The COVID-19 response shows government can't handle NHI

South Africa's government-imposed COVID-19 lockdown was supposedly instituted to buy the government time to manage the spread of the virus, and to allow the public healthcare sector to prepare its own facilities adequately for an increase in COVID-19 cases. But even with massive public goodwill, and a solid chunk of time to prepare, it has become clear that the government has not managed to do this.

We have been told countless times, including during President Cyril Ramaphosa's 12 July speech, that South Africa will have a National Health Insurance (NHI), and that this will be aimed at catering for the healthcare needs of the nation. That it will be run efficiently and will not increase healthcare costs. Yet, with the COVID-19 pandemic, the government was afforded the opportunity, and extra time, to tackle a looming crisis. Based on what we now know it is clear that the government was, and is, not up to the task.

According to Guy Richards, Professor of Critical Care at Wits University, two of the biggest problems are lack of staff and an inadequate number of ventilators:

"Even if you look at venues such as Nasrec [which has been set up to be a field quarantine and isolation centre with 470 beds in total], they don’t have enough staff, nor do they have the oxygen supply that you require in this situation."

As of early 3 June the country had only added 207 additional critical care beds and 350 ventilators since the start of lockdown on 27 March.

On 3 July, Professor Alex van den Heever, Chair of Social Security Systems Administration and Management Studies at Wits University's School of Governance, wrote that:

"… in contrast with other natural disasters, [the Minister of Health and the Gauteng MEC for Health] could have been in control, but instead they chose not to be. Our resources and options were squandered. The consequences of these choices are now very much before us."

Even after the government enforced one of the most restrictive lockdowns in the world, giving it time to evaluate and learn from other governments and implement preparations properly, it has failed. Van den Heever has also pointed out that, "It's only now [12 July] a hospital bed dashboard has been put together. Why has it taken so long? It's inconceivable that government is on such a back foot at this point when they have known since March that the Covid-19 storm was coming."

Even having the best people in place - and access to a never-ending funding source (in government's view) in the form of the South African taxpayer - does not guarantee that a system will run effectively in reality. It is simply impossible for a bureaucrat, or a whole department of bureaucrats, to account for the individual decisions, needs, and actions of nearly 60 million people. Each of us will make decisions that often surprise others, and the government should not pretend that it is capable of predicting how we will act at all times.

When a new problem or challenge arises in society, people handle the problem most effectively when they have individual and economic freedom. Government is typified by slow responses to complex problems. Usually the only 'solution' adopted is for the government to take control out of people's hands and decide things for them. As explained by the renowned Austrian economist F.A. Hayek, societies are incredibly complex, and no government plan can even begin to cater for all of our individual wants and decisions.

Health minister Zweli Mkhize said on 8 July that, "While the model projects a lower need for hospital [non-ICU] and ICU beds at a national level, bed capacity is still expected to be breached or overwhelmed in all provinces." As journalist Marianne Merten points out, this means that even with fewer patients than expected, there still aren't enough beds. Within the bigger picture, this particular revelation means that the country may run out of intensive-care unit beds within four weeks.

The NHI aims to monopolise the management of the healthcare needs of almost 60 million people. The government had over three months, while the country was in hard lockdown, to prepare its facilities for the predicted rise in cases. Given this practical example, how can anyone harbour any illusion that the government could efficiently cater for all our healthcare differences and needs? It took government about 2 months to ramp up their volumes to equivalent levels within the private sector. Given that pandemics require urgent and rapid responses, this in itself indicates government's inability to co-ordinate an appropriate and effective response. Crucial for a good COVID-19 response, is quick testing. The National Health Laboratory Service's turn-around times on testing – at typically 7-10 days – nullifies the ability to undertake effective contact tracing and quarantining.

Running everyone's healthcare through the government will mean stifled innovation, ballooning 'procurement' costs, the misallocation of resources (in terms of equipment and personnel), slower responses when new challenges arise, and protracted responses to any unforeseen crisis. When there is a problem in the private sector, it is decentralised, and thus better able to respond with agility and address the issue much faster than the slow, hulking machinery of the centralised government can manage.

There can be no doubt that COVID-19 represents an unexpected, potentially devastating threat to people's lives. This is precisely why it is crucial that everyone's healthcare should not be centralised and controlled, with resources wasted, often stuck in a pipeline of bureaucracy and red tape. Based solely on the fact that time in lockdown was clearly squandered, there is no reason to think that the state can administer the healthcare needs of nearly 60 million South Africans.

Chris Hattingh

Chris Hattingh is Deputy Director at the Free Market Foundation. He sits on the Foundation's Executive Committee and Health Policy Unit. He is a member of the advisory council of the Initiative for African Trade and Prosperity, as well as a Senior Fellow at African Liberty.

Publish date: 15 July 2020
Views: 3 494

Chris Hattingh, NHI, COVID-19, government, Healthcare

The views expressed in the article are the author’s and are not necessarily shared by the members of the Foundation. This article may be republished without prior consent but with acknowledgement to the author.

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