December 17, 2020

Universal Health Coverage: We need an overhaul of current systems

Under the framework of Universal Health Coverage (UHC), South Africa’s (SA) National Health Insurance (NHI) is punted as just about everything – the magic bullet to equity, solving quality woes, and ensuring we have a better health system.

The political will and commitment is strong for moving towards the NHI, although it is considered to be the only solution marred with rhetoric and promises.

The NHI purely focuses on financing, with the key aim of purchasing healthcare services through the NHI Fund. The mere mention of the word finances and the public sector in SA is enough to make anyone run. Covid-19 corruption sums it all up when it comes to tenders, and flawed procurement processes, the wastage of resources; paying up to five times more for Personal Protective Equipment (PPE) and even the quality of PPE procured being poor.

There are a couple of current National Department of Health (NDOH) Strategies which if implemented, may strongly complement the NHI. South Africa’s Digital Health Strategy 2019-2024 aims to achieve:

• Development of a complete health electronic record which will improve patient management.

• Digitisation of health systems business processes.

• Establishment of an integrated platform and architecture for health sector information system.

• Scaling up high impact health for community-based interventions.

• Development of digital health knowledge workers working to support digital health as well as economic development.

Reports show that close to 26 million patients are registered through the Health Patient Registration System (HPRS), although the use of this data is already fraught with problems in SA. The greatest offering of the digital health strategy is that it places focus on the digitisation of processes e.g. human resources, financing, procurement and supply chain.

The lack of seamless processes from the facility level all the way to the national level is one of the reasons the health system is exposed to corruption and inefficiency, the establishment of the NHI Fund and mechanisms for financial management alone will not address this in SA.

One example that comes to mind is how at the coalface, managers cannot provide you with accurate stock data, or if they do, it is through manual counting and double-checking with other colleagues. The procurement of necessary information and communication technology (ICT) itself is another area where we will need leadership to implement the Digital Health Strategy, unfortunately, and realistically, we are still far from this.

Neither is the digital way of working part of the organisational culture across most state departments in the country. Bureaucratic employment processes are one example, at least on an annual basis; the headlines are that young interns struggle with the placements. The Human Resources for Health Strategy 2030 points out that staffing data is not accurate.

The negatives aside, it is simple, if we begin to prioritise digitisation of processes, support and invest as per the Digital Health Strategy along with the NHI, we may be en route to changing the way things are done. Digitisation alone is of course not going to be a single solution either to UHC, but what it does offer is a strengthening of multiple health systems building blocks (e.g. procurement, financing), which are fundamental to the NHI being successful.

Another off-shoot and clear from going digital is that the new generation of healthcare professionals clearly thrive within smart environments, a finding which was echoed among a wide array of young health professionals including psychologists, dentists, clinicians and digital health entrepreneurs who participated in the launch of the Philips Future Health Index South Africa 2020 report.

It is about time that those holding key positions get with the times and the 21st century way of doing things. For that, of course, we also have to address pressing issues such as electricity and infrastructure, which in many parts of the developing world holds us back.

* Dr Choonara is an Award-Winning Independent Public Health Practitioner, recently appointed AMREF Health Africa AHAIC Commissioner for Universal Health Coverage.

National and International News