Wednesday , May 5 2021

Pilot projects of the NHI reveal deep problems

National Health Insurance (NIS) comes as the NZI bill was submitted to parliament Friday. But the detailed 200-page document for the 11 pilot projects makes for suppressed reading.

The report reveals that children identified as needing health care have not received it, there are incomplete infrastructure projects, and computers are sent to clinics without Internet access.

NHI Pilot Projects were implemented in 11 health areas across the country between 2012 and 2017. Following calls from political opposition parties and organizations, including the treatment treatment campaign, the assessment of the pilot projects was launched on Friday by health minister Cveley Mchise.

The evaluation was conducted from November 2017 to 2018 from Genesis Analytics Private Consulting with PwC support, Wits University Health Policy Center and Insight Consultants and Consultants. However, due to data quality problems, it can not be concluded that NHI pilot projects that cost more than R4bn for five years improve the overall health of each area.

Genesis Analytics chief Sol Johnson said: "It was difficult for the assessment team to assess the overall impact of interventions in the pilot areas." The things that prevented the conclusions include "lack of a control group due to the interventions that apply to both pilot projects. areas and non-pilot areas and lack of basic measures ".

Johnson added that the data sets used by Stati stics SA often change every year, making it difficult to accurately measure whether NHI pilots lead to overall improvement in health.

However, the NIS continues, said Msize, who welcomed the pilot project evaluation report as a "mirror" to help the health care department improve.


Pilot projects can be summarized as follows: The healthcare registration system has been developed to capture patient data in a computer system. By the end of 2018, 20 million people have been registered. But poor connectivity, hardware problems, and the lack of IT staff meant that some clinics could not connect to the Internet.

In order to improve staff levels, NIS projects implement staffing needs indicators, a model of the World Health Organization that allocates the right number of nurses and doctors to clinics based on the number of patients and the types of illness being treated. But the managers who made the analysis at the facilities could not fill the vacancies identified as the posts were frozen. Johnson said, "It was a bit disgusting for managers." He advised that when looking for staff, he needed the health department needed to work with the Treasury to finance posts.

Pilot projects have invested money to modernize 140 clinics to "improve infrastructure". However, "projects are rarely executed or terminated due to lack of planning and funds are not released on time". Johnson said: "The funds that were released were mainly used for new infrastructure and insufficient attention was paid to the maintenance of facilities, which is critical. The report says there is "worsening due to lack of basic maintenance". He advised the Health Service that "there is an urgent need to tackle aging and inadequate infrastructure."

The Stock Visibility System, which monitors drug stock levels in Pretoria clinics and hospitals to prevent shortages, has been affected by the lack of an Internet connection. The evaluators concluded that the sustainability of this program is uncertain as the pilot project is funded by "external financiers".

The development of the "ideal clinic" aimed to provide 3,344 clinics to meet a set of standards, but the assessment found clinicians to be "disappointed" because the training guide and "ideal clinic" standards are changing, "which makes it difficult for managers to continue. " In the end, 1507 out of 3,434 establishments have achieved "ideal clinic" status by the end of 2017/2018.

In one of the most advertised pilot projects, often debated by former Health Minister Aaron Mocooley, health inspection teams visited schools and surveyed over 4.5 million children for health problems. They identified half a million children with vision, hearing, or other health or learning problems.

But the evaluators could not say how much or if such children received glasses or health care, hearing aids or therapy. "No information," Johnson said. The medics and teams told the assessors that there was no transport for children targeting clinics or optometrists. Unable to assume how many children were treated, he warned that "international research shows that if a referral does not happen near the place where the children are checked and quickly there is a big dropout."

Another widespread intervention by the NZI was the negotiation of general practitioners (GPs) for work in government clinics to improve the level of care. But it turned out to be "much more expensive" than predicted. In the end, only 350 part-time physicians were hired to work on the 11 pilot projects.

There were 3519 teams who visited communities separated into wards to provide basic health care and direct patients to clinics. These teams often lacked "team leaders". The report says, "Sometimes there was not enough money for transport and equipment; this has affected the team's capabilities. "

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