Some of the strongest opposition to the government’s planned National Health Insurance (NHI) now comes from workers in the medical sector itself.
The opposition is so strong that many health workers would rather go abroad than work in a country where the NGV is implemented by the current government.
Research by the Solidarity Research Institute (SNI) which is aimed at health workers’ understanding and attitude about the NHS, shows how deep-seated the medics’ distrust of the plans with the NHS is.
Healthcare workers have indicated that they now have much more knowledge about the NHS – but with this knowledge also comes much sharper opposition to the NHS.
An overwhelming 99% of the respondents who took part in the study are deeply concerned about the government’s competence to introduce and properly manage the NGV.
In addition, respondents are deeply concerned about the consequences that the NGV has for the practice of their profession. Likewise, they fear the consequences that the NGV will have for patients and even for the country’s economy, should the government go ahead with its plans.
The report is the product of the fourth comprehensive Solidarity study which measured healthcare workers’ understanding of and attitude towards the NHI. The 2023 study follows similar studies conducted in 2021, 2019 and 2018. All these studies corroborate the latest research on the NGV.
A total of 1,514 respondents participated in the surveys over the past five years and represent diverse medical professions and demographic groups.
The latest research consisted mostly of women healthcare workers (55%) affiliated with private health practices (44%), private hospitals (22%) and government hospitals (13%).
Nicolien Welthagen, manager of SNI, says that healthcare workers have indicated in the latest research that their understanding and awareness of the NGV has increased sharply. This increased from 54.4% in the first study in 2018 to 79.4% in the latest study.
“This means there was an increase of 25% in respondents who feel they now have more knowledge about it. What is important is how their impressions of and conceptions of the NGV change along with it,” she says.
“The majority of healthcare workers now have a more negative and skeptical outlook than five years ago. In terms of negativity, there was an increase of 21% over this period.”
Corruption biggest cause for concern
While more than half of the respondents acknowledge the unaffordability of medical aid for the majority of citizens, they are concerned for several reasons about the effects that the NHI would have as a substitute – especially because it might drive health workers out of the country.
The mistrust in the NHI is of such a nature that 94% of respondents believe that private health practitioners may decide to work abroad because of the NHI.
While these much-needed practitioners may be able to leave the country in large numbers, the same percentage of respondents believe that it is unlikely that the NGV will be implemented successfully at all.
Only 2.9% of respondents believe that all citizens will have access to high-quality healthcare under the NHI.
According to Welthagen, there is also clear concern about the effects that the NGV will have on South Africa’s economy as a whole, and there is particular concern about the exposure of such a system to corruption.
“Corruption is considered the main obstacle to the NGV’s feasibility. Healthcare workers are therefore not only suspicious of the NGV; they are against it.
“The notion of expected corruption is of course reinforced by the presence of corruption in every other state-controlled institution,” says Welthagen.
According to her, there is a consensus among respondents that corruption will penetrate the NGV and that the NGV will be a vehicle for government officials to enrich themselves.
“Then we are not even talking about the general feeling that it simply cannot work. Shortages of essential elements such as financing, skilled personnel, good infrastructure and specialist knowledge stand out,” says Welthagen.
“Then the government does not even improve the current public health care system. We have one, but it is not renovated or improved.”
The minister of health, Joe Phaahla, has already admitted that the country’s state hospitals and clinics, despite an expenditure of R26 billion, still do not have the standards required for NGV accreditation.
The deadline for comments on the NGV, which must be submitted to the National Council of Provinces for consideration of the draft legislation, is the end of this week.
In the meantime, Solidarity has undertaken to also provide its input, together with the SNI’s latest report, on the NGV.
“Solidarity is completely opposed to the introduction of the NGV and the centralization of the South African health system.”