National Health Act, 2003 (Act No. 61 of 2003)

Notices

National Health Insurance Policy towards Universal Health Coverage

Chapter 1 : Introduction and Background

1.2 Background and Historical Context of Health Care Financing Reforms
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14. South Africa has endeavoured to implement health financing reforms over the past 89 years through: (a) the 1928 Commission of Old Age Pension and NHI; (b) the 1941 Collie’s Committee of Inquiry into NHI; (c) the 1943 African Claims that proposed equal treatment in the scheme of Social Security; (d) the Dr Henry Gluckman National Health Services Commission of 1943 to 1944 proposal for NHI15; (e)The Freedom Charter as adopted by the Congress of the People in 1955; (f) the 1994 Ministerial Committee on Health Care Financing; (g) the 1995 Ministerial Committee of Inquiry into NHI (Broomberg and Shisana Report); (h) the 1997 Social Health Insurance Working Group; (i) The 2002 Committee of Inquiry into a Comprehensive Social Security System (the Taylor Committee); (j) the Ministerial Task Team on Social Health Insurance; and (k) the 2009-2014 Ministerial Advisory Committee on NHI.

 

15. The Charter on Health under the 1943 African Claims in South Africa had advocated for major transformation of the health system under the British colonial rule.

 

16. Another key milestone in the evolution of the transformation of the health system in South Africa was underpinned by the Reconstruction and Development Programme (RDP)16 in 1994, which provided a framework through which the health of all South Africans would reflect the wealth of the country.

 

17. Sections 27 as contained in The Bill of Rights of the Constitution, 1996 articulates the constitutional obligation on the State to ensure that everyone has access to healthcare services:

"Everyone has the right to have access to health care services including reproductive health care...…

The State must take reasonable legislative and other measures within its available resources, to achieve the progressive realization of each of these rights.

No one shall be refused emergency medical treatment".

 

18. The imperatives of the RDP and the Constitutional obligation to ‘take reasonable legislative measures’ resulted in the 1997 White Paper for the Transformation of the Health System in South Africa provided a framework for the country to develop health care financing policies that promote equity, accessibility and utilisation of health services, to ensure greater equity between people living in rural and urban areas, and between people served by the public and private health sectors within a single, unified national health system.

 

19. The National Health Act 61 of 2003 and amendments thereof, as well as the development of regulations to effect the National Health Act (NHA) have not gone far enough to establish a single, unified national health system and to develop health care financing policies that promote equity, accessibility and utilisation of health services and to ensure greater equity between people living in rural and urban areas, and between people served by the public and private health sectors.

 

20. The NDP proposes that an NHI system needs to be implemented in phases, complemented by a reduction in the relative cost of private medical care, improved quality and supported by better human capacity and systems in the health sector. If the above measures and other interventions are implemented, the NDP envisages that by 2030:

"South Africa will have a life expectancy of at least 70 years for men and women; the generation of under-20 should be largely free of HIV; the quadruple burden of disease will have been radically reduced compared to the two previous decades, with an infant mortality rate of less than 20 deaths per 1000 live births, and the under 5 mortality rate of less than 30 per 1000 live births".

 

21. Furthermore, the NDP envisions that by 2030 there should have been a significant shift in equity, efficiency, effectiveness and quality of healthcare provision and that universal coverage is available. The risks posed by the social determinants of health and adverse ecological factors should also have been reduced significantly.

 

22. The 89 year history outlined highlights that many efforts undertaken to establish an equitable, accessible unified national health system for the entire population, that would move South Africa closer to the goal of universal health coverage (UHC) based on an equitable health financing mechanism, have been unattainable.

 

23. It is thus imperative that South Africa implements NHI in line with the values of the Constitution and the provisions of the NDP, to achieve the goal of an integrated health care system that serves the needs of all, regardless of race, socio-economic status and ability to pay for services.