A lot of noise has surrounded the issue of National Health Insurance (NHI), some saying it is unaffordable whilst others say the government is not ready. There is also the option of the Universal Health Coverage (UHC) versus NHI. To me the UHC and NHI difference is semantic and not substantive. The point is health is a matter for the government. A bifurcation of focus leads to a number being left behind.
My mother ultimately took her last breath at Baragwanath Hospital in South Africa in October of 1964. With all the will in the world, my parents – both teachers – their income would never afford a private facility. Fast forward to the days of medical insurance schemes.
I have walked through the corridors of public facilities. They have deteriorated so badly from the state they were then in 1964. Even the Military Hospital that prided itself with the treatment of successive leaders of South Africa is beginning to be a sorry sight of treatment. Steve Biko hospital, which prides itself and rightly so with a top facility Numeri runs the risk of this premiere facility attracting the private sector. It is a matter of time before it becomes so pre-eminently exposed.
The public sector premiere hospitals are rapidly becoming ghost towns. Why is that so? Mariana Mazzucato has an answer to this phenomenon. And Chomsky is more unforgiving in his language – defund government institutions, make things not to work, people get angry and rebel and destroy. Then the conditions are ripe to sell what used to work for scrap. This is a South African play book.
Mazzucato thesis of an entrepreneurial state says “stop listening to what America said it did – look at what it did. Then you will know that the commanding heights are not the business of the private sector. The private sector can only harvest what the government as an arm of the state did to innovate to the extent that the private sector can flourish. Apartheid South Africa is a clear case study of government excellence – albeit for the white population. An argument for population preponderance is not a brilliant argument. If it were, China would have to be the poorest country in the world, so would be India, yet some of the tinniest are the poorest, like Lesotho and Swaziland. So where does the truth lie?
Let us explore apartheid South Africa white civil service. They used public services throughout. A health public service, an education public service, a transport public service, an energy public service and a research public service. All was functioning and the converse of deterioration of that design cannot be attributed to preponderance of population unless we confirm the Malthusian thesis of overpopulation, albeit it has surreptitiously entered our lexicon through an undesirable low growth trap. You really have to be deliberately destructive with your economic policies to run South Africa to a level where the Malthusian ghosts are invoked in public policy.
On the question of health and the NHI – the ghost of Malthus is being dangled. And the here and now of rands and cents is the oft quoted dilemma. No one goes back to 2010, when Minister Aaron Motsoaledi worked on the Primary Health Care giving through the building of Community Health Providers.
It was in Geneva at the World Health Organisation Summit that I had a moment of discussion with him. He was quite stressed as he compared the ratios of Community health service workers in Germany compared to that of South Africa, where he had started building a cadet of them and looking ahead of meeting a target on impact. Guess what happened to him in 2015. I remember his demise. Because it was in that year that his budget was slashed with a sledge hammer. I remember too well because that was the year of significant austerity. In fact department of health, defence and StatSA were emasculated.
Some of the Community Health Workers Motsoaledi had started to build as a cadet of people to take on the health task had been offloaded because of budget. He was on the firing line and Treasury was no where to be seen.
So, when the question of NHI is questioned amongst other reasons on the state of readiness, the Treasury is no where to be seen. Yet it was Treasury that was central to undermining Motsoaledi’s effort who ten years ago as a health scientist, a medical practitioner and a decent human being who went to Steve Biko to be treated. So today people are pointing fingers to health instead of pointing their fingers at the offenders and those who undermine NHI.
Dr Pali Lehohla is a Professor of Practice at the University of Johannesburg, a Research Associate at Oxford University, a board member of Institute for Economic Justice at Wits and a distinguished Alumni of the University of Ghana. He is the former Statistician-General of South Africa.
*** The views expressed here do not necessarily represent those of Independent Media or .
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