The South African government is currently embarking on one of its most ambitious transformation projects of the last 20 years. The introduction of the National Health Insurance (NHI) has the potential to fundamentally shift how the provision of health care is funded, how the system is structured and how services are accessed. The NHI could, if implemented to its full potential, could be one of the country’s most important social justice projects. The NHI has the potential to promote greater equity in health care provisioning and ensure all people who reside in South Africa enjoy full access to health care services as enshrined in Section 27 of South Africa’s Constitution (Act 108 of 1996)
For this process to truly transform health care in South Africa, it is essential that the government implement reforms that effectively deal with deep fractures in the resourcing of care between various systems and contexts. This not only involves promoting greater equity between the public and private health systems, but also within the public system itself.
In this submission, the Rural Health Advocacy Project and its partner organisations, together forming the Rural Health Partner Network, provide a detailed critique of the treatment of rural health in the current version of the policy paper. We are cognisant of the fact that the White Paper is a broad framework that outlines the structure and key priorities of the NHI and is not meant to provide the substance of each of its components. That said, the explicit recognition of factors that make service delivery both more expensive and difficult in rural contexts is absolutely vital at this juncture.
Without due consideration of factors such as geography (distance and topography), demographic characteristics, epidemiological profiles, high levels of socio-economic deprivation and inequities in the resourcing of care, the NHI will simply duplicate historical and structural neglect that continues to define much of rural health.
There are opportunities, however, to systematically account for these factors in the design and structure of the NHI. In this submission we offer advice on areas that require rural-proofing and how this may be achieved. Our submission is not one that simply demands more resources for rural health but is one that demands that we all think differently, THINK RURAL!