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OPINION: Is Covid-19 a good test for public-private partnerships and the future of NHI?

29 April 2020

There is a saying that one should never let a crisis go to waste. At the end of the pandemic, we need to look at the learnings of all countries and apply them in the context of NHI, writes Ahmed Banderker.

Is the coronavirus (Covid-19) a test run for the implementation of the National Health Insurance (NHI)? Yes.

As the coronavirus continues to spread across the world in a unique and unprecedented manner, it is also a case study that demonstrates the need to create access to quality healthcare for the most vulnerable in our society.

We must provide integrated, sustainable and innovative solutions across the entire cycle of healthcare.

Coronavirus (Covid-19) is confirmation that for the NHI to succeed it cannot be implemented by the government alone, but through the participation of both the private and public sector for the benefit of all of us who are currently enduring the lockdown.

Data from Statistics South Africa shows that more than 47 million South Africans do not have medical aid, and just 9.4 million people enjoy the benefit.

Private Public Partnerships

To meet the needs of the uncovered 47 million people, we need a workable accommodation between the public and private sector, through Private Public Partnerships (PPPs).

As we brace ourselves for the full implementation of NHI after we have defeated the coronavirus, we need a reminder of what ails our healthcare system.

What ails our healthcare

According to the World Health Organisation (WHO), of the numerous maladies, three stand out. First, public healthcare is insufficient in most cases due to resource starvation and inefficient infrastructure and poor governance.

Secondly, our private healthcare has become predominantly a private profit business, heavily curative-oriented and prone to excessive pricing as a consequence of the legislative framework.

Thirdly, courtesy of WHO research, is the 'people aspect' of healthcare. The WHO says, “How people live and take care of their health has been allowed to degenerate; the protective armour of disease prevention has weakened.

Nutrition is poor. Rural and urban sanitation is dismal. Consumption of tobacco, alcohol, fast foods and lack of exercise have become major risk factors causing a mega-epidemic of diseases such as diabetes, cardiac problems and cancers.”

From the reasons cited above, it is easy to see that only well designed and implemented partnerships in the areas of infrastructure funding, service provision and overall health system strengthening will help implement an NHI which will be ready to tackle future pandemics.

Will the NHI cope with a future pandemic?

At the end of this pandemic, we should ask ourselves: Will the NHI cope with a future pandemic? Will there be enough ventilators? Will there be enough funds? Will the public hospitals have enough beds?

For example, at the moment, medical schemes have R125-billion of reserves that can be utilised by those in the private medical aid schemes.

When we look at the economic strain a pandemic creates, if the NHI was in place, then the bulk of the funding would have to come out of government coffers or out of individuals pockets at a time when they can least afford it.

So how will PPPs take our health services out of the doldrums?

A key driver for PPPs is for the private and public sector to work together to finance health care infrastructure.

Indeed, public-private partnerships could be the most promising model for financing a successful healthcare infrastructure.

We can leverage the comparative advantages of both the private and public sectors and build hospitals to serve millions of poverty stricken citizens.

We can learn from governments around the world, especially countries which have increasingly used private sector involvement in developing, financing and providing public health infrastructure and service delivery through PPPs.

These partnerships would enable communities to combine the resources and medical expertise of the public sector with the operational and environmental specialties of the private sector to create sustainable infrastructure.

The partnership between the private and public sector is essential if we are to achieve any meaningful success and PPPs can make a substantial contribution to the delivery of healthcare projects.

I would like make the point somewhere in this document, that government should start with finding solutions for the indigent, then the uninsured but working. Leave the private sector to self-fund their own needs out of after tax money. This phased approach is the most pragmatic.

PPPs are certainly a promising model, which in conjunction with other economic and social policies, could lead to new ways of commissioning care and promoting innovative healthcare service delivery.

To build a healthy nation and citizens, we need PPPs and collaboration with the government to find solutions to social challenges envisaged by the National Development Plan.

Through the PPPs, our country has the potential to increase access to critically needed services and goods that otherwise would not be available.

Make no mistake, dealing with the coronavirus pandemic is the biggest single challenge the NHI would have faced had the healthcare for all dream been realised by now.

Now and in the future, South African manufacturing firms - even those not normally involved in producing medical equipment, need to start making thousands of extra ventilators that could be needed if intensive care units were to become completely over-run with desperately sick patients.

Of course the government would ask suppliers to quadruple production.

But even if the manufacturing fraternity does somehow manage to produce life-saving ventilators at a faster rate, hospitals would need staff to operate them.

During this crisis, the health sector had to relook and acquaint itself with other modes of consultations such as virtual consultations and telemedicine.

After all, in these difficult times patients can choose from voice, video or online chat to talk to a general physician or specialist and discuss their health issues conveniently.

These new service channels of virtual consultations and telemedicine, plays a vital role in creating more equitable access to healthcare across South Africa while lowering costs.

But let us remember that intensive care medicine is one of the most specialised fields of healthcare, requiring specialised training and expertise that include monitoring high-tech equipment and the precise control of drug dosages.

All of the above issues means the government cannot fight and defeat Covid-19 alone, it also cannot implement NHI alone.

The state will need the participation of the private and public sector, but more importantly, of the people who are observing social distancing at the moment.

Should Covid-19 infections spike to unprecedented levels, the National Department of Health is currently looking at private hospitals to provide extra beds that may be required if there is a shortfall of public beds.

It is great to see the collaboration. But it also makes one wonder whether the total cost of NHI could be a lot less if the two systems collaborated to provide sufficient beds in a particular region.

Imagine if we never had medical schemes today? How would the government have handled the cost of providing care for all those who are sick? What if 500 000 South Africans require hospitalisation at the expense of the state? Can we afford this?

There is a saying that one should never let a crisis go to waste. At the end of the pandemic, we need to look at the learnings of all countries and apply them in the context of NHI.

Covid-19 is a good test for PPPs, for the development, testing and implementation of mutually beneficial and innovative healthcare delivery models and solutions for our Rainbow Nation.

Through PPPs, we can get an NHI which is pro-growth, pro-business, pro-job creation and be ready for the next pandemic.

- Ahmed Banderker is Group CEO of AfroCentric Group, South Africa’s largest health administration and medical risk management solutions provider, which owns health companies such as Medscheme.