Transcript Slide 1

“ ….. you can have the nicest of Constitutions on
paper. If it doesn't relate to reality then there are
difficulties…one can't speak of a person’s dignity
when that person is living in squalor and that
person can't have access to facilities, medical
facilities, and it is for that reason I presume that
we have in our Constitution … socio-economic
rights.”
- Interview with Justice Skweyiya, Constitutional
Court, October 2003
1
The Right to Health:
Rights and responsibilities –
developments in health policy (incl NHI)
Free State Consultative Workshop
6-8 June 2011
- Elroy Paulus (Black Sash)
2
Current Context and Recent Policy
Developments
3
4
Interrelationship across the Health Sector Negotiated
Service Delivery Agreement, the 10 Point Plan and the
National Health Insurance
Health Sector 10 point Plan
A LONG & HEALTHY
LIFE FOR ALL
SOUTH AFRICANS
Defined Targets
NHI
NSDA
Defined
Timeframes & critical
milestones
5
Human Rights?
Legitimate and valid demands or claims on society –
claims are for:
•
•
•
•
•
•
Social and material resources,
Respect, tolerance
At core - respect for human dignity
Represent some fundamental need
General or universal
“ … in some sense equally possessed by all human
beings everywhere..”
• Inherent - exist by virtue of being human
6
International Law and Health
• 1948 Universal Declaration of Human Rights
• unanimously proclaimed by the UN General
Assembly as a common standard for all humanity
• The Declaration sets forth the right to a “standard
of living adequate for the health and wellbeing
• of himself and his family,
• including . . . medical care and . . . the right to
security in the event of . . . sickness, disability
• . . . or other lack of livelihood in circumstances
beyond his control.”
7
International Law and Health
• The Declaration does not define the components of
a right to health; however, they both include and
transcend medical care.
• The right to health was included in the International
Covenant on Economic, Social and Cultural Rights
(ICESCR).
• Article 12 of the ICESCR explicitly sets out a right to
health and defines steps that states should take to
“realize progressively” “to the maximum available
resources” the “highest attainable standard of health”
8
What does it mean to have a right?
•
•
•
•
Rights imply a claim; more than charity
For every right corresponding duty bearer
Usually duty bearer = government
With rights go responsibilities e.g. Cannot
enjoy right to health care if you target a clinic
for crime
9
How is govt obligated?
•
•
•
•
If govt ratifies a treaty or has a Bill of Rights, it must
– Pass laws
– Budget for implementation
– Put in place programmes
4 obligations
To respect rights:• Refrain from actively violating your right
• Through laws, policies
• To protect your rights from third parties
• To fulfill right through active programmes, resources, etc.
• To promote rights: Knowledge, opportunities to use rights
machinery, Chapter 9 Institutions
10
Rights and Civil Society Action
• Rights are not just about the law
• A human rights approach can:
– Hold govt accountable
– Shape policy
– Get redress for violations
– Build civil society mobilisation
11
Health as Human Right in SA
•
•
•
•
•
•
•
•
Access to health care services
Emergency treatment; reproductive health care
Right to Life
Safe, healthy environment
Access to adequate housing
Access to sufficient food and water
Bodily integrity; freedom and security of person
Children - basic nutrition & health care services,
shelter
• Dignity, equality, non-discrimination
• Access to information
12
Health and the Constitution
(check with in in your Constitution p.13)
27. Health care, food, water and social security
(1) Everyone has the right to have access to (a) health care services, including reproductive health care;
(b) sufficient food and water; and
(c) social security, including, if they are unable to support
themselves and their dependants, appropriate social
assistance
(2) The state must take reasonable legislative and other
measures, within it’s available resources, to achieve the
progressive realisaiion of each of these rights.
(3) No one may be refused emergency medical treatment.
13
Social Determinants of Health
14
Social Determinants of Health
15
Vulnerable communities and social
determinants of Health in SA
16
Progressive realisation
• Not possible to provide all forms of health care
• Resources are limited
• So rationing decisions are permitted, but:
– Must be transparent
– Must be based on evidence
– Cannot be unreasonable or arbitrary
• Even if unable to afford now, must show
how state will provide in future, over time
17
Policy Developments
• Department of Health Strategic Plan 2006/07 to 2008/09 - Some
elements of the Strategic Framework (5 years)
• “ We will introduce a National Health Insurance scheme in a phased
and incremental manner. ...to initiate the NHI, the urgent
rehabilitation of public hospitals will be undertaken through PublicPrivate Partnerships - State of the Nation Address by President J G Zuma (3 June
2009)
“ We have made it clear that our POA is being implemented within the
context of the National Health Insurance (NHI). A major aspect of
this policy direction is the need to create a national health
insurance that is based on the principles of universal coverage,
social solidarity and efficient of public administration
- late Deputy Minister of Health, Dr Molefi Sefularo (2 September 2009)
18
Policy Developments
• THE 10 POINT PLAN OF THE HEALTH SECTOR
2009-2014 - DEBATE ON THE HEALTH BUDGET VOTE, SPEECH BY DR
AARON MOTSOALEDI MP – MINISTER OF HEALTH, NATIONAL ASSEMBLY 13
APRIL 2010
“.....second year of implementation of our 10
Point Programme for transforming the health
sector into a well functioning health system
capable of producing improved health
outcomes. To refresh the memories of
Honourable Members”....
19
Policy Developments
“.......the 10 Point Programme consists of the following priorities:
(i) Provision of Strategic leadership and creation of a social compact for
better health outcomes;
(ii) Implementation of National Health Insurance (NHI);
(iii) Improving Quality of Health Services;
(iv) Overhauling the health care system and improving its management;
(v) Improved Human Resources Planning, Development and
Management;
(vi) Revitalization of infrastructure;
(vii) Accelerated implementation of the HIV and AIDS and STI National
Strategic Plan 2007- 2011, and increased focus on TB and other
communicable diseases;
(viii) Mass mobilisation for better health for the population;
(ix) Review of the Drug Policy; and
(x) Strengthen Research and Development.
20
Recent NHI developments
Quick guide to an NHI (ANC NGC Discussion Doc):
(21 Sept 2010) – a mere 9 months ago
• Founded on principles of the right to health care, universal
coverage, social solidarity and public administration, in
which access to health care will be based on need, not only
ones ability to pay.
• Free at point of service as it is prepaid through mandatory
tax contributions and general tax.
• A universal system covering everyone, irrespective of
whether one is employed or not.
21
Quick guide to an NHI - continued
• Inclusive of all South African citizens will be under a
single publicly funded and publicly administered national
health insurance rather than two-tier system
• An integrated system in which health care services are
delivered by accredited public and private sector.
• Based on quality and affordable facilities that meet
criteria for quality and cost and need
• Patients will have a choice within the district on where
they can register for health care
22
Key Proposals of NHI
• Founded on the principles of the right to health care, universal
coverage, social solidarity and single public administration in
which access to health will be based on need(and therefore
ensuring universal free access to health care, at the point of
service, to all South Africans) rather than ability to pay.
• A publicly and publicly administered NHI Fund – operating like
SARS and situated within the Ministry of Health - will be created
to receive to receive funds through a single-payer system.
• This refers to 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 African citizens and legal
residents through a single “insurance pool”.
23
Key Proposals (contd.)
•
NHI Fund will provide a comprehensive cover of health services
primary, secondary, tertiary and quarternary (high-care services)
which will be provided by accredited public and private providers
to ensure quality health care standards.
• At the core of NHI would be primary health care, which is the first
point of entry into the health system. The report foresees a
“reengineered primary health-care system”, served by teams,
each consisting of a doctor or clinical associate, a nurse and three
to four community health workers.
• Membership to the NHI would be compulsory for the whole
population, but the public can choose whether to continue with
voluntary medical scheme cover.
24
Funding and funding sources
•
•
•
•
Liaison with national treasury to explore NHI funding and
various sources of revenue.
Funding methods include a surcharge on taxable income, payroll
taxes (for employees and/or employers) and an increase in value
added tax which is earmarked for the NHI.
Main sources of revenue for the NHI Fund : allocations from
general taxation. All of these funds will be combined in the NHI
Fund, from which all services covered by the NHI system will be
funded.
Preliminary costs
Increase from R128 billion in 2012
R 267 billion in 2020
R376 billion in 2025,
expressed in current financial terms (real terms).
25
Funding and funding sources
•
The budget for 2010/11 was R107 billion, the current
budget is R115 billion and increases to R122 billion in
2012/13.*
• Over R200 billion (public and private) spent on health
services in South Africa in 2010. The NHI will provide
comprehensive quality health care at less than the
current spending by the public and private health
sectors.
•
The costing sub-committee’s preliminary findings
suggest that the health sector’s share of the overall
government budget will need to increase from 12% to
14.5%.
* Budget Review 2010 - Chapter 7
26
Proposed process for NHI
• Will kick off with wide consultations with all interested
parties  review of the current legislation and the
drafting of new legislation to facilitate the NHI system.
• Implementation : phased in over 14 years  roll out
will start in 2012 in the seriously underserved areas
where people have difficulty accessing health care.
At same time : various mechanisms will be put in place
to revitalise the public health infrastructure, the
introduction of quality improvement and assurance
programmes, and the development of human resource
programmes.
27
Legislative processes (2010-2011)
• 2010/11 - draft national health insurance policy proposal
document submitted to Cabinet for consideration, after which
an interministerial committee was established.
• A revised policy document has been developed and will be
resubmitted to Cabinet in 2011/12.
• The department is also in the process of preparing enabling
legislation for establishing the National Health Insurance
Fund, to be submitted to Cabinet before December 2011.
28
• Amartya Sen (1999): “... the issue of social allocation
of economic resources cannot be separated from the
role of participatory politics and the reach of
informed public discussion. ...If it is the doctor or the
schoolteacher or the nurse who feels more
threatened by resource considerations than the
military leaders, then the blame must lie partly on
us, the public, for letting the militarist get away with
these odd priorities. Ultimately, there is nothing as
important as informed public discussion ... The
public has to see itself not merely as a patient, but
also as an agent of change. The penalty of inaction
and apathy can be illness and death...”
29
To conclude....
"The day will come when nations will be judged
not by military or economic strength, nor by the
splendour of their capital cities and public
buildings, but by the well-being of their people:
by, among other things, their opportunities to
earn a fair reward for their labour, their ability to
participate in the decisions that affect their lives;
by the respect that is shown for their civil and
political liberties; by the provision that is made for
those who are vulnerable and disadvantaged“
UNICEF Progress of Nations Report (1998)
30