Health services for all, with and for the workers and the poor

The recent release of the Green Paper on National Health Insurance (NHI) is a major milestone and development for the working people and the poor of our country. This development also marks a historic victory in the struggle of South Africa's working class for the right to health and decent life for all.

The introduction of the NHI marks an important step towards the decommodification of health services, so that health services are not only accessible to those who have money, but to all our people, especially the workers and the poor. The introduction of the NHI also marks a huge defeat for all those who have sought to profit from poor access to health for the majority of the people of our country.

The NHI will be the bedrock for the re-distribution of funds so that money will be spent on providing health to all of our people rather than just for those who can afford medical aid membership. It is also a major milestone for the ANC-led Alliance and the country as a whole towards the realisation of one of the five national priorities as set out in the 2009 election manifesto, electorally endorsed by the overwhelming majority of our people.  

The Green Paper is an unambiguous reaffirmation of the cornerstone and essence of the NHI in that it ensures access to health care as enshrined in our constitution; that access to decent health care is a human right, based on the principles of universal coverage for all citizens of South Africa. For the SACP this marks an important milestone in the struggle for building elements of, and momentum for, socialism in the here and now.

The capitalists in the health sector have been asking how the NHI is going to be funded. For the SACP, there is a simple answer to this; let the rich be taxed so that all of our people can have access to decent health care! The NHI can only be achieved through social solidarity which will force cross-subsidisation between the rich and the poor. The NHI will ensure that services are procured at reasonable cost, recognising that health is not a commodity to be bought and sold, but must be a right for all.

The SACP believes that these principles must be defended at all costs so that the NHI is fully a National Health Insurance and is not turned into a site for profit making by the business sector, whose objective is to make profit out of disease!

The SACP also fully agrees with the Minister of Health that for the NHI to be sustainable it must not be a curative system, but must be a system premised on healthy lifestyles for the people of our country. The SACP commits itself to wage a campaign for healthy lifestyles and for primary health care in order to ensure that we do not premise our health system on expensive curative measures in our clinics and hospitals.

We also welcome the fact that Minister Motsoaledi has made a commitment that the NHI Fund will be established in the next five years. The SACP believes that the establishment of this NHI Fund will and must be in line with the directive of the ANC National General Council (NGC), which defines it as a publicly-administered fund to receive moneys through a single-payer as one entity acting as administrator, or payer, set up by the government to receive all health care funds, and pay out all health care costs for all South Africans.

The SACP wishes to reiterate that we will reject any funding formula for the NHI that will use value added tax (VAT), to wholly or partly, to fund the NHI. To use VAT to fund this system will be tantamount to robbing the poor in order to fund the poor!

It is for the above reasons that the SACP is concerned about the statement in the NHI Green Paper that "a multi-payer system in a National Health Insurance will also be explored as an alternative to the preferred single-funder, single-purchaser publicly administered Fund". We totally reject this because we believe that it is another ploy to water down the original NHI model and to privilege medical aid schemes at the expense of the poor.

The SACP believes it is possible to achieve universal health insurance based on principles of solidarity, universal coverage, redistribution and fairness in a multi-payer system, as any other method will only continue to benefit medical aid scheme members. This will exclude the 84% of our population who are not members of medical aid schemes but solely depend on the over-streched and under-resourced public health care sector.

The green paper allows for an extensive role for the private sector - general practitioners, hospitals and specialists. The SACP firmly believes that these must be incorporated into the transformed health system on terms which do not compromise the NHI's financing of health services for all. We have seen the way in which private hospitals and specialists have held our people to ransom and are the major cost-drivers incurred by medical aids.

What we need to change is that private capitalist hospitals must not be allowed to refuse to treat our people if they do not pay upfront. This has often left our people in dire financial straits because they cannot access health care without paying astronomical sums they cannot afford. This capitalist plundering and profiteering must not be allowed in the NHI!

In 1991, in launching the SACP's Triple H Campaign (the fight against hunger and for access to health and housing for all), our late General Secretary, Cde Chris Hani said "Socialism is not about big concepts and heavy theory. Socialism is about decent shelter for those who are homeless. It is about water for those who have no safe drinking water.

It is about health care, it is about a life of dignity for the old. It is about overcoming the huge divide between urban and rural areas". What Cde Chris was displaying was a deep understanding of the primary health care approach. He was in fact highlighting the fact that the capitalist system is the primary genesis of all the health problems faced by the overwhelming majority of our people.

The SACP also salutes the fact that the NHI Green Paper goes beyond the issue of the financing of health care, and intends to cover other important pillars in the transformation of the health system, such as the quality of the delivery of services, the emphasis on the primary health care approach and refurbishment of the dilapidated health infrastructure. These interventions will be key in turning around our country's heavy burden of disease.

What should we be focusing on as SACP members?

Whilst we are in full agreement with the Minister in his attempt to ensure better management of our hospitals, it is our belief that this transformation involves more than changing or upgrading hospital managers. It also points to the need to create a new model of health care in our country, whose goal must be functional health care institutions to improve patient care, management efficiency, and staff satisfaction and morale of workers in our public hospitals.

The SACP's Medium Term Vision (MTV) calls upon the SACP and all its members to engage in all sites of struggle, including the struggle for access to health care for all. We therefore call upon all members of the SACP who are public sector workers to intensify the struggle for a truly state-led and public national health insurance system. Communists in the health care sector must ensure that they become the vanguard of promoting, defending and advancing the goals of the NHI, with and for workers and the poor.

The success of the NHI also depends on the production of skilled health workers, through joint actions and activities by the Ministers of Health and Higher Education and Training. The Minister of Health must be commended on announcing that the process of revamping nursing colleges is underway, committing to the immediate revamping and refurbishing of the 72 of the 122 nursing colleges in our country. In achieving these objectives we must also ensure that universities need to play their part in the training of high quality health professionals.

Critical in the construction of an effective NHI must also be the mobilization of our communities behind the campaign for access to health for all. This must include the effective incorporation and training of community health care workers into our entire health system.

The bedrock for the success of the NHI will be the working class itself - hence our call for its voice to be heard during the consultations around the Green Paper. There can be no transformation of our public health system without the power of the organised working class being in the forefront of this effort.

The SACP calls upon communities, workers, community health care workers, to visit hospitals and community clinics to assess the state of these institutions, hold community and workers' red forums, as such activism will greatly accelerate the struggle for the realisation of health care for all. Such mobilisation is also important to wage an effective struggle against the capitalist health sector, and to ensure that we roll back capitalism in the provision of health care.

The SACP commits to mobilise all its structures to engage with the Green Paper on the NHI through active debate and engagement through the mobilisation of all our people behind access to health care for all. In undertaking such mobilisation, the SACP will also seek to expose all those professors and health practitioners who have been bought by the capitalist health sector to advance their narrow and selfish interests, both inside and outside our own movement. We shall not allow any capitalist attempts to undermine the introduction of the NHI!

Communist cadres to the front... for national health insurance, with and for the workers and the poor!

Asikhulume!

This article by Blade Nzimande, General Secretary of the SACP, first appeared in the party's online journal Umsebenzi Online.

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