Comments and suggestions - List of figures

Forty percent of respondents made comments and suggestions. The themes are discussed in order of importance as identified from the comments.

The government has management problems

The reason mostly cited as to why the NHI will not be a success is that the government will not be able to manage various aspects of the proposed NHI. This opinion is based on the fact that neither the government nor the Department of Health has been able to maintain the current public health system and ensure it is in good working order. Furthermore, according to them, the government also has shown that it cannot properly administer and regulate any state-controlled institution. According to some respondents, public hospitals and healthcare in the public sector used to be just as good and effective or even better than in private institutions. At present, finances are wasted and mismanaged, and there are shortages of staff, equipment and medication at many government institutions.

There is deep distrust of the government’s management and administrative abilities, and

consequently also of the NHI. Centralisation, corruption and a lack of transparency are pointed out as core problems.

• Alles waaraan die staat vat, word vrot. Denel, SAL, ESKOM, YSKOR, Hantering van waterprobleme, SANW, en nog meer. Daar is te veel korrupsie en bedrog teenwoordig en die kaders beskerm mekaar.

• Die hantering van enige sisteme- munisipaal, die gesondheidsorg tans, ESKOM - gee geen bewys dat die regering in staat is om die NGV suksesvol te loots en te bestuur nie. Daar is net te veel korrupsie en ondeursigtigheid.

• Die huidige regering kan skaars provinsiale hospitale en hulle eie GEMS ordentlik bestuur. Hoe gaan dit die NGV bestuur? Nee.. Hoeveel werk gaan nie verlore nie. Hoeveel mediese personeel gaan emigreer. Wat bly oor? Gemors spul! Die NGV beteken TOTAAL aangewese op die STAAT wat reeds in ALLE STELSELS KAPITULEER EN NET CHAOS SAL SKEP. GEEN DIENSLEWERING SAL GESKIED.

• Sentralisasie en magsbeheptheid kelder ŉ vinnige en effektiewe uitrol program van bv. inenting.

• Hierdie is die domste van dom dinge wat die regering nóg gedoen het. Daar is genoeg beskikbaar maar staat gesondheid personeel is swak opgelei en het ŉ swak werksetiek en word nie

verantwoordbaar gehou vir hulle aksies nie. Dokters kan nie vertrou word om te weet wat hulle doen nie en die verpleegpersoneel stel nie belang om meer te leer as wat hulle weet nie.

Opleidingstandaarde is kommerwekkend. Staats gesondheidspersoneel vat hulle mediese fonds kaarte en gaan sien privaat dokters omdat hulle self te treurig is om vertrou te word. Absolute wanbestuur van regeringsvlak tot by plaaslike bestuursvlak waarvan ek persoonlike ondervinding het. Die regering het genoeg geld om goeie gesondheidsorg te lewer maar hulle steel alles en weet nie hoe mens geld bestuur nie.

• Korrupsie, negatiewe houding onder personeel en swak bestuur sal beslis aangespreek moet word voordat daar sukses kan wees.

• Ek het geen vertroue in die regering om die NGV effektief en eerlik te bestuur nie en daarom is ek teen dit.

• Ons het NGV nodig maar huidige Departement van Gesondheid kan nie dit bestuur nie.

The NHI will not be a success

Most of the respondents believe the proposed NHI will not be a success. The main reasons for this are a lack of funds, staff shortages, lack of infrastructure and lack of expertise. The fact that a

small number of taxpayers will have to foot the bill for the high costs of the NHI, compared to many who will be able to make no or a very small contribution, makes the NHI unaffordable.

They believe it will not be sustainable and argue that national healthcare does not even work effectively in First World countries. According to them, a first-world concept cannot be applied in a third-world country such as South Africa, especially given the fact that current state-run

healthcare institutions are not properly managed.

The consequences and end-result will be that the NHI may weaken and eradicate (“doodruk”) the private healthcare market, as one respondent put it. The quality of medical care currently offered in the private sector will not be sustainable under the NHI. The public health care system as it had existed before 1994 was not maintained and could not be effectively built and

expanded upon. Currently, the infrastructure and care provided in state hospitals and clinics are of very poor quality and this makes people question how the government will be able to provide high quality healthcare to the whole of South Africa. According to them, it is impossible to expect that everyone should receive quality medical care for free.

There will also be legal obstacles in the way of the NHI, especially if there is a type of

nationalisation of private practices and other institutions. Respondents believe the proposed NHI is a waste of time and that it will not be able to get off the ground.

• RSA kan HOEGENAAMD NIE die NGV bekostig nie!

• Almal moet bydra tot die fonds anders kan dit nie werk nie.

• Dit werk nie eens in eerste wêreld lande nie. Hoe op dees aarde gaan dit ooit werk in SA?

• Ek as dokter het gesien hoe pensionarisse ure lank wag dat dokters hul moet sien en ure wag vir voorskrif medisyne en weke, maande en selfs jare vir nodige operasies.

• Ek het geen vertroue in die vermoë van die staat om so ŉ ingewikkelde gesondheid sisteem te hanteer nie. Dit gaan ŉ moordmasjien word en minderhede sal die stryd verloor!

• Ek was betrokke by ŉ streek waar die stelsel getoets is en dit het geensins gewerk nie.

• I do not believe that the healthcare system will survive in S.A. if this is implemented.

• I will close my practice when NHI is forced on me

• Kan nie sien hoe dit kan werk nie. DOH het gesondheidsdienste op sy knieë, NHI kan die nie red nie.

• Menslike hulpbronne is tans klaar ŉ probleem a.g.v. staat se langdradigheid met die implementering van nuwe opleiding curriculum.

• Staat ook nog nie nuwe hospitale gebou in die laaste 20 jaar nie. Hoe wil hulle dan NGV uitrol?

• ŉ Redelik goed funksionerende gesondheidsisteem gaan deur wanbestuur, korrupsie en

rassediskriminasie verwoes word en nooit weer herstel nie. Die eksperiment is onbekostigbaar en ŉ duidelike stap verder in ons totale ondergang.

• NGV is doodgebore

• Klasaksie sal ingestel word teen die Staat vir waarde van praktyk, sowel as vir verlies van inkomste, met inflasie, tot en met aftrede ouderdom.

• NGV sal die privaat sektor dooddruk.

• "The NHI will not work in practice as we do not have efficient, knowledgeable, intelligent, qualified leaders to handle this large project. At present it is impractical as most of the State hospitals - talking about the Eastern Cape - are not in a standard to give quality care to all.

• Privaat praktyke is geregistreer by SAID as besighede en SAID kliënte, dit kan dus nie genasionaliseer word sonder die goedkeuring van die eienaars en die SAID nie.

Corruption

The respondents do not trust the government to establish and manage the NHI ethically and reliably under any circumstances. Many respondents believe that the government easily will be able to gain access to the NHI funds for self-enrichment, abuse and misappropriation. Corruption is specifically referred to as a major obstacle in the management and roll-out of the NHI because

it is visible and endemic in every state-controlled entity. According to the respondents, corruption is one of the biggest reasons why the NHI will fail and become a huge financial burden for South Africa.

• As die huidige staatsgesondheid sisteem nie eers doeltreffend en sonder korrupsie hanteer word nie is daar geen kans dat die NGV enigsins 'n kans het om suksesvol te wees nie

• Corruption is my greatest concern.

• Die regering sal soos in alle ander omstandighede meer korrupsie pleeg en die land nog verder in die gemors laat beland.

• Die Staat se Gesondheid baanrekord is van so ŉ aard dat ŉ NGV gedoem is tot ŉ korruptiewe mislukking!

• Die swak fasiliteite en korrupsie in staatsinstellings kan nie anders dui as dat NGV 'n groot gemors gaan wees nie. As 'n eerste wêreld land soos die VK nie dit kan doen nie, wat dink ons gaan ons regering vir ons kan doen! Ek sal NGV ondersteun as al politici in 'n Staatshospitaal opgeneem word vir behandeling en in die ry gaan staan om hulle medikasie te kry (sonder sekuriteit personeel...)

• Dit gaan groot chaos wees en korrupsie gaan baljaar.

• Korrupsie, negatiewe houding onder personeel en swak bestuur sal beslis aangespreek moet word voordat daar sukses kan wees.

• ŉ Redelik goed funksionerende gesondheidsisteem gaan deur wanbestuur, korrupsie en

rassediskriminasie verwoes word en nooit weer herstel nie. Die eksperiment is onbekostigbaar en ŉ duidelike stap verder in ons totale ondergang.

• NHI is another licence to steal.

• Waar die ANC betrokke is, is korrupsie, diefstal en ongerymdhede. Hulle is NIE in staat om die NGV te hanteer nie!!!!!

Very concerned about the implementation of the NHI

The government’s intentions regarding the NHI are cause for concern and tension among the respondents. They are concerned that the implementation of the NHI will cause the entire

healthcare system in South Africa (which is already in a crisis and shaky) to collapse. They go so far as to say that it will drive the country “into the abyss” and that many skilled medical practitioners will leave the country. According to them, this will result in a major crisis for the country and cause another major mess as is the case with other state-owned institutions, and it will plunge the country even deeper into bankruptcy and paralyse the economy. People believe that the NHI must be opposed and fought at all costs. It will be extremely difficult for the government and the

Department of Health to gain the trust and co-operation of private and public healthcare practitioners because even before the implementation of the NHI, they are extremely distrustful, pessimistic, sceptical and negative towards it.

• Is Baie bekommerd oor toekoms van mediese sorg!

• Baie negatief!

• Die implementering van die NGV sal die laaste spyker in die doodskis wees. Meer belastingbetalers sal die land verlaat, waaruit wil hulle die NGV befonds? Is moontlik om toe te pas in eerste wêreld lande waar die meerderheid van die bevolking belasting betaal, nie in ŉ land waar so ŉ groot hoeveelheid mense afhanklik van die staat is en GEEN bydrae lewer nie en in ŉ land wat sit met staatsamptenare wat geld links en regs steel en korrupsie as die norm aanvaar word. Net nog ŉ plan om ANC stemme te verwerf en meer geld vir ANC politici om te steel en met duur Duitse motors rond te ry. Moeg vir hulle onuitvoerbare planne, daar is nie meer geld nie en niemand vertrou die

ANC meer met die bietjie geld wat daar nog is. Wil die belastingbetaler ontneem van goeie mediese sorg wat ons gelukkig darem nog vind in die privaat gesondheidsorg.

• Die NGV sal die land net verder oor die afgrond stuur met gekwalifiseerde mediese personeel wat die land gaan verlaat en die land se mense aan die swak mediese personeel oorlaat. Wat 'n verdere ramp vir die land gaan beteken. Niemand kan so 'n NGV in Suid-Afrika hanteer nie.

• Die NGV sal die land se mediese bedryf tot op sy knieë dwing. Dit sal lei tot "mediese toerisme" na eerste wêreld lande vir die wat dit kan bekostig en uitlewering aan die genade van 'n gewetenlose staat, vir die wat nie kan nie. Die NGV, soos al die ander sosialistiese programme van die ANC moet ten alle koste beveg word!

• Die NHI gaan ŉ totale gesondheid ramp wees wat sal uitkring na die ekonomie soos

gesondheidsorgwerkers die land gaan verlaat. Ons sal net dieper sink na 3de wêreldse land. Tragies

• Ek is bekommerd!!!

• Hulle stuur SA in die afgrond in met hierdie plan.

• South Africa is beyond repair.

First fix the current healthcare system

Many respondents argue that the government and the Health Department should FIRST overhaul and improve the management of the current healthcare system and GEMS. For them, it is illogical that this is not being done, because it will be cheaper and much more effective than to

implement a whole new system. Many respondents ask the question why government officials in particular do not make use of the state’s healthcare system, but rather visit the private sector or even go abroad for medical care.

There are even suggestions that the entire state health care system should be privatised and that there should be more support and encouragement for the establishment and expansion of private practices. They also argue that state medical facilities and services can exist alongside and in conjunction with private healthcare.

• Die regeringsamptenare almal sit met mediese fondse ... nie een is bereid om Staatsfasiliteite te gebruik nie. Hoekom?

• Die huidige regering kan skaars provinsiale hospitale en hulle eie GEMS ordentlik bestuur. Hoe gaan dit die NGV bestuur? Nee.. Hoeveel werk gaan nie verlore nie. Hoeveel mediese personeel gaan emigreer. Wat bly oor? Gemors spul!

• Die huidige stelsel van publieke gesondheid moet reggemaak word. Publieke gesondheid en privaat gesondheid m.a.w. ook mediese skemas moet langs mekaar kan bestaan.

• Die sisteem is so swak op die oomblik, dit kan regtig nie slegter nie. Ek voel dat die politici geen mediese fonds mag hê nie en dat hulle van Staats omstandighede gebruik moet maak. Maande wag vir 'n afspraak en dan word dit gekanselleer weens vervoer nalatigheid of 'n vol voertuig. Voel hoe dit voel dat jou kind nie geopereer kan word nie omdat daar nie narkotiseurs beskikbaar is nie en dat dit verseker nie beter gaan in hierdie jaar nie...

• Die staat kan nou nie eers die Staatshospitale en klinieke ordentlik bestuur nie. Die aan stuur van sake is meer bekommerd oor hulle eie gat sakke as die man op straat se gesondheid.

• Maak eers die huidige publieke gesondheidsorg fasiliteite reg, (soos wat dit was voor 1994) voor julle nog meer wil aanpak. Hoe gaan die Staat dit regkry om 100 mediese fondse se werk te doen en dit bedien net 9 miljoen mense? Wat nog van 59 miljoen?

• Verleen eerder hulp om klinieke uit te brei en ondersteun die skep van privaat praktyke vir dokters sowel as Verpleegkundiges en verlaag medikasie se pryse.

• Privatiseer die hele staatsgesondheidstelsel. Betaal privaatsektor die belasting tans spandeer op gesondheidsorg en almal in die land sal beter gesondheidsorg hê.

Cooperation with the private sector

For the respondents, the fact that the government and the Health Department do not encourage and speed up greater cooperation with the private sector, is a sign of incompetence, and it is also incomprehensible. There are existing healthcare models and institutions that function excellently, but no transparent cooperation or knowledge transfer takes place.

• Te min samewerking van regering met ander rolspelers in gesondheid.

• Vir my klinkklare bewys, weereens, oor die omvang van die onbevoegdheid in regeringskringe.

• Meer konsultasie met kundiges is nodig. Algemene publiek moet beter ingelig en betrek word.

Finansiële implikasies moet wyer ondersoek word en groter deursigtigheid is nodig.

• Privaat bestuur funksies deur bewese administrateurs behoort gebruik te word.

Gesondheidsdiensverskaffer behoort deel te wees van beplanning en beheer van alle dienste en moet geken word op alle vlakke.

• Wantroue word deur Departement van Gesondheid en privaatsektor permanent aangeblaas, geen opregte vennootskappe word gebou nie.

Healthcare practitioners from a wide field of healthcare professions participated in this research survey. The fact that results are verifiable with the previous two studies conducted in 2018 and 2019 confirms and reinforces the themes of negativity and opposition to the NHI.

Although most respondents do agree that healthcare in South Africa should be more accessible, of higher quality and cheaper for all, there are red flags, uncertainty and serious bottlenecks with regard to the proposed NHI.

One third of the respondents (29,5%) are nursing staff, while 19,4% are general practitioners. There are 7% who indicated that they are specialists and 21,4% who can be classified in the “other”

category of medical fields. Most respondents are employed in private practices or at private pharmacies and the pharmaceutical industry.

From 2019, the level of knowledge decreased from what it had been in 2018. During the Covid-19 pandemic, there was less visible pressure to implement the NHI, although comments were made from government circles that the pandemic did pave the way for the establishment of the NHI.

Dealing with the vaccination programme and the pandemic in general has confirmed to

healthcare workers that the NHI will not be a success. It is as if they, more than ever before, do not take the government seriously and do not believe it will work.

Since 2018, more than 90% of respondents in each of the three studies have been concerned about the state’s ability to manage and administer the NHI. They are also still concerned and sceptical about state interference in terms of the state being able to prescribe to them what their rates, protocols and place of work should be, and the fact that these measures could be

enforced. They are further concerned about the fact that their own choices regarding treatment, patient load and medication may be limited and that they and their patients will not have a choice as to whether they want to belong to the NHI or contribute to it or not. 86,6% of respondents believe that healthcare practitioners should work in their own practice or in the private sector.

There is great concern about a shortage of healthcare workers, especially nurses, doctors and specialists. Although slightly fewer respondents (6,3% less) indicated in 2021 that they have already taken steps to emigrate, and 5% less than in 2019 will consider emigrating when the NHI is

implemented, the loss of healthcare workers from South Africa remains a great cause for concern.

Most of the respondents (85,3%) are convinced that the implementation of the NHI will lead to healthcare workers leaving the country or their professions. Only 21% of the respondents indicated that they would be willing to work with the government to develop a sustainable NHI.

Only 15% of the respondents are of the opinion that the NHI can be implemented successfully, and 79% believe that the NHI has the potential to destabilise the healthcare system in South Africa.

Most (78%) also believe that the NHI will not improve service delivery or the current healthcare sector. They are also of the opinion that the NHI will not lead to all South Africans having access to quality and affordable healthcare (74,3%).

Although the respondents indicated that they would to some extent have the necessary infrastructure, administrative knowledge, professional knowledge and skills and support staff to adapt to the objectives of the NHI, 41% indicated that they would not be willing to accept lower

In document List of figures (pagina 21-28)