A webinar was hosted recently by the Health Justice Initiative (HJI) in partnership with the World Health Organization Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice at UKZN, focusing on Medicines Access under the National Health Insurance (NHI) – Selection, Pricing and Procurement. South Africa has committed to providing universal health coverage by 2030 through the implementation of the NHI. However, progress has been hampered both by the pandemic as well as the fiscus crisis.
The webinar looked at the recent Bill that was published and was presented to the Portfolio Committee for discussion. HJI has prepared an Issue Paper 1: National Health Insurance Paper Series that outlined 17 questions that needed to be addressed before the implementation of NHI proceeds. Presentations were made by Ms Fatima Hassan (setting the scene), Dr Andy Gray (on selection, procurement and pricing in the public sector) and Ms Inez Naidu (on selection and reimbursement in the private sector). A robust discussion unfolded during the webinar highlighting several stumbling blocks to ensure equitable access by 2030.
The pandemic highlighted the importance of a healthcare system, with the right skills, funding base, and transparency in decision-making around health policy and medicine selection. According to Hassan from the HJI, there are several concerns amongst practitioners. She said, ‘The financial feasibility of implementing the NHI is still unclear and a huge risk to the fiscus in a post-COVID economy that is dealing with a recession, load shedding, and high unemployment rates. At the moment, there is also concern around high novelty medicines for chronic patients which the NHI will not offer.’
Naidu, from the Discovery Health Medicine Unit said that Discovery had more than 30 years’ experience in the market representing 8.95 million lives. Discovery Health is highly regulated by the Medicines and Related Substances Act and access is extensive. She commented, ‘Medicine Legislation is intended to provide more affordable access to medicine and the Department of Health caps the extent to which medicine prices can be increased. However, we operate in a global market where pricing is high. It is important that we are guided by international standards but national guidelines are essential to ensure cost-effective pricing for all South Africans.’
Dr Sham Moodley, a community pharmacist was in support of the NHI as a concept but stated that there are a number of discrepancies and lack of transparency. He said, ‘The pandemic presented us with the best opportunity to deliver on a model that is similar to the NHI. However, there was a lack of transparency as to how donor funding was used. Funding for the Sisonke project was managed through Treasury with no accountability. To date, some private pharmacies have not been reimbursed for the dispensing of the COVID-19 vaccines. Government cannot be trusted to deliver on the model they have presented.’
Gray from UKZN has many years of experience in medicines regulation having served on the former Medicines Control Council and as technical advisor for the South African Pharmacy Health Products Regulatory Authority. He envisaged that during the interim rolling out phase of the NHI, there will be three systems in place simultaneously. ‘Firstly, the NHI will enrol everyone, and allow for services to be obtained in both the public and private sectors. The second is the medical scheme funded private sector. The third system is the public sector which will need to cover uninsured persons whose needs are outside of the NHI benefits package. Initially, there will be an overlap of services offered by both the medical aids and the public sector. Right now, there are many questions as to how the phases will unfold but not many answers.’
Professor Fatima Suleman from UKZN stated that whilst the NHI is being phased in, a transitional arrangement will exist. ‘With different systems in place, have we thought this through? Some medicines will not be covered by the NHI, especially high novelty medicines for chronic patients. Medical schemes have many years of reimbursement experience and existing structures that link patients and providers that are just not being tapped into, instead we are focused on reinventing the wheel.’
Words: MaryAnn Francis