This report comprises the research conducted by the Solidarity Research Institute (SRI) as a follow- up study after two previous studies in July 2018 (n = 311) and in October 2019 (n = 651). While the 2018 study included only Solidarity members, questionnaires were sent to health practitioners in the private as well as the public sector throughout South Africa in 2019 and again in 2021. A wide range of medical professions has also been covered. The main purpose of this research is to determine health care workers' opinion, knowledge and ability to accommodate the NHI.
The NHI is an issue that seriously affects health practitioners and the general public. Although there are still many ambiguities and unresolved issues regarding the NHI, it is constantly expected that the government will use the Covid-19 pandemic to try to implement the NHI in an attempt to transform the economy. As part of Solidarity's continued opposition to the implementation of the NHI, the Solidarity Movement is ready with input and comments that are constantly being
provided regarding the NHI, and the Movement is prepared to consider legal action against the government should the NHI be enforced.
In the 2021 survey, 448 respondents completed the online questionnaire. A feedback rate of 10,1%
was obtained, which was sufficient for valid and reliable results. An error margin of 4,2% at a 95%
level of confidence applies to these results.
The results of the 2021 study verify, confirm and deepen the findings of the 2018 as well as the 2019 study (the same questionnaire was used in all three cases). The research follows a mixed
qualitative/quantitative research methodology, and the sample can be considered to be a non- random convenience sample. Atlas, SPSS and Excel were used for data analysis.
The results of the research will provide Solidarity with strategic expertise to keep its members and fellow South Africans informed and to provide support with regard to aspects of the
implementation of the NHI.
The findings indicate serious mistrust of and opposition to the government with regard to how they want to implement and manage the NHI. According to the results of this report, the respondents neither believe that the NHI will be able to improve the healthcare system and service delivery, nor that the government or the Department of Health has the ability to successfully implement and manage the NHI. The respondents believe the implementation of the NHI could destabilise healthcare in South Africa and impair the high quality of service currently being provided by the private sector. As serious mistrust and suspicion as well as very low levels of acceptance of and support for the NHI exist among healthcare workers, this is an extremely expensive project that is likely to fail.
Overview
Content
Overview ... 2
Content ... 3
Content ... 3
List of figures ... 4
List of tables ... 4
Introduction ... 5
Methodology ... 5
Results ... 6
Demographics ... 6
How informed are the respondents? ... 9
General opinion ... 10
Views on the implementation of the NHI ... 11
Impact on healthcare workers and the public ... 13
Emigration ... 15
For whom should a healtchare worker work? ... 16
Possibility to accommodate the NHI’s objectives... 17
Handling the Covid-19 pandemic ... 18
Handling of the vaccination programme ... 19
Does the handling of the vaccination programme create confidence in or mistrust of the NHI? ... 20
Comments and suggestions ... 21
Conclusion ... 26
Sources ... 28
Sources ... 28
Content
List of figures
Figure 1. Gender, age, occupational field, and province ... 6
Figure 2. Place of work ... 8
Figure 3 Level of knowledge and information regarding the NHI (2018,2019,2021) ... 9
Figure 4 General opinion ... 10
Figure 5. Serious concerns about aspects of the implementation of the NHI ... 12
Figure 6 For whom should healthcare workers work? ... 16
Figure 7 To what extent can the NHI’s objectives be accommodated? ... 17
Figure 8. Handling of the Covid-19 pandemic ... 18
Figure 9. Handling of the vaccination programme ... 19
Figure 10. Confidence in or mistrust of the NHI regarding the handling of the vaccination programme ... 20
List of tables
Table 1 Related medical professions ... 7Table 2 Impact on healthcare workers – Statements with which the respondents agree or disagree ... 13
Table 3 Statements on which the respondents were uncertain or neutral ... 14
Table 4. Emigration ... 15
With the implementation of the NHI, the state seeks to restore two critical problem areas in the South African healthcare sector, namely the unequal distribution of quality healthcare and the fact that medical aid funds and private medical services are unaffordable for the majority of the population.8 According to the state, quality healthcare is only accessible to and affordable for the rich, while poorer people do not have access to the same services and quality care. The NHI will be a central state-regulated national health fund that seeks to provide essential healthcare and overall coverage for all South Africans on an equal footing. The proposal is that it will be implemented in phases up to 2026. A lot of uncertainty and questions exist about how the medical cover will be structured, what illnesses will be covered and to what extent, how much taxpayers will have to contribute monthly, what will become of current medical aid funds and what the structuring and contracting of healthcare practitioners will look like.
Solidarity conducted countrywide surveys among healthcare workers in South Africa to determine how informed medical personnel are, what their opinion is of the proposed NHI, how they will be prepared to adapt to it and how geared they are to accommodate the NHI’s objectives.
In this way, Solidarity as a pressure group and trade union will gain greater clarity and strategic insight on how to inform, support and protect its members and fellow South Africans regarding aspects of the NHI.
This study employed a descriptive survey method, where mixed quantitative/qualitative design and data processing methods were used, and it could be considered to be an exploratory study.
A non-random convenience sample was taken by sending an invitation to 7 443 health care practitioners to participate in the study. Six-hundred-and-fifty-one respondents completed the electronic questionnaire during October 2019. This indicates a feedback rate of almost 9%, which is sufficient to obtain valid and reliable results. The results of the 2019 study also verify, confirm and deepen the findings of the 2018 study (the same questionnaire was used in both cases). Atlas (a qualitative data analysis program) and IBM SPSS (Statistical Package for the Social Sciences) were used for data analysis. Qualitative data analysis in the form of content analysis was performed on the ATLAS program.
Introduction
Methodology
Demographics
The respondents were asked to indicate their gender and age, as well as to provide the broad field of specialisation and the province where they work.
More women (66%) than men (34%) participated in the study. More than half of the respondents (55,9%) are between 41 and 60 years old. Just under half (47,2%) are employed in Gauteng, and 13,8% work in the Western Cape. The rest of the provinces are proportionally well represented in terms of the distribution of healthcare workers across the country.
About 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. Table 1 below outlines all the medical fields and occupations represented in the study.
Figure 1. Gender, age, occupational field and province
In addition to general practitioners and specialists, 45 other medical professions are represented in the study. Most of the respondents who are not general practitioners or specialists are
psychologists (12). Nine respondents indicated that they are paramedics and six are medical representatives. Five respondents each are occupational therapists and dentists.
The sample consisted of a good representation of a wide variety of medical staff and professions.
86; 19,4%
31; 7,0%
131; 29,5%
39; 8,8%50; 11,3%
12; 2,7%
95; 21,4%
36; 8,2%
63; 14,3%
124; 28,2% 122; 27,7%
79; 18,0%
16; 3,6%
20 - 30 jr 31 - 40 jr 41 - 50 jr 51 - 60 jr 61 - 70 jr Ouer as 70 jr
208; 47,2%
15; 3,4%
49; 11,1%
25; 5,7%
35; 7,9%
19; 4,3%
13; 3,0%
61; 13,8%
16; 3,6%
GAUTENG LIMPOPO NOORDWES / NORTH WEST MPUMALANGA VRYSTAAT / FREE STATE OOS-KAAP / EASTERN CAPE NOORD-KAAP / NORTHERN CAPE WES-KAAP / WESTERN CAPE KWAZULU-NATAL
Results
Table 1 Related medical professions
Psychologist 12
Paramedic 9
Medical representative 6
Occupational therapist 5
Dentist 5
Social worker 4
Radiographer 4
Dietitian 2
Healthcare advisor (Broker) 2
Audiologist 2
Radiotherapist 2
Nurse 2
A specialised treatment centre for addiction 1
GP 1
Retired nurse 1
Pharmacy Manager, financial 1
Pharmacist 1
Occupational physician 1
Biokineticist 1
Biomedical engineer 1
Clinical research support manager 1
Animal health technician 1
Facilitator 1
Financial Manager in Global Pharmaceutical company 1
Physiotherapist 1
Community service doctor 1
Hospital manager 1
Case manager 1
HAST (HIV/AIDS, STI, TB) Counselor 1
Chief medical officer at medical scheme 1
Hospital manager 1
Clinical technologist 1
Laboratory analyst 1
Maintenance manager 1
Medic 1
Medical Diagnostic Sonographer 1
Optometrist 1
Orthotist en Prosthetist 1
Pastoral therapist 1
Physiotherapist 1
Product specialist 1
Community health specialist, Lecturer 1
Speech therapist and audiologist 1
Tandarts-assistent 1
Therapist 1
Veterinary nurse 1
Most respondents are employed either in private practice or at a private hospital. Seven of the respondents work in the pharmaceutical industry. It should also be borne in mind that many practitioners can work in various work environments.
Figure 2. Place of work
29,2% 31,9%
10,1% 10,1%
4,3%
Eie praktyk / Own
practice Privaat hospitaal /
Private hospital Staatshospitaal /
State hospital Privaat kliniek /
Private clinic Staatskliniek / State clinic
Plek van werk / Place of work?
How informed are the respondents?
The respondents were asked how informed they were about the NHI in general. Just under half (48,1%) of the respondents indicated that they had sufficient knowledge of the NHI. During 2018, 46% of the respondents indicated that they had sufficient knowledge, and in 2019, about 56,3%
indicated that they had sufficient knowledge of the NHI. More respondents (34,6% - 2021) than in the 2019 survey (25,2%) indicated that they did not have good knowledge (39% in 2018). In 2018, 9% of the respondents indicated that they had no knowledge of the NHI, while 4,8% in 2019 and 6,3% in 2021 stated that they had no knowledge of the NHI. Only 8,4% were well informed in 2018, while 13,7% were well informed in 2019 and 11% were well informed in 2021. The respondents were therefore more informed about the NHI in 2019 than they were in 2018.
Therefore, the respondents had been best informed about the NHI in 2019, after which their level of knowledge and information decreased in 2021.
The White Paper published in June 2018 is vague and lacks actual detail regarding the scope, operation and implementation of the NHI. It highlights the amount of thinking, planning and work that still lies ahead until 2026, which is the planned date for full implementation of the NHI.2
Figure 3 Level of knowledge and information regarding the NHI (2018,2019,2021)
11,0%
48,1%
34,6%
6,3%
13,7%
53,3%
25,2%
4,8%
8,4%
46,0%
39,0%
9,0%
GOED INGELIG (EK VOLG DIE PROSES NOUKEURIG) / WELL INFORMED (I FOLLOW THE PROCESS METICULOUSLY) EK HET GENOEGSAME KENNIS (EK LEES NUUSBERIGTE OOR
DIE NGV) / I AM SUFFICIENTLY INFORMED (I READ NEWS ARTICLES ABOUT THE NHI)
NIE GOED NIE / NOT WELL EK HET GEEN KENNIS OOR DIE NGV NIE / I HAVE NO
INFORMATION ON THE NHI
Kennis van die NGV / Knowledge of the NHI
2018 2019 2021
General opinion
Over the three-year period of 2018, 2019 and 2021, most respondents have been negative and sceptical about the NHI. About three times more respondents were neutral towards the NHI in 2018 than is the case in 2021.
Figure 4 General opinion
1% 3% 4%
77% 80%
72%
6% 10%
19%
7,9% 8% 6%
2021 2019 2018
Algemene opinie / General opinion
Positief / optimisties // Positive / optimistic Negatief / skepties // Negative / sceptical Neutraal / Indifferent Ek weet nie / I don't know
Views on the implementation of the NHI
Almost all the respondents (93,4%) have serious concerns regarding the state’s ability to manage and administer the NHI. In addition, 87,7% are seriously concerned about the state's ability to make payments to health practitioners effectively and on time. (This question has only been included in the 2019 and 2021 studies, and because the 2018 data for it is absent, these results are not included in figure 5 above).
The total administration and management of funds and decision-making will be in the hands of the state. The respondents’ opinions are quite possibly shaped by the observed mismanagement and maladministration at institutions such as Eskom, the SAA and the SABC. The NHI will be
significantly larger and more complex, must serve a population of more than 55 million people, and will have to manage and execute a multitude of contracts. Alex van den Heever,
chairperson of the Social Security Systems Administration and Management Studies at the University of the Witwatersrand, warns that the NHI's administrative and management system is seriously vulnerable to corruption and mismanagement and that there is too much power in the hands of the Minister.1
Most (86,6%) are seriously concerned about the fact that the state can determine and enforce tariffs, place of work, type of diagnostic tests and type of medication and treatment. Total state control implies that the tariffs that may be charged per consultation are controlled, and that the state can prescribe the equipment, medication, diagnostic tests and place of work for medical practitioners. Former Health Minister Aaron Motsoaledi4 indicated that different fees for the same services could no longer be permitted and that uniform tariffs should be paid: “We cannot continue to run a system where people are paid differently for the same services,” Motsoaledi said.3 Many respondents (71,7%) are also seriously concerned that they could very well be paid lower tariffs per patient.
The shocking shortage of specialists, doctors and other healthcare workers are a well-known fact.5 A former Health Minister, Aaron Motsoaledi, mentioned that at least three times more doctors will be needed for the NHI than there currently are in South Africa.1 Most respondents (85,7%) are seriously concerned about the shortages of healthcare providers.
The NHI will be compulsory for all citizens and legal immigrants.6 Most respondents (86,6%) are seriously concerned about this.
In 2019 and also in 2021, more respondents were seriously concerned about all the various aspects of the NHI than they were in 2018.
Figure 5. Serious concerns about aspects of the implementation of the NHI
86,6%
71,1%
93,4%
65,2%
85,7%
86,6%
87,5%
75,3%
95,1%
66,5%
87,4%
88,3%
83,2%
69,2%
93,8%
63,2%
84,6%
86,0%
LANDSBURGERS SAL GEEN KEUSE HÊ OOR OF HULLE TOT DIE NGV-FONDS WIL BYDRA OF NIE. /CITIZENS WON'T HAVE A CHOICE WHETHER THEY WANT
TO CONTRIBUTE TO THE NHI FUND OR NOT.
GESONDHEIDSORGWERKERS GAAN VERGOED WORD VOLGENS VASTE TARIEWE SOOS DEUR DIE STAAT BEPAAL. / HEALTHCARE WORKERS WILL BE
REIMBURSED AT FIXED TARIFFS DETERMINED BY THE STATE.
DIE VERMOË VAN DIE STAAT OM DIE NGV TE BESTUUR EN TE ADMINISTREER. / THE CAPABILITY OF THE STATE TO MANAGE AND
ADMINISTER THE NHI.
DOKTERS SAL NGV-PASIËNTE MOONTLIK TEEN 'N LAER TARIEF SOOS DEUR DIE STAAT BEPAAL, MOET BEHANDEL. /DOCTORS MIGHT HAVE TO TREAT
NHI PATIENTS AT LOWER TARIFFS, AS DETERMINED BY THE STATE.
DAT DAAR NIE GENOEGSAME DOKTERS, VERPLEEGPERSONEEL EN ANDER GESONDHEIDSPRAKTISYNS VIR DIE NGV BESKIKBAAR SAL WEES NIE. / THAT
THERE WON'T BE ENOUGH DOCTORS, NURSES AND OTHER HEALTHCARE PRACTITIONERS AVAILABLE FOR THE NHI.
DAT DIE STAAT TARIEWE, PLEK VAN WERK, AARD VAN DIAGNOSTIESE TOETSE EN TIPE MEDIKASIE EN BEHANDELING GAAN VOORSKRYF. /THAT TARIFFS, PLACE OF WORK, TYPE OF DIAGNOSTIC TESTS, MEDICATION AND
TREATMENT WILL BE PRESCRIBED BY THE STATE.
Ernstig bekommerd / Seriously concerned
2018 2019 2021
Impact on healthcare workers and the public
Although many (68,1%) respondents agree that medical aids are too expensive and not
affordable for most people in South Africa, 85,3% are strongly convinced that the implementation of the NHI could result in medical practitioners who provide private healthcare could take the decision to leave SA. About 84,6% do not believe that the NHI can be successfully implemented, and 78,9% are convinced that the NHI has the potential to destabilise the healthcare system in South Africa.
Table 2 Impact on healthcare workers – Statements with which the respondents agree or disagree
Agree
Die implementering van die NGV sal waarskynlik daartoe lei dat beroepslui wat private
gesondheidsorg lewer, die land verlaat. // The implementation of the NHI will likely lead to private healthcare professionals leaving the country.
85,3%
Die NGV kan nie suksesvol geïmplementeer word nie weens die huidige gesondheidsektore se onvermoë om doeltreffende gesondheidsorg aan die meeste Suid-Afrikaners te lewer. // The NHI cannot be implemented successfully due to the failure of the current healthcare sectors to deliver effective healthcare to the majority of South Africans.
84,6%
Die NGV het die potensiaal om die gesondheidsorgstelsel in Suid-Afrika te destabiliseer. // The NHI
has the potential to destabilise the healthcare system in South Africa. 78,9%
Mediese fondse is onbekostigbaar vir die grootste deel van die Suid-Afrikaanse bevolking. // The
affordability of medical schemes is out of reach for most of South Africa's population. 68,1%
In addition, 77,9% do not agree that the NHI can improve service delivery and healthcare in SA.
Almost three-quarters (74,3%) also do not agree that all South Africans will be able to enjoy access to affordable and quality health care under the NHI. Most (72,4%) are not convinced that the government has consulted with sufficient stakeholders to solicit contributions from everyone in terms of design and planning.
Two thirds (60,6%) of the respondents feel that the proposed subsidy-based system is unfair. This is almost ten percent LESS than in 2019 and can possibly be explained by the fact that many people urgently needed medical care during the Covid-19 pandemic, as well as by the financial impact of the pandemic on many people. Some people may start to think that it would be better if there was a subsidy-based system. This determines that those who have an income will contribute to the NHI in proportion to their income, thereby subsidising those who have no income and cannot contribute to the NHI.
Most of the respondents (56%) do not agree that healthcare workers are strong, resilient and creative enough to adapt to the new circumstances of the NHI.
Do not agree
Ek is bereid om te reis of te werk volgens die behoefte wat deur die staat bepaal word. // I am
willing to travel or work according to where my services are needed, as determined by the state. 81,1%
Die NGV sal dienslewering en die lewering van gesondheidsorg verbeter. // The NHI will improve
service provision and healthcare delivery. 77.9%
Die regering het genoegsaam met belanghebbendes gekonsulteer om hulle geleentheid te gee om bydraes te lewer ten opsigte van die ontwerp en beplanning van die NGV. // The
government has had adequate consultations with stakeholders to give them the opportunity to provide inputs with regard to the design and planning of the NHI.
72,4%
Met die NGV sal alle Suid-Afrikaners toegang hê tot bekostigbare gesondheidsorg van hoë gehalte, ongeag hul werkstatus en vermoë om regstreeks 'n geldelike bydrae tot die NGV-fonds te maak. // Under the NHI all South Africans will have access to affordable, quality healthcare services regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.
74.3%
Die subsidiegebaseerde stelsel ingevolge waarvan diegene wat tot die NGV kan bydra, dié wat nie kan bydra nie sal subsidieer, is regverdig. // The subsidy-based system, in terms of which those who are able to contribute to the NHI will subsidise those who can't contribute, is fair.
60,6%
Gesondheidsorgwerkers is veerkragtig, weerbaar en kreatief genoeg om aan te pas by die nuwe omstandighede wat die NGV mag inhou. // Health care practitioners are resilient and creative enough to adapt to any circumstances that the NHI may bring.
56,%
One third (26,9%) of the respondents were neutral on whether they would be willing to work with the government to develop a sustainable NHI, while 43,6% indicated that they would not be willing to do that, and a quarter (26,9%) said that they would be willing. Although 38,7% agreed that everyone has the right to the same healthcare regardless of the extent to which they can contribute financially, 31,4% did not agree with that and 26,4% were neutral.
Table 3 Statements on which the respondents were uncertain or neutral Ek stem saam /
I agree
Neutraal / Neutral
Ek stem nie saam nie / I don't agree
Ek weet nie / I don't know Ek is bereid om met die regering saam te werk om 'n
volhoubare Nasionale Gesondheidsversekering (NGV) te ontwikkel. // I am willing to work with the government to develop a sustainable National Health Insurance (NHI).
21%% 26,9% 43,6% 8,5%
Almal het die reg tot dieselfde gesondheidsorg ongeag die mate waartoe hulle finansieel daartoe kan bydra. // Everyone has the right to receive the same healthcare regardless of their ability to contribute financially to healthcare.
38,7% 26,4% 31,4% 3,4%
Emigration
In answer to the question whether the respondents are already taking steps to emigrate, 13,7%
(20,8% in 2019) indicated that they have already started the emigration process. A further 35,95 (41,6% in 2019) said that they will take steps to emigrate when the NHI is implemented. Only about 15% are sure that they will not take steps to emigrate when the NHI is implemented.
Table 4. Emigration Ek stem saam / I agree
Neutraal / Neutral
Ek stem nie saam nie / I don't agree
Ek weet nie / I don't know Ek is reeds besig om stappe te doen om te
emigreer weens onder andere die voorgestelde NGV. // Because of the proposed NHI, amongst other factors, I have already taken steps to emigrate.
13,7% 37,4% 36,5% 12,3%
Ekself sal stappe doen om te emigreer wanneer die NGV geïmplementeer word. // I myself will take steps to emigrate when the NHI is
implemented.
35,9% 24,3% 15,3% 24,5%
Between 2012 and 2017, NHI pilot projects were rolled out in 11 health regions across South Africa.
These projects cost about R4 billion, and it was found that none of the NHI pilot projects contributed to improving health care. The main reasons for this were poor infrastructure and equipment, vacancies and too few health care workers, and poor financial planning. Fifty-five (55) out of 75 medical practitioners who served in 17 clinics participated in a study after the trial run to determine what their experiences were. More than 60% of them were convinced that the NHI would not be able to improve the quality of service delivery and most of them indicated that they would not want to work under the NHI.
Four factors may lead to the destabilisation of the healthcare sector in South Africa:6
• A shortage of specialists, doctors, nursing staff and other healthcare workers
• Financial management of the NHI
• Purchasing and distribution of medicines and equipment
• Maintenance of infrastructure and equipment
In recent years, the media has been inundated with reports of shortages of well-trained staff, doctors and specialists, equipment shortages, lack of maintenance of equipment and
infrastructure, and negligence claims of between R80,4 and R98 billion that have been instituted against the state from the public health care sector. Although it has been argued that some of the claims involve corruption, service delivery has been negatively affected, especially if the pattern were to increase.9
The NHI is not exactly built on a solid foundation. One of the many troubling questions is for whom medical practitioners will work. Will everyone be employed by the NHI, or will they have to enter into compulsory contracts with the state?
Almost 86,6% of the respondents indicated that medical practitioners should be able to work for themselves in private practices and that it should be their own choice for whom or where they work.
For whom should a healtchare worker work?
The respondents could choose more than one option. On average, 42,1% indicated that healthcare workers should work for a hospital, the state or independent employers. Only 26,6%
indicated that they should work for a medical aid fund. Just over a third (35,7%) indicated that healthcare workers should work for independent employers.
However, it was clear from the respondents’ comments that it should be their own choice for whom or where they want to work, that they do not want any political interference in this regard and that they do not want to be forced or be prescribed to in any way. They feel that it should be their own right to be able to choose. Some of the comments are listed below:
• A Doctor may work anywhere he chooses after he has finished his training and the compulsory community service.
• Hy moet die reg hê om te kan kies waar en vir wie hy wil werk volgens sy omstandighede en vaardighede.
• Mediese personeel soos mediese dokters, sielkundiges, tandartse ens. kan vir 'n organisasie werk MAAR moet steeds 'n onafhanklike status hê.
• As ʼn professionele persoon, moet ʼn dokter vir homself/haarself werk. As hy/sy besoldig word deur die staat, moet die dokter se onafhanklikheid altyd eerbiedig word.
• Vir wie sy wil. Nie gedwonge wees om vir die staat te werk nie
Figure 6 For whom should healthcare workers work?
Privaat, eie praktyk ; 86,6%
Mediese fonds ; 26,6%
Staat; 30,7%
n Hospitaal ; 42,1%
Onafhanklike werkgewers ;
35,7%
Privaat, eie praktyk Mediese fonds Staat
n Hospitaal Onafhanklike werkgewers
Possibility to accommodate the NHI’s objectives
Medical practices, clinics and hospitals will be expected to provide equal health care to all. No payment will be expected from patients who turn up at practices, clinics or hospitals for
assistance, and no co-payments will be charged for any service.7 As a result, the private medical sectors in South Africa are expected to be severely affected, and the expectation is also that NHI could be very detrimental to the economy as a whole.6
It appears that the respondents are largely not geared to accommodate the NHI’s objectives.
Although more than a third of the respondents (34,2%) indicated that they do have the
knowledge and skills regarding preventative healthcare, and 35,5% indicated that they have the knowledge and skills related to community healthcare to accommodate the NHI, only 24,9%
stated that they may have the administrative knowledge and skills, and 19,9% that they may have the infrastructure. Very few (21,7%) think that they may possibly have time available to
accommodate the NHI, and only 18,5% are of the opinion that they will have sufficient administrative staff. Only 17,4% feel that they will be able to accept possible lower rates, or accept such rates to some extent.
A lot of uncertainty exist among most respondents regarding how prepared they are at present to be able to accommodate the NHI objectives, precisely because no clear facts have been
disclosed about how the NHI will affect practices, clinics and hospitals.
Figure 7 To what extent can the NHI’s objectives be accommodated?
37,8%
41,6%
39,7%
22,6%
25,6%
28,9%
44,1%
16,9%
15,4%
20,3%
20,0%
20,2%
21,1%
15,7%
37,4%
35,4%
33,8%
34,2%
35,5%
35,2%
31,9%
4,9%
4,5%
4,7%
14,7%
12,7%
11,0%
6,7%
3,0%
3,1%
1,4%
8,6%
6,1%
3,8%
1,7%
INFRASTRUKTUUR / INFRASTRUCTURE ONDERSTEUNINGSPERSONEEL / SUPPORT STAFF MY BESKIKBARE TYD / MY AVAILABLE TIME KENNIS EN VAARDIGHEDE TEN OPSIGTE VAN VOORKOMENDE GESONDHEIDSORG / KNOWLEDGE AND SKILLS REGARDING
PREVENTATIVE HEALTH CARE KENNIS EN VAARDIGHEDE TEN OPSIGTE VAN GEMEENSKAPSGESONDHEIDSORG / KNOWLEDGE AND SKILLS
REGARDING COMMUNITY HEALTH CARE
ADMINISTRATIEWE KENNIS EN VAARDIGHEDE / ADMINISTRATIVE KNOWLEDGE AND SKILLS
MOONTLIKE LAER TARIEWE PER PASIËNT SOOS DEUR DIE STAAT VASGESTEL / POSSIBLE REDUCED TARIFFS PER PATIENT AS
DETERMINED BY THE STATE
Volledig akkomodeerbaar Akkomodeerbaar volgens die NGV doelwitte
Onseker In 'n mate akkomodeerbaar
Kan geensins akkomodeer
Handling the Covid-19 pandemic
As it is relevant to the Covid-19 pandemic during which the 2021 study was conducted, as well as because it relates to the healthcare system, respondents were asked what their opinion was on the way the government handled the Covid-19 pandemic. The majority of respondents said that there are problems with the way the pandemic is being dealt with (43,7%), or that the pandemic is being handled very poorly (38,1%). Only 10% are satisfied with how the pandemic is being handled and 2% think that the pandemic is being handled well.
Here are some of the respondents’ comments on the issue:
• I feel the public Health system has had more than enough time to get hospitals etc ready for the second,third and any other waves of the pandemic that have occurred and may still occur.They have not.
• Regering het beslis foute gemaak, veral oor uitreiking van vaksines - privaat instansies moet ook toegang hê om mense in te ent.
• Vaksines moes van die begin af aan die privaatsektor beskikbaar gestel gewees het. Dan was 50 % mense al geënt.
• Die staat se beheptheid met sentrale beheer, lei tot ʼn tragiese uitkoms met swak bestuur van die pandemie, swak besluite, diefstal en geen vaksine nie.
• Ek dink nie dit word te sleg hanteer nie. Die privaatsektor se personeel en hospitale help baie. Daar is ook goeie leier-dokters in die staatshospitale. Die alkohol en sigaret verbod is net belaglik. Die
wynboere is sleg benadeel. Ons vaksine inentings verloop net te stadig. En as hul dit nie eers kan hanteer nie, hoe wil hul ʼn NHI bedryf!!!
• Te veel onsekerheid omdat regering korrup is - gelde word gesteel nou wie sê ons gaan baat by nuwe stelsel.
• Nee kry eers betroubare regering dan kan mens besluit.
• Vertrou ons regering net mooi niks.
• Die uitrol van die vaksines is beroerd. Dit sal 20 jaar vat om ons hele land in te ent. Die staat beheer die uitgee van vaksines so, dat die privaatsektor glad nie mag deelneem nie.
• Die inentingsveldtog en die korrupsie is bewys hoe pateties NHI sal wees. Te min te laat met verwaarloosde bates en walglike bestuur.
Figure 8. Handling of the Covid-19 pandemic
2,0%
10,6%
2,9%
43,7%
38,1%
DIT WORD BAIE GOED HANTEER. / IT IS BEING HANDLED VERY EFFECTIVELY.
EK IS TEVREDE MET HOE DIT HANTEER WORD. / I AM SATISFIED WITH THE WAY IT IS BEING HANDLED.
EK WEET NIE. / I DON'T KNOW.
DAAR IS PROBLEME MET DIE HANTERING VAN DIE PANDEMIE. / THERE ARE PROBLEMS WITH THE WAY THE PANDEMIC IS HANDLED.
DIE PANDEMIE WORD BAIE SWAK HANTEER. / THE PANDEMIC IS BEING HANDLED VERY POORLY.
Opinie oor die regering se hantering van die Covid-19-pandemie? / Opinion with regard to the way the government is handling the Covid-19 pandemic?
Handling of the vaccination programme
Only 2,3% of respondents think that the vaccination programme is being handled well, and 9,1%
are satisfied with how it is being handled. ʼn A further 41% feel that it is being handled poorly and 43,5% are of the opinion that there are problems with the vaccination programme.
Figure 9. Handling of the vaccination programme
2,3%
9,1%
4,1%
43,5%
41,0%
DIT WORD BAIE GOED HANTEER. / IT IS BEING HANDLED VERY EFFECTIVELY.
EK IS TEVREDE MET HOE DIT HANTEER WORD. / I AM SATISFIED WITH THE WAY IT IS BEING HANDLED.
EK WEET NIE. / I DON'T KNOW.
DAAR IS PROBLEME MET DIE IMPLEMENTERING VAN DIE ENTSTOFPROGRAM. / THERE ARE PROBLEMS WITH
IMPLEMENTING THE VACCINATION PROGRAMME.
DIE ENTSTOFPROGRAM WORD BAIE SWAK HANTEER. / THE VACCINATION PROGRAMME IS BEING HANDLED
VERY POORLY.
Hantering van die entstofprogram? / Handling of the
vaccination programme?
Does the handling of the vaccination programme create confidence in or mistrust of the NHI?
The respondents were asked the question: “Watter van die volgende aspekte van die regering se hantering en uitrol van die entstofprogram in Suid-Afrika het jou vertroue versterk of wantroue geskep in die hantering van die toekomstige NGV? / Which of the following aspects of the government's handling and roll-out of the vaccine programme in South Africa strengthened your confidence or created mistrust in the handling of the future NHI?”
No aspect of the way the Covid-19 pandemic or the vaccination programme has been handled has instilled confidence in the respondents that the NHI will be a success. However, there has been a slight shift in sentiment, where 58% of the respondents believe that the pandemic did emphasise the need for universal health care.
Figure 10. Confidence in or mistrust of the NHI regarding the handling of the vaccination programme
9,4%
12,3%
4,5%
5,2%
3,0%
3,9%
4,1%
3,0%
3,9%
3,2%
2,1%
32,42%
19,13%
22,45%
17,54%
18,86%
17,46%
16,78%
17,85%
15,26%
12,87%
13,76%
58,22%
68,56%
73,02%
77,22%
78,18%
78,68%
79,14%
79,18%
80,87%
83,91%
84,17%
DIE PANDEMIE HET DIE NODIGHEID VIR UNIVERSELE GESONDHEIDSORG BEKLEMTOON. / THE PANDEMIC STRESSED THE NEED FOR UNIVERSAL …
BEPLANNING EN BESTUUR VAN DIE TOEDIENING VAN ENTSTOWWE. / PLANNING AND MANAGEMENT OF ADMINISTERING THE VACCINES ONDERHANDELING MET VERSKAFFERS VAN ENTSTOWWE / NEGOTIATIONS
WITH VACCINE SUPPLIERS
DIE AANKOOP EN VERSPREIDING VAN ENTSTOWWE / THE PURCHASE AND DISTRIBUTION OF VACCINES
AANKOPE EN VERSPREIDING VAN MEDIKASIE EN TOERUSTING SAL MET DIE NGV BAIE BETER WEES AS DIE HUIDIGE …
DIE ENTSTOFPROGRAM IS 'N AANDUIDING VAN DIE REGERING SE VERMOË OM UITGEBREIDE AANKOOP- EN VERSPREIDINGSPROSESSE EN SISTEME TE KAN …
SENTRALE BEHEER VAN DIE AANKOPE VAN ENTSTOWWE / CENRAL CONTROL OVER THE PURCHASING OF VACCINES
DEURSIGTIGHEID VAN AANKOPE EN BESTEDING / TRANSPARENCY WITH REGARD TO PURCHASING AND SPENDING
VERANTWOORDBAARHEID VIR ASPEKTE WAT SKEEFLOOP / ACCOUNTABILITY FOR ASPECTS THAT GO WRONG
DIE ENTSTOFPROGRAM DUI OP DIE VAARDIGHEDE EN VEMOÊ VAN DIE REGERING OM DIE NGV TE KAN BESTUUR. / THE VACCINE PROGRAMME IS … DIE HANTERING VAN DIE COVID-19-PANDEMIE EN DIE ENTSTOFPROGRAM VOORSPEL DAT SUID-AFRIKANERS VOLDOENDE EN GOEIE GESONDHEIDSORG …
Skep wantroue en bekommernis oor die uitrol en bestuur van die NGV./Creates concern and mistrust Onseker/neutraal // Uncertain/indifferent
Skep vertroue in uitrol en bestuur van die NGV./ Creates confidence in the roll-out of the NHI
Comments and suggestions
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 tariffs as prescribed by the government.
Conclusion
The majority of respondents (82%) are of the opinion that the government does not handle the Covid-19 pandemic well. Only 10% are satisfied with the way the pandemic is handled. Most (84%) also indicated that the vaccine programme is being handled poorly, with only 9% who are
satisfied with the way it is being handled. Dealing with a challenging medical issue highlighted the shortcomings and poor governance of public healthcare and created tremendous mistrust in the ability of the government and the Department of Health to manage the NHI at all. Less than 10%
are convinced that the pandemic has highlighted the need for universal health care.
From the comments and suggestions, it is clear that the respondents do not believe that the NHI will be able to succeed. They blame poor management by the government and the Department of Health, which already has proven to be ineffective in many government institutions, as well as corruption and the high costs that will have to be incurred. The respondents are extremely
concerned about the effect that the NHI will have on the country’s economy, taxpayers’ pockets and the quality of healthcare in South Africa. They question why there can be no closer
cooperation with the private sector and why the state cannot even overhaul the current healthcare system and get it up to standard.
Despite the failure of the pilot projects, criticism and concerns being voiced from all quarters within the healthcare sector, the government is going ahead with the implementation of the NHI.
Some comments and suggestions are conveniently ignored so that the ideologically driven plans can be politically steamrollered. If public health were the government's first priority, they surely would have launched the planning of the NHI with extreme care and with the utmost precision and consideration of numerous options and proposals. In an already struggling healthcare system and shaky economy, the planning of the NHI is handled irresponsibly and in a very ill-considered way.
Solidarity strongly criticises and opposes the nationalisation and state interference of and control over South Africa's healthcare system.
Sources
1. Mitchley, A. 29 June 2016. News 24. NHI compulsory for all South Africans – Motsoaledi. Verkry vanaf https://www.news24.com/SouthAfrica/News/nhi-compulsory-for-all-south-africans-motsoaledi-20170629.
2. Erasmus, S. 7 July 2017. Fin 24. NHI and your medical scheme: as clear as mud. Verkry vanaf https://www.fin24.com/Money/Health/nhi-and-your-medical-scheme-as-clear-as-mud-20170707.
3. Kahn, T. 22 June 2018. Business Live Premium. Disputed health bills head for heated debate. Verkry vanaf https://www.businesslive.co.za/bd/national/health/2018-06-22-disputed-health-bills-head-for-heated- debate/).
4. Rakabe, E. 26 June 2018. Businesslive. Challenges facing healthcare system are structural rather than clinical. Verkry vanaf https://www.businesslive.co.za/bd/opinion/2018-06-26-challenges-facing- healthcare-system-are-structural-rather-than-clinical/.
5. Cullinan, K. 20 June 2018. Health e-news. Massive shake-up of health laws ahead of NHI. Verkry vanaf https://www.health-e.org.za/2018/06/20/massive-shake-up-of-health-laws-ahead-of-nhi/.
6. Chowles, T. 5 March 2018. Ehealthnews. What the 2018 National Budget Means for the Health Sector.
Verkry vanaf http://ehealthnews.co.za/2018-national-budget-means-health-sector/.
7. Omarjee, L. 22 June 2018. Fin24. 6 ways the NHI bill will affect consumers' pockets. Verkry vanaf https://www.fin24.com/Economy/6-ways-the-nhi-bill-will-affect-consumers-pockets-20180622.
8. Green, A. 12 July 2017. Medical Brief. Not even its supporters agree on what NHI means for private health.
Verkry vanaf https://www.medicalbrief.co.za/archives/not-even-supporters-agree-nhi-means-private- health/.
9. Health Systems Trust. July 2019. Evaluation of Phase 1 implementation of interventions in the National Health Insurance (NHI) pilot districts in South Africa, Evaluation Report, Final. NDOH10/2017-2018. Verkry vanaf
https://www.hst.org.za/publications/NonHST%20Publications/nhi_evaluation_report_final_14%2007%20201 9.pdf
