Posted by: davidjolson | 10/04/2010

The implications for national health insurance in South Africa

This guest blog was written by Jeanette Strydom, the relationship officer at Africa Health Placements, a member of GHC based in Johannesburg, South Africa.

JOHANNESBURG, South Africa —The African National Congress’ National General Council recently decided that South Africa will launch its own National Health Insurance (NHI) scheme in 2012 which will be implemented in a phased approach over 14 years. NHI refers to a health insurance program funded through taxes and administered by the government to provide comprehensive health care for all citizens, the goal being improved health care delivery for all.

The idea of NHI has attracted widespread criticism for being overly ambitious for South Africa at this stage in the game. Many articles published since the announcement paint an extremely bleak picture of the public health system in South Africa which only serve to mystify it further.

The South African general public appears to be concerned about what this means for the average tax payer, and for health care in general. While this unease needs to be addressed, public opinion may be slightly misguided. Even with the added boost to 14% of government spending on health care; the government would still be underspending on health, seeing as the global average is around 16%. The greatest problem that the uninsured face is not a lack of hospitals, medicine or equipment; all of these things are available. The problems are gross mismanagement and severe staffing shortages of health care professionals, which fail the system and its people, particularly in rural and peri-urban areas.

My organization, Africa Health Placements (AHP), has been placing doctors in the public, rural health sector since 2005, and doing it very effectively. During that time, over 1,750 doctors have been placed in hospitals in South Africa, Swaziland and Lesotho, 900 of whom where foreign nationals.

Recruiting foreign health care workers helps build the long term solution, which AHP has proven time and time again. When a hospital is well staffed, operations run more smoothly and local doctors, as well as community service doctors, are more willing to work there. This has been seen with numerous hospitals where AHP health care practitioners have been placed.

Ngwelezane Hospital is an excellent example of how a hospital can be turned around to function optimally through recruitment. This hospital, located near to Richards Bay by a township plagued with violence, has a history of seeing many patients with alcohol-related trauma and has to deal largely with HIV/AIDS and TB — which are widespread. In the past AHP has placed several doctors in this hospital which allowed patients to be treated quicker. Before long, the hospital staffers were all working as a team which became stronger with each placement.

In this manner, Ngwelezane Hospital has been able to attract local doctors, interns and community service doctors, eventually resulting in many of them staying indefinitely. Due to the effective hire of a few foreign doctors, the capacity of this hospital has been increased, and will stay that way because it is adequately staffed.

For over ten years now, civil society organisations have been tackling health care problems head on – most of which do so successfully and make a remarkable impact. The government does not have to do this alone. With effective public-private partnerships between the government, civil society and other organisations, these efforts can be increased exponentially.

Do you agree that these efforts to find more health care workers can meet the challenge of national health insurance in South Africa? We welcome your thoughts below.


  1. How current is this blog? Also, I would like to know what progress, if any has been made regarding the implementation of NHI.

    • It was written a few days before it was published on Oct. 4, 2010. That is almost eight months ago.

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