 Introduction
The colloquium, held from 31 July to 2 August 2007, looked at challenges facing the South African health system. It aimed to explore policy and make recommendations to health policy developers. Specific issues explored included: - Developing a policy position on a unitary national health system (NHS).
- Locating the debate within the context of a comprehensive system of social security.
- Risks and opportunities.
- Required structures and processes.
A range of stakeholders were involved including policy makers, parliamentarians, government officials, academics, civil society, health professionals, representative bodies of health professionals, the Board of Health Care Funders and non-governmental organisations. The colloquium was divided into four themes: Download the colloquium programme. Downloadable background documentsRestructuring the National Health System for Universal Primary Health Care: Report of the Committee of Inquiry into a National Health Insurance System [2.7MB]
Appendices to the Report of the Committee of Inquiry into a National Health Insurance System [2.7MB]
Restructuring the National Health System for Universal Primary Health Care: Appendices [1.7MB]
Draft: A National Drug Policy for South Africa. December 1995 [1.6MB]
Draft Report of the Health Care Finance Committee to the Minister of Health, December 1994 [2.2MB] Setting the sceneKeynote address, Dr Manto Tshabalala-Msimang, Minister of Health
Welcome address, Dr Temba Masilela, Executive Director, Policy Analysis Unit
Closing address, Dr Olive Shisana, President and CEO, HSRC
Theme 1: Trajectory for a future unitary national health system: reform path since 1994Post-apartheid South Africa’s health policy agenda, outlined in the 1994 National Health Plan, clearly expressed the need for a unitary national health system. This started with an overhaul of the entire health system, reshaping both the private and public sector.
Since 1994, various committees were set up to investigate proposals for a unitary health system. The 1995 Committee of Inquiry into National Health Insurance (NHI) argued strongly for an NHI, and some of its recommendations were implemented by prioritising reforms to the medical schemes environment.
Falling short of ensuring a unitary system, a follow-up Committee of Inquiry argued in 1997 for a phased approach to access to health for all by means of social health insurance (SHI), with an NHI seen as a second step. However, implementation of recommendations for the SHI has been patchy, with limited progress in the implementation of a Risk Equalisation Fund (REF).
Recent reforms saw the implementation of a state-sponsored scheme, the Government Employees Medical Scheme (GEMS). Subsequent debates remain devoid of a consensus approach to a unitary health system. Presentations
National health policy: past and future trajectory
Alex van den Heever, Advisor on Social Security Reform, Council for Medical Schemes The role of GEMS towards a unitary national health system
Department of Public Service Administration
Theme 2: Policy options for health in the context of a comprehensive social security systemA re-commitment to a comprehensive system of social security was expressed in the President’s State of the Nation Address in 2007, with additional information subsequently provided in the Minister of Finance’s budget speech. Such a system would consist of: - National pensions
- Social assistance grants
- Social insurance schemes
- Unemployment insurance.
Debates on a future health system should happen within the framework of comprehensive social security instead of being limited to a sector (health) specific reform process. The overall aim of social security reform, the risks or benefits to be covered and eligibility for these benefits are still vague. What has been considered but not yet catered for within this envisaged system of social security is health coverage. PresentationsFramework of comprehensive social protection and social programmes
Mr V. Madonsela, Director-General Social Development Funding models and potential alignment with future social security options
Dr M. Blecher, National Treasury Role of SASSA in benefit administration: Current and future options
Mr F. Makiwane, CEO, South African Social Security Agency
Theme 3: Local and international evidence on health systems modelsEspecially in developing countries, social insurance arrangements, as opposed to tax-funded systems, have increasingly been used as models for delivering and funding health care. If the comprehensive system of social security were extended to include some type of health benefit or cover, various models would need to be explored in terms of how they meet the challenges of the South African health system and how they interface with the evolving Comprehensive System of Social Security. This session attempted to explore: - Country experiences of types of health systems delivery and financing models.
- The risks and opportunities to be managed for each model.
PresentationsExperiences with a tax funded system: the NHS
Professor M. Powell, Health and Social Policy, University of Birmingham Health system reforms in Latin America: a cautionary tale
Dr P. Lloyd-Sherlock, School of Development Studies, University of East Anglia Health insurance and tax mechanisms to address health system challenges: Evidence from international experience
Professor D. McIntyre Health Economics Unit, University of Cape Town
Theme 4: Health systems reform and stakeholder engagement Due to its technical complexity and political sensitivity, technical work on the key features of any health systems reform is likely to be an insulated process. However, it is necessary to seek stakeholder consensus on it in order to gain support and retain legitimacy, and for the process to be perceived as legitimate. This session attempted to explore:
- Getting policy options through the policy and political process.
- Consumer expectations and quality of health care provided in the context of contributions in exchange for health benefits.
- Do health insurance mechanisms serve the interest of the working class or do they just pave the way for privatising health?
- The role of private providers.
- How the policy option is likely to affect the organisation, delivery and funding of health services and how stakeholders ought to prepare for and manage this.
- Challenges and positive spin-offs for stakeholders.
Presentations International experience of bringing about change in health care financing policy
Professor L. Gilson, Centre for Health Policy, University of Witwatersrand Health within a comprehensive system of social security
Dr K. Letlape, South African Medical Association Chickens, eggs and a unitary national health system: Health service delivery planning as an integral part of the funding debate?
Mr J. Burger, AIDS Law Project
Download the report of the colloquium A national health system financed through National Health Insurance: possibilities and challenges [2MB]
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