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Universal health coverage (UHC) is central to achieving the targets of the global sustainable development agenda, and is defined by the World Health Organization as "ensuring that all people can use the promotive, preventative, curative, rehabilitative and palliative services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship".
This embodies three intertwined objectives: equity in access to health services, high-quality health services and financial risk protection. South Africa's National Health Insurance (NHI) is conceived as a protective financing mechanism to enable full access to health care which is open to all individuals based on their health needs rather than their ability to pay.
The NHI model is designed around the pooling of financial, human and technological resources to achieve optimal health service delivery in line with global best practice. There will continue to be much debate around the feasibility and prospects for the success of NHI as a funding model in our setting. However, there is no question that our highly unequal society urgently needs a high-performing health system that places patients at the centre. Therefore, vital to the success of NHI will be the implementation of a sustainable funding model which takes into account South Africa's socio-economic realities and prioritises and rewards efficiency and effectiveness.
The National Department of Health has piloted and rolled out various interventions to prepare the country for full NHI implementation, beginning with re-engineering primary health care (PHC). These interventions have been introduced over the past decade to improve the point at which individuals, the family and community first come into contact with the national health system.
As the country moves forward with NHI implementation, strong primary health care services need to remain the heartbeat of the public health system. The four streams of PHC — municipal Ward-based Primary Health Care Outreach Teams, the Integrated School Health Programme, District Clinical Specialist Teams, and contracting non-specialist health professionals — need to be continually monitored, evaluated, adapted and adequately resourced to ensure that they form the strong foundation for universal health care access that NHI seeks to deliver. In addition to these four streams, the Ideal Clinic Realisation and Maintenance initiative, introduced in 2013, seeks to improve the infrastructural integrity and performance standards of health services at PHC level.
The success of NHI will depend on regulatory bodies and other innovative health programmes reaching full maturity. As an institutional component, the Office of Health Standards Compliance routinely monitors and evaluates public and private health establishments to assess their compliance levels in order to set high standards of health care. Innovations such as the Central Chronic Medicine Dispensing and Distribution programme enable stable patients to collect their repeat medicines from convenient pick-up points near their home or place of employment, thereby reducing facility workloads and patient waiting times and improving the efficiency of health services.
The extensive debates on NHI as a vehicle for attaining universal access to quality health services have elucidated the significant transformation that will be necessary in the functioning of our health system. These discussions bring additional meaning and significance to the pledge by 193 member states of the United Nations, including South Africa, in adopting the 2030 Agenda for Sustainable Development in which "no one will be left behind". This pledge is a commitment to provide the greatest protection to the most vulnerable in our society.
Achieving UHC through NHI will require considerable resolve and political commitment and an evidence-based health systems approach, delivering better return on investments in the country's health services in order to make this fundamental right a reality for all of South Africa's people.
Dr Themba Moeti Chief Executive Officer of Health Systems Trust
Posted: 29 November 2018