• by IPS Correspondents
• Monday, July 09, 2012
• Inter Press Service

Jul 09 (IPS) - CAPE TOWN, South Africa, Jul 6 2012 (IPS) - Experts say that underfunded pilot universal healthcare sites to be set up by South Africa as part of its proposed national health insurance may be doomed to fail as debate rages about how the move to more equitable healthcare will be funded.

In March, South Africa announced 10 districts across the country that will pilot universal healthcare under its proposed national health insurance (NHI).

Pilot sites have only been allocated an additional R11 million (or 1.3 million dollars) to implement the NHI, according to Di McIntyre, professor at the School of Public Health and Family Medicine at South Africa’s University of Cape Town.

“The NHI is actually about comprehensive reform of the healthcare system…you can’t do anything with R11 million,” said McIntyre, speaking at the South African National Health Assembly in Cape Town on Jul. 6. “We have to apply pressure to the national treasury to actually start funding the rebuilding of the public health system.”

Researcher Daygen Eagan, with the South African pro-bono human rights law organisation, SECTION27, estimated that pilot sites could need at least several hundred million rands to roll out the necessary healthcare improvements as part of the pilot, including district-based interventions to reduce maternal and child mortality, and expanded school-based health service.

South Africa released a draft policy document on the NHI in August 2011, and is hoping universal healthcare will not only increase access but also improve health outcomes and value for money. According to the World Health Organization (WHO), South Africa spends about 400 dollars per person on healthcare, roughly the same amount as Cuba but charts much poorer results for this investment than the island nation.

Maternal mortality in South Africa, for instance, is about seven times higher than that in Cuba, according to the WHO. Now, researchers say that not only are pilot sites underfunded but that they have serious concerns as to how the country will fund the NHI.

Government has proposed that the NHI be funded through a National Health Insurance Fund, a public entity outside of the Department of Health but accountable to government. This pool of money may be funded through increased health budget allocations from general tax, or though increased personal income tax or the value added tax (VAT) placed on most purchased goods, which many argue would allow the country to tap into its huge informal economy.

However, McIntyre warned that increasing VAT would shift the burden of funding the NHI to poorer households, while the middle class and wealthy have enjoyed successive cuts to personal income tax since the country ushered in democratic rule in 1994.

© Inter Press Service (2012) — All Rights Reserved. Original source: Inter Press Service

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