Black Sash Media Statements

'Support for universal access to tax-funded NHI' - Black Sash, 28 July 2011

For immediate release: Thursday, 28 July 2011

Community representatives consulted by the Black Sash support the introduction of a tax-funded National Health Insurance system if it will provide substantially improved healthcare that is accessible to all, according to a report released by the Human Rights organisation just days before Cabinet is due to meet to endorse a policy on NHI. The comprehensive report on public healthcare provision and health policy proposals, including those for a NHI scheme, was compiled following nine provincial consultative workshops organised by the Black Sash, UCT’s Health Economics Unit and the Health-e News Service over the past 18 months. More than 400 leaders from CBO’s, NGO’s, human rights and health organisations from every province and almost every district municipality were consulted in a rigorous process. 

There was broad agreement that the health insurance scheme should be funded either through PAYE or employer payroll tax or a combination of both, and that any NHI system should endorse the principle of cross subsidisation, with contributions linked to a percentage of a person's income. Participants in all provinces also largely agreed that certain categories of people should not be asked to contribute but should have equal access to the same quality healthcare. These included people who are unemployed; those who access social grants or who are included in indigent policies; children and the elderly.  

Black Sash Advocacy Programme Manager Elroy Paulus says the organisation held the provincial workshops following concern that there had been very little public engagement on healthcare reform despite government's commitment to public mobilisation in their Ten Point Plan.  "85% of our population depends on our public healthcare system. It is these citizens’ values that should be driving the decision-making process, and their experiences that should inform system reform. As an organisation committed to social protection, particularly for the most vulnerable, we were encouraged that most people we consulted said the health system should reflect the principle that everybody has a right to basic healthcare regardless of their ability to pay for it,” explains Paulus.  

Consulted representatives did acknowledge significant gains by government to improve services in some areas but pointed out that quality healthcare had yet to be realised by most. Across all nine provinces, communities identified a number of common priorities that needed to be addressed urgently in order to realise people’s constitutional right to healthcare. They all said there were not nearly enough clinics, doctors and nurses to meet patient demand and that clinic hours were too restricted – leading to high travel costs (which often erode social grants), long queues and patients being turned away from service points. Verbal abuse, discrimination, and the violation of patient rights especially in relation to confidentiality was widespread. Shortages of medication at clinics was common and pain killers were routinely handed out instead. A severe lack of ambulances, undermining emergency care, was reported.  And there was widespread maladministration of patient records and referrals. Participants also reported that environmental causes of illness (such as poor quality of water and sanitation) remained common, putting pressure on health systems. Deep concern was also expressed that those suffering from chronic illnesses needed access to social and financial support as well as medical treatment.

Black Sash Advocacy Programme Manager Nkosikhulule Nyembezi says the consultations also exposed a complete absence of effective monitoring and evaluation systems. “There are no central points at which patients can lodge complaints. Systems to monitor staff and institutional performance are not well implemented or simply don't exist. Through our Community Monitoring and Advocacy Project (CMAP), community monitors have begun working to assess the quality of local healthcare facilities. We hope to work together, engaging provincial and local government, to ensure that specific needs are addressed with urgency and that action is taken where quality standards are not met," explains Nyembezi. 

The Black Sash keenly anticipates the release of Cabinet's draft policy on NHI and hopes it will show a serious commitment to equitable financing mechanisms as well as concrete plans for meaningful system improvement. "We look forward to a constructive engagement over government's policy proposals, drawing on our extensive consultations with community representatives from across the country. We will continue to work towards the realisation of our constitutional right to decent healthcare services," says Paulus.

Read the full National Synthesis Report on the Black Sash Provincial Health Consultations and the individual Provincial Reports. Find out more about the Community Monitoring and Advocacy Project or CMAP.

For interview requests, please contact:

Elroy Paulus

Black Sash Advocacy Programme Manager

Cell: 072-382 8175

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.


Nkosikhulule Nyembezi

Black Sash Advocacy Programme Manager

Cell: 082-429 4719

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.