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
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The Right to Health:
Rights and responsibilities –
developments in health policy (incl NHI)
Gauteng Consultative Workshop
07-09 March 2011
- Elroy Paulus (Black Sash)
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Current Context and Responses
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The Millennium Development
Goals
Goal 1: Eradicate Extreme Hunger and Poverty
Goal 2: Achieve Universal Primary Education
Goal 3: Promote Gender Equality and Empower Women
Goal 4: Reduce Child Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV/AIDS, Malaria and other diseases
Goal 7: Ensure Environmental Sustainability
Goal 8: Develop a Global Partnership for Development
SAHR Indicators and the MDGs
Goal
1990
Eradicate extreme hunger
Under fives
under-weight
9.3
Reduce child mortality
Combat HIV & other diseases
Unlikely
625
Possible
8.7
% pop using improved water source
61
Unlikely
104
HIV prevalence
9.3
Environmental sustainability
10.2
MMR per 100 000 live births
369
Status
Unlikely
Under five mortality / 1000
59
Reduce maternal mortality
2010
92
Achieved
Human Rights?
Legitimate and valid demands or claims on society –
claims are for:
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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
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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.”
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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”
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What does it mean to have a right?
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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
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How is govt obligated?
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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
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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
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Health as Human Right in SA
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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
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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.
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Social Determinants of Health
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Social Determinants of Health
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Vulnerable communities and social
determinants of Health in SA
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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
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Health Policy Developments
Department of Health Strategic Plan 2006/07 to 2008/09:
Some elements of the Strategic Framework (5 years)
• Improve governance and management of the NHS
• Promote healthy lifestyles
• Improve management of communicable diseases and noncommunicable illnesses
• Strengthen primary health care, EMS and hospital service
delivery systems
• Human resource planning, development and management
• Planning, budgeting and monitoring and evaluation
• Prepare and implement legislation
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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)
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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”....
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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.
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Very recent NHI developments
Quick guide to an NHI (ANC NGC Discussion Doc):
(21 Sept 2010)
• 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.
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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
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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”.
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Key Proposals (contd.)
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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.
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Funding and funding sources
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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).
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Funding and funding sources
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The current budget for 2010/11 is R101 billion, and
increases to R117 billion in 2012/13.
• Over R200 billion 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.
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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%.
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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.
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Policy developments – very latest
re health system Reform
SONA 10 Feb 2011 - Health sector:
• emphasise the appointment of appropriate
and qualified personnel to the right positions.
• Revitalise 105 nursing colleges countrywide,
to train more nurses.
• Open a medical faculty at the Limpopo
Academic Hospital to train more doctors.
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Policy developments – very latest
re health system Reform
• Ongoing renovations and refurbishments of
hospitals and clinics
• broaden the scope of reproductive health
rights
• HIV and AIDS - revitalised our programmes
and promote various prevention measures
including medical male circumcision,
prevention of mother to child transmission
and the promotion of HIV testing.
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Policy developments – very latest
re health system Reform
• 2010 - developing the National Health
Insurance policy and implementation plan.
• Government will soon be releasing the policy
document for public engagement.
• Government Position Paper on Social Security
Reform - expected to be released in 2011 for
discussion.
– funding and nature of the National Social Security Fund,
role of the private sector occupational and retirement
funds, and the possible regulatory structure.
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Vote 16 – Health
(National Budget Feb 2011)
• The gross total allocation to the health
function over the medium term is R18.5
billion.
• Most of this funding is allocated by means of
the provincial equitable share.
• R1.4 billion is allocated to the national DoH:
• towards increasing HIV counselling and
circumcisions.
•Improve health facilities and medical
equipment.
•In preparation for national health
insurance, the department receives a
further R1.6 billion.
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Vote 16 – Health
(National Budget Feb 2011)
Improved primary health care and public health
facilities
• A re-engineered primary health care model for
South Africa has been developed, which
emphasises: a population oriented service
delivery approach; strengthened community
based services; the deployment of
multidisciplinary primary health care teams,
including community health workers across
defined geographic areas; and greater community
involvement in securing and promoting health.
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Vote 16 – Health
(National Budget Feb 2011)
• The primary health care approach is vital for
improving health outcomes, and for achieving
national health insurance.
• District support teams will be established with
medical specialists.
• apprx 1 200 quality improvement projects are
being implemented with partners in health
facilities across the country to improve patient
experiences of health care provision in the
public sector.
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Vote 16 – Health
(National Budget Feb 2011)
Progress with setting up an NHI
• Key milestones are also being achieved in the
implementation of national health insurance.
• In 2011, a detailed plan for the implementation
of the NHI will be produced, a public discussion
paper released and draft legislation compiled.
• NHI = a key priority in the 2011/12 budget and
several budget allocations are intended to
support its preparatory phase.
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Vote 16 – Health
(National Budget Feb 2011)
• R250 million, R500 million and R750 million
(MTEF) allocated for the national tertiary
services conditional grant to support
• public hospitals to achieve norms and standards
partly in preparation for the national health
insurance and to implement standards and
guidelines of the Office of Standards Compliance
and Quality Assurance, as well as to address
differential costs of occupation specific
dispensation for doctors.
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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 abinet before December 2011.
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• 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...”
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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)
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THANK YOU
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