National Health Insurance Pilot Kicks Off in Eden

While the Western Cape Government does not support national government’s National Health Insurance (NHI) model in its current format, the Province’s approach is that the Western Cape is able to make a significant contribution to develop the best ultimate model.

The strengthening of public health services in the Eden district in preparation for national government’s proposed phased implementation of NHI is on track. The Eden District has an estimated population of approximately 575 000 people, of which 89% are uninsured. The district is divided into six sub districts, each  headed by a medical manager.

The clinical services that the district provides are covered through:

• Community based services
• School health
• NGO-run home based care and intermediate care.
• Primary health care through community health centres
• Six district hospitals
• Alan Blythe Hospital, Ladismith
• Knsyna Hospital
• Mossel Bay Hospital
• Oudtshoorn Hospital
• Riversdal Hospital
• Uniondale Hospital
• One regional hospital: George Hospital
• A patient transfer system – HealthNet

All the above health services role players meet every three months to plan and implement integrated care.

During the past year 14 NHI activities were undertaken, with the following outcomes:

• Putting structures in place to implement NHI, with a project co-ordinator and administrator.
• The development of an appropriate supply chain model for human resources, finance and supplies to strengthen the district health system.
• Identifying the key challenges in contract management that require action.
• Situation analysis of the patient referral system at George Regional Hospital.
• Standardising the existing folder and filing systems at primary health care facilities.
• Developing a training package for community-based health care co-ordinators and care workers on chronic disease management. The project will be completed during the first quarter of 2013/2014, and about 330 CCWs will be done during 2013/2014.
• Developing affordable and sustainable eye care.
• Review the current home and community-based care, as well as the intellectual disability policies.
• Standardising a list of bandages, dressings and sutures to be used in the district.
• Procurement and distribution of medical equipment for primary health care facilities in need, such as a sonar probe and wheelchairs.
• Appointment of school health programme staff.

In the past year:

• 152 schools were visited.
• 12 147 learners were screened.
• 5 744 grade 1 learners were referred.
• 244 grade R and -1 learners were dewormed.
• 1 880 referrals
• 1 452 Td vaccinated (six years)
• 3 899 pupils treated on site

Abnormalities found:

• Dental - 4 160
• Minor ailments -2 187
• Visual -287
• Speech and Hearing -355

Position of the Western Cape Government on the NHI pilot project

While the Western Cape Government is participating in the Eden NHI pilot, this does not indicate unqualified support for the as yet not formally tabled policy document for NHI.

There are ten pilots in the country that are "piloting" various options and we are implementing the pilot in the den district. There is no final model. The reason for the Western Cape participation is the belief that the province can contribute to the development of the best ultimate model.

The Western Cape Government policy is one of "Universal Health Care for All", which is supported by the World Health Organisation, but through a model of a functioning health system at provincial level without the centralising of all funding and management through the National Department.

All that is currently being undertaken by Western Cape Government through the support of the NHI pilot project is to strengthen health services in the Eden District and to provide the country with viable models of health care that have worked and will continue to provide quality patient-centred health care services.