Abstract
Background: In 2012, the National Department of Health of South Africa launched the National Health Insurance (NHI) pilot program in 11 districts, towards universal health coverage for all South Africans. Health Care Practitioners (HCPs) are important role-players in its implementation. We decided to evaluate to what extent the HCPs were aware of the NHI program after three years of the pilot phase. Objective: To evaluate the awareness of HCPs about the NHI in the pilot Tshwane district of South Africa. Method: A cross-sectional survey was conducted among 1753 HCPs in Tshwane district. At 95% confidence level and 5% error margin, the sample size was 315 HCPs, but we over-sampled to 480. The study was conducted in 25 health facilities within the district. A pre-tested self-administered questionnaire was used. Results: A high proportion of HCPs were unaware of the objectives of the NHI program (p < 0.001); number of NHI pilot sites [(281; 59.4%) versus (145; 30.7%), p < 0.001]; rationale used to select pilot sites [(223; 46.9%) versus (193; 40.5%), p = 0.047]; role of the Integrated School Health Services (ISHP) [(250; 52.7%) versus (70; 14.8%), p < 0.001]; and specialists constituting the District Clinical Specialist Team (DCST) (p < 0.001). However, awareness regarding the Ward-Based Outreach Team (WBOT) leader was high [(236; 49.9%) versus (135; 28.5%), p < 0.001]. Conclusion: HCPs in Tshwane district demonstrated poor awareness of the NHI. This reveals that any awareness effort towards the NHI has not taken effect among the HCPs in this district.
Highlights
Countries have been encouraged by the World Health Organisation (WHO) to move towards Universal Health Coverage (UHC) [1]
The study demonstrated poor awareness of the Health Care Practitioners (HCPs) regarding the objectives of the National Health Insurance (NHI), number of pilot sites, the rationale used by the government of South Africa in choosing the pilot sites and the role of the Integrated School Health Program (ISHP) in the district schools
The authors of this study are of the opinion that the difference in the sample sizes (86 in their study versus 480 in the current study) and the fact that their study was conducted in only one setting (Mthatha General Hospital) versus the whole Tshwane District in the current study may have accounted for the difference in the levels of awareness about the NHI objectives
Summary
Countries have been encouraged by the World Health Organisation (WHO) to move towards Universal Health Coverage (UHC) [1]. The goal of the NHI is to ensure that the South African population has access to needed quality health services at an affordable cost [1]. The system is entirely or partially funded with tax money In some countries, such as the UK's National Health Service, contributions to the system are made via general taxation and is not optional even though the use of the health scheme is [3]. In South Africa, the NHI is a “financing system” meant to ensure that all citizens of South Africa, and legal long-term residents, are provided with essential health care, regardless of their employment status and ability to make a direct monetary contribution to the fund [4]. In 2012, the National Department of Health of South Africa launched the National Health Insurance (NHI) pilot program in 11 districts, towards universal health coverage for all South Africans. We decided to evaluate to what extent the HCPs were aware of the NHI program after three years of the pilot phase
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