Pharmaciae (SAPC) | Pharmacists gearing to play a pivotal role in NHI

Pharmacists gearing to play a pivotal role in NHI

Pharmacies and pharmacy clinics are often the first port of call for people needing medical assistance, and the pharmacy profession is currently examining the role pharmacy will play in the government’s proposed National Health Insurance (NHI) plan. Author: Jackie Maimin

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NHI aims at Universal Health Coverage (UHC), implying access to key promotive, preventive, curative and rehabilitative health services of good quality for all at an affordable cost without the risk of financial hardship linked to paying for care. It sounds idealistic, but the publication of the government’s National Health Insurance (NHI) White Paper on 30 June 2017, has laid the foundations for a UHC system in South Africa.

The white paper indicates that it is government’s intention to utilise all available professional resources to achieve UHC, including a broad range of private facilities and services. Subsequently the Medical Schemes Amendment Bill and NHI Bill were both published for public comment. Dr Aaron Motsoaledi, speaking on the Medical Schemes Amendment Bill at a media briefing on 21 June 2018, indicated that “the first reason for this amendment is that the implementation of NHI is not going to be a once-off event but it will take place in a phased-in approach. While this is happening the population of medical schemes beneficiaries need immediate relief from serious challenges experienced in the current medical scheme regime. The nature and magnitude of the challenges is that it will be undesirable for medical scheme beneficiaries to have to wait for long term changes.

The second reason for the amendment is to align the medical scheme environment to that which will exist under NHI so that there is a smooth, harmonious transition that does not unduly disrupt access to health care.”

The NHI Bill sets out to:

provide mandatory prepayment health care services
establish a National Health Insurance Fund and to set out its powers, functions and governance structures;
provide a framework for the active purchasing of health care services by the Fund on behalf of users;
create mechanisms for the equitable, effective and efficient utilisation of the resources of the Fund to meet the health needs of users;
preclude or limit undesirable, unethical and unlawful practices in relation to the Fund and its users; and
provide for matters connected herewith.

NHI presents pharmacy with a unique opportunity to reshape the profession. Engagement with government on NHI will require a unified profession with a common vision & purpose. To this end the NHI Pharmacy Forum was established to draft a strategic document advocating for the inclusion of pharmaceutical services within NHI. This includes utilising all available pharmaceutical healthcare professionals and resources, in order to achieve the positive clinical outcomes at the best possible price.

Initially, pharmacists will have to try and maintain quality and quantity at the same time. There’s going to be task shifting with the inclusion of pharmacy support personnel in the pharmacy team. Multi-disciplinary health teams will manage patients within identified regions with a primary healthcare focus on preventative medicine. To effect this there need to be changes to other pieces of legislation and ethical rules.

There is no doubt that pharmacy and pharmacists are ideally positioned to play a vital role in the delivery of universal health coverage and Pharmacy Council has already enacted a number of regulatory amendments to ensure an enabling environment for pharmacists to provide equitable and quality pharmaceutical services to all South Africans.