Nonprofit organisations like Marie Stopes South Africa are following the rollout of the National Health Insurance (NHI) closely to see how best their service delivery operations will fit into the new countrywide scheme.
The National Health Insurance Green Paper was published in August 2011 and says the NHI is set to be implemented in three phases over a 14-year period.
“At Marie Stopes, we see the NHI policy proposal as a timely response and are impressed by the visionary steps the Department of Health is taking toward improving the health system. The vision behind the NHI, of quality healthcare for all, will have dramatic impact on the health status of South Africans,” says Denise Hunt, Marie Stopes South Africa’s Country Director.
According to a circulating explanatory presentation from Minister of Health, Aaron Motsoaledi, in the first five years of the NHI, the government will focus on:
- Strengthening the health system;
- Improving the service delivery platform; and
- Policy and legislative reform.
Marie Stopes is well positioned to support the government, particularly in improving the service delivery platform, according to Hunt. Marie Stopes has a nationwide network of 33 centres providing safe abortion, family planning, HIV testing, male circumcision, sexually transmitted infections (STI) screening and other sexual health services for men and women.
“We provided sexual and reproductive health services to 682 000 clients countrywide between 2007 and 2011,” reports Hunt. She says nonprofits, in particular those that deliver services like Marie Stopes, can play a key role in the provision of quality healthcare in South Africa, and that the organisation believes that, “Multi- stakeholder approaches and collaboration of all sectors will have bearing on the new NHI’s success.”
According to page 16 of the NHI Green Paper, “Covered healthcare services will be provided through appropriately accredited and contracted public and private providers and there will be a strong and sustained focus on the provision of health promotion and prevention services at the community and household level.”
“We hope the government includes nonprofits, like Marie Stopes, in the pilot project of the NHI. We have vital services, experience and expertise to offer in sexual and reproductive health,” says Sarah Osman, head of new business development at Marie Stopes.
Nonprofit service providers, she says, should not be considered in the same category as private, for-profit, healthcare providers. “At Marie Stopes, we are not in the business of making money. Our mission - to help women have children by choice not chance - is in keeping with the NHI’s vision of safe, accessible healthcare for all,” Osman says.
“We employ a successful social-entrepreneurial model, wherein surplus generated is reinvested back into our centres to sponsor those in need,” explains Osman.
Regular access to sexual and reproductive health services is important for individuals as it: alerts to the presence of reproductive cancers; prevents unwanted pregnancies and reduces infections and transmission of STIs and HIV, says the International Planned Parenthood Federation in their 2011 annual report.
Beyond the individual, the United Nations says sexual and reproductive health plays a role in development and is directly linked to the achievement of the Millennium Development Goals (MDGs) providing universal primary education, achieving gender equality and empowering women, reducing maternal mortality and morbidity and combating HIV/AIDS.
Preventing unintended pregnancy greatly reduces maternal and infant deaths, improves educational and employment opportunities and increases family savings which, according to the World Bank, reduces poverty, increases economic growth and improves gender equity.
What is needed to successfully engage with nonprofits, as well as civil society at large are, “Spaces for government to dialogue with civil society organisations focused on the health sector”, Osman says.
One such space, she says, is the Joint Primary Health Care Forum, which was founded in November 2011 and officially launched on 8 May 2012. The forum’s guiding document describes its objective as “provision of equitable and comprehensive primary health care in both communities and facilities, within the district health system” and to “significantly improve access to health promotion, preventative, treatment and care and support services at local level.”
Jack Lewis is co-director of the Community Media Trust and a member of the forum’s steering committee. When asked how the forum will support the national health insurance, Lewis explains simply, “We need less sick people and less dead people in order to successfully implement the NHI.”
And it is the improvement of the primary health system, he says, “That’s the main tool which exists to lower morbidity and mortality (sickness and death).”
The goal of the forum is “To speak as a unified voice (of civil society organisations and individuals) on the key questions in primary healthcare,” says Lewis.
He says it is based on civil society’s previous experiences with the healthcare system, such as the introduction of antiretrovirals in 2004. Hopefully, he says, it will “Allow government to speak to one representative group” rather than “Having individuals or NGOs lobbying them on this and that issue.”
“The forum is in the early stages of providing a much-needed, structured platform through which government can inform and liaise with civil society,” says Osman, who represents Marie Stopes on the forum steering committee.
“If there are hiccups or challenges we can lobby government together, with a unified voice,” Lewis explains.
This is particularly important in light of concerns that have been raised over the NHI Green Paper, in particular around financing and implementation.
Some of these concerns, and suggestions on how to address them, were noted in a written response to the proposed NHI by a group of civil society organisations in the health field, coming together as the National Health Insurance Coalition.
The response says that, “The content of the benefits package will ultimately determine the form and quality of the health system created and should be legally defined. It should be appropriate, comprehensive and incorporate preventive and promotive health strategies. It should also include the kinds of services delivered by a wide range of health care workers, professionals and community health care workers (CHWs), and not only concentrate on curative services currently delivered by doctors and other professionals on a mainly fee-for-service basis.”
The Coalition’s response also points out the challenges of implementing such a system, both the cost and the high demand for trained health providers.
One way to address these challenges, says Hunt, is through maximising the existing human resources of nonprofit organisations, for example through the subcontracting of healthcare to service delivery organisations.
This, says Hunt, would reduce strain on public sector resources.
“Marie Stopes has existing, quality centres of highly-trained staff in South Africa, as well as access to international quality improvement, technical and clinical expertise as a member of the Marie Stopes International Global Partnership,” she says.
On a small scale, Marie Stopes is already successfully collaborating with government-run facilities, Hunt reports. Since 2007, Marie Stopes has referral agreements with public hospitals in the Western Cape and KwaZulu-Natal to provide termination of pregnancy to clients at their centres.
Clients who have been referred from a public hospital receive their procedures free of charge and Marie Stopes invoices the district hospital directly each month based on the number of clients who received services.
In the Western Cape, Marie Stopes receives referrals from nine hospitals, many of which are located in Eden district (one of the pilot districts for the NHI).
According to clinical statistics, since the partnership began, the George centre has averted 266 mortalities of children under five, 208 infant deaths, 6 000 unplanned pregnancies and 3 800 unsafe abortions.
- Andrea Thompson is communications lead at Marie Stopes South Africa.