Lahja Nashuuta
Former health minister Dr Bernard Haufiku’s proposal for Namibia to emulate neighbouring South Africa’s National Healthcare Insurance (NHI) has evoked mixed feelings within the health sector.
The recently-endorsed Act in that country advocates for the creation of a state fund, financed with taxes, through which the government procures healthcare services for all citizens residing in the country by utilising public or private healthcare.
That government said everyone will be able to “access NHI-contracted GPs, clinics or hospitals closest to them, whether in the public or private sectors”.
“This means that when you feel unwell, you can go to your nearest GP or clinic that has a contract with the NHI, and not worry about the cost of care,” it added.
The government has not specified the treatments that NHI-accredited private hospitals and GPs will have to provide, but said they will include emergency services, mental health services, palliative care and rehabilitation services.
One widely-shared view is that while some form of NHI is needed and could provide much-needed reform in the local healthcare system, it should not be seen as a silver bullet which would magically solve all the problems.
In an interview with New Era recently, Haufiku commended the government of South Africa for passing the NHI.
“It is a good move to emulate. You know the costs of healthcare services in Namibia now are escalating in a way that is not sustainable. We also need to push for national health coverage for us to bridge the gap between the rich and poor when it comes to access to quality healthcare,” he said.
However, local medical practitioner Dr Nelson Makemba said the initiative is noble in an ideal world.
However, given the country’s infrastructure, implementation might be very difficult to achieve.
He argued that there is a need to first close the gaps between the State and the private sector so that the services are comparable on both sides of the fence.
“When that happens, perhaps one can consider such initiatives,” Makemba said.
Sharing similar sentiments was Dr David Emvula, a specialist obstetrician and gynaecologist, who questioned the affordability of the scheme.
“Critical to this model is funding. Who will fund for the majority of unemployed South Africans?” he questioned.
He believes the proposed general taxes to fund the scheme would add a strain to an already high cost of living for an ordinary Namibian.
Furthermore, the contributed amount may not be sufficient, which may compromise patient care in situations where critical medication is required.
“How will the government fund the upgrading and maintenance of State facilities to the level of the private facilities?” he questioned.
Another concern Emvula has against the scheme is governance.
He said the public health sector is not in shambles because of the lack of funds, but rather how the funds are managed.
“The public health system is a cash cow for often overpriced tenders, incomplete hospital projects, and poor-quality equipment with no accountability to the culprits,” he emphasised.
He further argued that the government-run NHI would be equivalent to an SOE, and prone to non-transparent poor governance and looting without accountability.
“NHI is a great ideology, and looks promising on paper, but likely an impossible dream. In the Namibian context, the challenges we face are almost similar to those experienced in South Africa. Year in and year out, the Ministry of Health and Social Services is allocated the second-highest budget, yet our public healthcare system is in shambles,” stated the doctor.
Added Emvula: “The governance needs to improve, and in my opinion, the procurement system for the ministry of health needs to be reviewed to establish a unique cost-effective suitable system. As highlighted in the media recently, we are currently experiencing a critical medicine shortage in the State because of a tender dispute”.
Paediatrician and paediatric intensivist Dr Tjijandjeua Kandetu said the proposed health scheme sounds good on paper.
“It makes sense to develop a system which cares for the health of everyone. I don’t really understand the legal nitty-gritty of the Bill. This is just my basic understanding of it all… In our current experience, both in South Africa and Namibia, the public health sector is completely overwhelmed and has many struggles. So, the question is then how they will efficiently manage the health sector under the NHI,” he observed.
Kandetu also expressed his concerns about how the NHI will be financed through taxes, and how those funds might be misappropriated.
“For Namibia, I think we will most likely follow suit soon. If done well, this would benefit the Namibian patient. It would give all Namibians equal access to good quality healthcare, regardless of their financial background, which is a fundamental right. Only if it is done right,” he stressed.
However, Kandetu maintained there is a lot that needs fixing first within the health sector, from human resources to the procurement systems.