By Nsovo Mayinemele

It was in the early years when we millennials were starting to qualify and receive our degrees when Minister Motsoaledi dropped the National Health Insurance bomb on us. I for one did not understand what it was and what it meant. I did an internship at Dr George Mukhari Academic, a previously disadvantaged hospital from the Apartheid era. I was subsequently compelled to do community service in Thabazimbi Hospital, a hospital in a rural mining town. Working in these two hospitals made me come to one stark conclusion about the healthcare system in South Africa: We had a problem and something needed to change. I was not sure how we could solve this problem, but I knew that we had to solve this sooner rather than later.

My Masters’ research was around implementing quality improvement systems for the supply of medicines. The National Drug Policy (1996) was the foundation of my research. One of the health objectives of the policy document is ‘to ensure the safety, efficacy and quality of drugs’. The policy document was published in 1996, at the very dawn of our democracy. The government administration of 1996 had many other issues they could have prioritised, but they chose medicines as one of the first ones to address. Ensuring access to medicines that are safe, effective and of good quality is still as important to me as a millennial pharmacist as it was for the government of 1996. It’s important to ask if this has been achieved in the past 23 years since the adoption of this crucial document. And if the status quo remains, do we stand a chance of achieving this? Is the current healthcare system sustainable?

The NHI is a financing system that promises to make sure all citizens of South Africa are provided with essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund. We cannot afford to romanticise the NHI as it introduces many risks, however I am also of the belief that millennial healthcare professionals should support the NHI. Many sceptics of the system have cited malfunctioning state-owned enterprises such as Eskom and Transnet, as possible examples of the DOOM that will happen to the NHI. These are fair examples but we must support the NHI, period.

Firstly, healthcare is a human right. The constitution of South Africa in its Bill of Rights, enlists the right of access to healthcare. Further, the constitution instructs the state to ‘take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.’ The rights being referred to include healthcare. Implementing the NHI is a constitutional mandate of the Department of Health.

Secondly, our patients need us to advocate for their access to healthcare. If you have worked in the private sector and public sector, you know that your patients in the public sector deserve better. Being a privileged millennial I only used the private sector for my healthcare needs. This was not a perfect system, but it was definitely better than the system I served in when I did my internship and community service. I lived in the United Kingdom with the National Health Service (NHS), which has been in existence for 71 years. I was a beneficiary of the system and it worked well for me. I couldn’t help wishing that the same would apply in South Africa. As a rational healthcare professional who knows and understands the past injustices of Apartheid and inequality, I say yes to the NHI.

Lastly, we need it. Working in the public sector and private sector are two different systems that consequently impact one another. Being a conscious healthcare professional, refusing to provide services that are in my oath because of the unavailability of money are not easy. The disproportionate distribution of patients with one system being overcrowded is one of the reasons why we cannot work efficiently when serving the public sector. Resource constraints limit us from thriving in the work we do.

There are many arguments about why the NHI will not work in South Africa. Some say our financing is limited and South Africa is not ready for universal healthcare coverage. The UK implemented the NHS just after the Second World War. The UK was one of the countries that received development loans from the Bretton Woods Institution. No system is perfect in the world and the NHI will not be perfect but it is worth implementing for the injustices it seeks to correct. Therefore, there will never be a perfect time to implement the NHI.

Now is the time.

As a black millennial healthcare professional, I sing for its implementation.


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