No such thing as NHI

This letter was published in the Business Day, 5 June 2012

The letters The idiot’s guide to doublespeak and Calculated hate speech (BD thursday 31 May 2012), and the increasing and troubling abuse of language by the ruling party refer.

Since the Department of Health (DoH) released the Green Paper on a National Health Insurance (NHI) for South Africa, health care discourse has been channelled to the prospect of the implementation of “the NHI”.

The attention now given to longstanding problems in the public health sector are being branded under the rubric of “the NHI”.
In March the Health Minister identified 10 pilot districts “for the phased piloting of the ...(NHI) due to start on 1 April.”  In releasing its policy to improve hospital management - perhaps the most pressing issue in public health - the DoH invoked “the NHI”.       

Blatant propaganda was used to entrench the idea of “the NHI” in the minds of the public as THE remedy for a failing health system. Why? Because the NHI does not exist.

“The NHI” will not improve health care - only better governance, accountability and greater political will can.
These semantics risk conflating real action with the adoption of a politically motivated policy proposal - it is not yet even a White Paper, let alone draft legislation. Government has made “the NHI” synonymous with the health system whereas “the NHI” is just a poorly proposed financing mechanism.

George Orwell remarked in The Politics of Language, “When there is a gap between one's real and one's declared aims, one turns as it were instinctively to long words and exhausted idioms”.  

The public and civil society share some of the blame for perpetuating this myth. There is significant consent for the conceptual idea of “the NHI” despite major concerns about the Green Paper’s lack of detail,  lack of clarity, and its numerous contradictions.

To improve service provision the DoH needs to put processes in place that ensure only qualified, competent candidates are appointed to management. Increasing access means maintaining infrastructure, procuring equipment in a transparent manner, and providing transport for those who have to travel long distances for treatment. These processes have nothing to do with “the NHI”.
The government’s proposal needs to be debated by all stakeholders, devoid of ideological constraints and the manipulation of language.