Low uptake among GPs a threat to success of NHI

Ina van der Linde

The government’s white paper on the national health insurance (NHI) proposes a single, compulsory medical scheme for all, with private medical schemes being reduced to offering ‘complementary services’. A central NHI fund will buy health services from accredited healthcare providers. A critical component of phase two of the implementation plan is the process whereby the state contracts private general practitioners (GPs) to provide services at primary care level.

In the cover story of this edition, Charles Hongoro and colleagues report on a study (page 10) conducted in the Eastern Cape to find out why there is such a low uptake of national contracts by GPs to provide these services. Their findings mention a variety of factors for the low uptake, such as ‘inadequate communication and consultations with the local GPs on contract details’, a  picture that mirrors numerous other research findings on this topic.

For example, the NHI’s biggest pilot in the Tshwane district, published in the November 2016 South African Medical Journal (SAMJ), showed a high level of frustration with the current situation in hospitals, such as drug stock-outs, staff shortages, the pressure of long queues. An article by Daygan Eagar from the Rural Health Advocacy Project mentions that only about 150 out of the country’s 27 000 registered medical practitioners not currently working in the public sector have taken up NHI contracts in 2014. 
This begs the question of whether the Department of Health is not putting the cart before the horse. The working conditions in hospitals and better contracting stipulations need to be improved to lure GPs into the NHI.

In an insightful opinion editorial on page 20, Ivan Turok ponders the problems facing hung councils in four of the metros and 28 other municipalities, which promises a period of energetic rivalry and heightened scrutiny of each party’s actions and the quality of political management in these municipalities. He warns that governing large fractured cities like Johannesburg or Tshwane is a far more complex undertaking than managing a business or social movement. If the ongoing political contest is dominated by tactical considerations, with politicians intent on gaining some short-term advantage over their rivals, the result may be entertaining, but ultimately draining and debilitating.

On the productive use of land transferred to communities, Tim Hart and colleagues argue on page 7 that the debate should move away from the question of whether land is used ‘productively’ for agricultural purposes by new owners but should refocus on the question of whether the recipients use the land for agricultural purposes that help to sustain or improve their wellbeing.

Then there is an article by Aubrey Mpungose, who reviews the literature on projects similar to the Durban port-expansion project and warns that this might result in permanent and irreversible negative social, economic and environmental consequences for the community of South Durban.
A last word: After 13 years and more than 50 editions of the HSRC Review, the time has come to move on. A new editor will soon be appointed, so watch this space.

With regards
Ina van der Linde