South Africa Moves Towards Universal Health Care, While India Stagnates

Tuesday, July 28, 2015

South Africa’s bold new proposal for universal health coverage in the face of stiff opposition from private health care providers is likely to become a model for providing sustainable health care for much of the developing world. The proposal, called National Health Insurance, or NHI for short, has set off quite a debate within South African society. But health care experts believe it’s the first real step in post-apartheid South Africa towards bringing equity in health care.

“South Africa has a deeply divided health system,” said a recent report of the non-profit group Global Health Watch, going on to list the proposed reform’s main goals: “To begin by rebuilding the public health system, with a particular emphasis on primary healthcare; to increase management authority in public hospitals and districts, accompanied by improved governance and accountability mechanisms; to increase tax funding for health services; and to introduce an NHI Fund as a strategic or active purchaser of services at a later stage. These reforms have the potential to move South Africa towards a universal health system,”

While India is yet to roll out the ambitious, but thus far vague, National Health Assurance Mission, South Africa is going ahead with a plan to increase taxes to pay for a government-run health scheme that will combat escalating private healthcare costs in the country. National Health Insurance was nominally launched in 2014, in one of 11 under-served districts across South Africa.

While the pilot has had far-reaching impact on health care delivery, the question of most minds in South Africa is where will the money come for a wide scale increase?

On this front, the South African government is committed to boldly going where most governments fear to tread – an increase in taxes. In an exclusive interview, South African health minister Aaron Motsoaledi staunchly defended increasing taxes to fund free point-of-care delivery of services.

“I understand why people ask about money for NHI,” he said. “Governments all over the world earn money from tax payers – that’s how governments run. That is how health and education are funded, through taxation. There’s no other way that governments get money except through taxation.”

The clear structure of the programme is yet to be adecided, he added. “I don’t determine taxes. That’s determined by the minister of treasury. We have a new committee that will soon come up with a new tax regime for South Africa. So the new committee will address this question as well,” Motsoaledi said.

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