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9 September 2021
What COVID-19 Teaches Us For An NHI That Provides Equitable & Effective Healthcare For Today And Tomorrow

“South Africa’s two-tiered healthcare system ensures that the majority of resources are in the hands of the minority. So how can we ensure that a National Health Insurance plan provides truly universal healthcare? By drawing some lessons from COVID-19.”

Dr Sinesipho Jojo, Deputy Director of the People’s Health Movement South Africa (PHM-SA), delivered the 2021 David Sanders Lecture in Public Health and Social Justice, speaking about Opportunities not to be missed from COVID-19 for the National Health Initiative (NHI).

PHM-SA is no stranger to the concept of the NHI. As the South African Chapter of the People’s Health Movement, the movement’s mission is to improve the capacity of individuals and communities to realise their right to health and health care - and ultimately to aim for a form of universal health care (UHC) that is equitable and just. 

“PHM supports the NHI in principle as a vehicle to achieving UHC,” Dr Jojo explained. “We view universal health coverage as a tool to address and redress inequalities of the past as well as of the current health system, to ensure that there’s a unified national health system that affords citizens sufficient financial risk protection. More specifically, we demand a People’s NHI.”

This People’s NHI would be characterised by a single pool of funds where patients pay no fee at the point of care, but still receive comprehensive care embedded in a primary healthcare approach.

“That’s the dream,” Dr Jojo said. “Of course PHM has expressed concerns around the NHI as well. We are concerned that it was heavily influenced by the private sector and vested interests. We are concerned about the unchecked authority of the National Department of Health, which can open doors to corruption and misuse of government resources. We are concerned about the lack of transparency as well as community engagement, and the top-down approach being taken.”

These concerns were well-founded, and for a while they seemed insurmountable in a country like South Africa - one of the most unequal countries in the world, and a nation where healthcare exists in a distinct two-tiered system: world-class private health care for the wealthy and insured, and under-resourced and over-stressed public health care for the vast majority.

Rising To The Challenge: Lessons Learned From COVID-19

“The pandemic has forced us to learn how to work together for the common good,” Dr Jojo said. “We have been forced to rapidly expand our conception of what’s possible and change the way we do things. There were many mistakes made along the way, and far too many lives have been lost to this deadly pandemic - but the fact that a country that was in dire straits before the pandemic has dealt with it so effectively is something that should inspire us.”

The COVID-19 pandemic response can provide the following lessons for the future of the NHI: 

  1. Leadership is pivotal
  2. Effective communication is a powerful tool in building collaboration
  3. Enhance common goods for the common good
  4. Investment in human resources is key
  5. We need to be prepared to deal with the social determinants of health

“During the COVID-19 pandemic, we have seen strong, sustained political leadership at the highest level of government to navigate us through this period of crisis. Actions were evidence-based, and there were great collaborations between the Department of Health and academic and social institutions, and great community engagement.”

That collaboration was particularly evident in the creation of a communication strategy that encompassed multiple platforms and audiences, from posters and newspapers to radio and TV and social media, in multiple languages and at various levels of complexity.

“Communications were used not only to relate information, but as a tool to build public trust and rapport, and national solidarity. This kind of effective, continuous communication results in an informed public that is willing and able to do what needs to be done to get through a difficult situation.”

Comrade Prof: A Legacy Of Academics, Activism And Inspiration

The Annual David Sanders Lecture in Public Health and Social Justice series honours the legacy of Emeritus Prof David Sanders - as a founder of UWC’s School of Public Health, a co-founder of the People’s Health Movement, and a tireless crusader for effective and equitable public health, both locally and internationally.

“David was always worried, in that way that passionate people are, that there were not enough young people to carry on his work,” his widow, Dr Sue Fawcus, noted. “He worried that when oldies like him die out, that their vision and goals and dreams would die out with them. I’m so glad to say that he’s clearly been proved wrong - that there is a younger generation of public health activists like Dr Jojo, who have so much passion for their work... and who have so much to teach us as well.”

David’s legacy can be seen in the works of activists like the Public Health Movement; in the deeds of advocates like young firebrand Advocate Adila Hassim, lead counsellor in the Life Esidimeni arbitration and the 2019 deliverer of the David Sanders Lecture; and in the efforts of academics like the SOPH’s Catherine Pereira and Tamryn Frank, who were behind a recent national mobilisation to stop Nestle advertising their products in an illegal manner.

And it can be seen in all those who are willing to go above and beyond to fight for public health and social justice for all.

“As Sue mentioned, his legacy lives on through us - the next generation,” Dr Jojo concluded. His global reach yet local relevance; his boldness; his intelligent conversation and tactful ability to deliver uncomfortable truths in the most gentle way; and above all his commitment to better health for all - these are the things that inspire us to keep fighting to change the world.”

The David Sanders Lecture is sponsored by the South African Research Chair in Health Systems, Complexity and Social Change, and supported by the South African Research Chair's Initiative of the Department of Science and Technology and National Research Foundation of South Africa (Grant No 82769). Any opinion, finding and conclusion or recommendation expressed in this material is that of the author and the NRF does not accept any liability in this regard.