The South African Federation of Trade Unions stands fully in support of the long-overdue introduction of a national health insurance (NHI) system, and welcomes this week’s conference convened by Public Service International to discuss how the unions should intervene in the process.
SAFTU is clear that the NHI is the only way to end the present, disastrous and racialised two-tier health regime which provides top-class service to the wealthy white majority but a dysfunctional, understaffed and underfunded service to the overwhelming poor black majority.
The South African Constitution’s Bill of Rights, Section 27, headed “Health care, food, water and social security” could not be clearer:
(1) Everyone has the right to have access to —
(a) health care services, including reproductive health care;
(b) sufficient food and water; and
(c) social security, including, if they are unable to support themselves and their dependants, appropriate social assistance.
(2) The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.
(3) No one may be refused emergency medical treatment.
It is just as clear that the government is not complying with any of these requirements. The Esedimeni scandal was the worst possible proof that those most in need of the protection promised by Section 27 were fatally denied any access to humane treatment.
At least 144 patients died and 28 remain missing, following the transfer of 1700 mental health patients out of Life Esidimeni facilities into ill-equipped and mainly unlicensed NGOs, which Justice Moseneke referred to in his arbitration report as “death traps of sites of torture”.
Appalling though this case was it was just the tip of the iceberg of the cruelty inflicted on poor patients in public hospitals, clinics and community healthcare. Despite the heroic efforts of underpayed and overworked staff, patients face long queues and overcrowding, and dirty buildings which have even led to deaths from multi-drug resistant bacterial infections.
Gauteng Health MEC, Gwen Ramakgopa, recently reported that the provincial health department is facing a “critical shortage of skilled nursing personnel”. Tembisa Hospital in Gauteng only has 40% of the nurses that it requires. The Bongani Hospital in the Free State has one nephrology sister to attend to patients suffering from kidney diseases, despite health norms and standards indicating that hospitals should have nine.
Staff at state hospitals have had enough. Workers at Baragwanath Academic Hospital have marched to demand the acting CEO to step down, filling of vacant posts, fair employment opportunities for everyone, corrupt officials to be removed and the release of a long-held report of an investigation into rife corruption at the hospital, which has crippled health-care service at the facility to the ground for far too long and led to sub-standard healthcare at the facility to patients.
This disastrous situation is getting worse and inequality is getting wider, with more budget cuts for the state facilities, while the profit-based private health sector gets richer. South Africa currently spends 8.7% of its GDP on health. 4.5% of is spent on private healthcare for around 16% of South Africans, while only 4.2% of GDP is spent on public healthcare, for 84% of South Africans!
The National Health Insurance scheme is intended to end this outrageous bias in favour of the rich. Resources were to be allocated purely on medical grounds so that every South Africa would have the right to the same best-possible level of treatment and care.
“The NHI is fundamentally about social justice” said President Ramaphosa on 24 August, “Providing universal and quality health care for all is not only a matter of moral principle… The National Health Insurance is meant to ensure that all our people, black and white, rich and poor, receive the quality health services they need without the imposition on them of financial hardship. Our people should be able to access a comprehensive range of health services, including prevention, treatment, rehabilitation and others. These services – no matter who is providing them – should be of good quality”.
The danger is however that these fine words will not lead to any fundamental change for the better, as powerful vested interests in the private sector, private hospitals and medical aid copanies are mounting a furious campaign to sabotage the the National Health Insurance (NHI) Bill and the Medical Aid Schemes Amendment Bill which are to be put to Parliament.
The right-wing Free market Foundation and the Institute of Race Relations have joined in, and the white, sweetheart union Solidarity has claimed that “Research found more than 80% of healthcare professionals don’t believe the NHI could work, and would consider migration if it is implemented”.
It is crucial therefore that trade unions and civil society launch a mass counter-attack and the PSI conference must be the launching pad. The July Working-Class Summit demanded sufficient time for full community and worker consultation on the NHI Bills; SAFTU and its allies will make submissions, raise awareness, share information and mobilise their members and civil society organisations to produce mandated responses to the Bills.
But while it is right and necessary to provide time for public consultation on the two bills, this must be made an excuse for more delays. It is alarming that Aaron Motsoaledi has said that the NHI will only be fully implemented by 2026.
Workers are impatient for change and should not have to wait until 2026.
It has already taken far too long to move on the NHI, which was first adopted in 2007 at the ANC Polokwane Conference, which resolved to “reaffirm the implementation of the National Health Insurance System by further strengthening the public health care system and ensuring adequate provision of funding”.
That is why the NHI must from now on be right at the top of the government’s list of priorities and speed up. SAFTU will do everything possible to end the scandal of the current unequal and racist two-tier system and fight for free, quality and equal health care for all.