered
PHC system.”
Without large-scale leadership development
activities which move beyond training, efforts to
re-engineer PHC, improve quality or implement
steps towards NHI will most likely achieve less than
what is intended
Improving Health care infrastructure
Physical infrastructure: This includes
• Clinics having adequate space, electricity and running
water
• Hospitals with enough beds and working equipment
• Roads and Vehicles to allow access to health care
• Laboratory service for conducting basic investigations
Human infrastructure of :
• Appropriate staffing levels
• Basic standard of clinical and public health
competency
• A level of morale, motivation and commitment to the
job.
Improving Health care infrastructure
Organisational infrastructure :that ensures, for
example, good working relationships between:
• clinics and hospitals
• nurses and doctors
• provincial and local government and
• for prevention of mother- to-child transmission in
particular, between maternal health programmes
and HIV programmes.
Improving Health care infrastructure
• Good health care infrastructure also means a
health system that allows multi- disciplinary frontline health workers to work as an integrated team
to address the specific health needs of a particular
area.
• A system capable of ensuring that the basic
logistics of a health service, such as medicine
supply and distribution, are in place.
BACK TO BASICS IN HIV & AIDS
• The health system's response to HIV includes
more than just anti-retroviral drugs. There are
many preventative strategies and vital treatment
requirements for HIV patients, and good basic
primary health care is in itself good for our HIV
health sector programme.
• Emphasis on “prevention is better than cure” is
required without undermining the need for ART
that will improve the life expectancy and quality
of life of our people living with HIV infection.
BACK TO BASICS
• Tuberculosis is not only an opportunistic condition
of HIV but one of the most potent accelerators of
the progression from infection to full-blown Aids
while sexually transmitted infections are
considered to be a potent co-factor for HIV
transmission. And yet on neither front can we say
that the health-care system is performing
adequately. Despite improvements seen in the
former we are far from the target. We should be
striving towards the general implementation of
mother-to-child-transmission prevention keeping
equity high on the agenda.
HIV & AIDS BACK TO BASICS
• To prevent the spread of the epidemic through the promotion of
safer sexual behaviour, adequate provision of condoms and
control of STDs, promote male medical circumcision.
• to protect and promote the rights of people living with HIV or
AIDS by ensuring that discrimination against such people is
outlawed
• to use the mass media to popularise key prevention concepts
and develop life skills education for youth in and out of school;
• to reduce the personal and social impact of HIV/AIDS through
the provision of counselling, care and social support, including
social welfare services for persons with HIV/AIDS, their families
and the community; and
• to mobilise and unify local, provincial, national and international
resources to prevent and reduce the impact of HIV/AIDS.
MCWH: BACK TO BASICS
• Maternal, child and women's health (MCWH) services should be accessible
to mothers, children, adolescents and women of all ages, the focus being on
the rural and urban poor and farm workers.
• MCWH services should be comprehensive and integrated.
• Individuals, households and communities should have adequate knowledge
and skills to promote positive behavioural related to maternal, child and
reproductive health.
• MCWH services should be efficient, cost-effective and of a good quality.
• Women and men be provided with services which will enable them to
achieve optimal reproductive and sexual health.
• District health teams' capacity for monitoring and evaluating MCWH
services will be built through training, and streamlining the health
information system. The focus will be on the use of data at all levels,
especially at the point of collection.
Nutrition programmes
• Nutrition programmes should be integrated,
sustainable, environmentally sound, people and
community-driven, and should target at most
vulnerable groups, especially children and women.
• Nutritional well-being should be promoted and
monitored within nationally-defined goals. There
should be clear nutrition information strategy.
Improving Delivery of Health Care
• This implies the need to move from one-size-fits-all
policies and plans to more appropriately targeted
planning and upliftment of health care from the
bottom up, rather than a top-down imposition of
development.
• We also need to raise the technical level of debate
through better analysis and understanding of
resource allocation and the relative costs and
benefits of different interventions within the
health care system.
I THANK YOU