Public engagement in the development of the National Health Insurance: a study involving patients from a central hospital in South Africa

Lizeka Amanda Tandwa,Ames Dhai

doi:10.1186/s12889-020-09270-8

Abstract

BackgroundThe National Health Insurance (NHI) is a proposed health policy in South Africa that aims to change the structure of the current health system. Public involvement in policy making is important and it is a constitutional requirement in the legislation development process in South Africa. Patients are key stakeholders and should be engaged in NHI policy process. Before patients can be engaged, they need to be provided with sufficient information about the NHI. Therefore, the aim of this exploratory study was to examine the levels of patient awareness of the NHI, which is a requisite for meaningful engagement.MethodsThis was a cross sectional study of 244 patients from the follow-up clinics at the Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital in the Gauteng Province, South Africa. The patients were interviewed using a structured interview process and a questionnaire. Descriptive statistics and logistic regression analyses were conducted.ResultsThe majority (79.51%) of the participants were not aware of the proposed National Health Insurance (NHI) in South Africa even though the NHI policy process commenced in 2011. Of the participants who were aware of the NHI, 86% responded that they had not been provided with an opportunity to be involved in the policy making process of the NHI. The odds of awareness were higher for male (OR: 2.08, 95% CI: 1.11–3.9, p value: 0.02) than female participants; White (OR: 2.36, 95% CI: 1.06–5.26, p value: 0.04) and Indian (OR: 2.76, 95% CI: 0.10–7.60, p value: 0.05) participants when compared to Black participants; and retired (OR: 3.13, 95% CI: 1.35–7.25, p value: 0.008) than unemployed participants.ConclusionThe levels of awareness of the NHI were low among the participants from Department of Internal Medicine, CMJAH. Without the awareness and information about the NHI, patients are not equipped to be involved in the NHI policy process in a meaningful way. Public patients are the intended beneficiaries of universal health coverage, therefore they should be prioritized in the NHI community engagement process to ensure that the NHI is community and patient centred.

Highlights

The National Health Insurance (NHI) is a proposed health policy in South Africa that aims to change the structure of the current health system
This study investigated whether the patients, who were aware of the NHI, had been involved in the NHI policy making process
Of those who were aware of the NHI, 19.67% replied that they had heard about the NHI before they were provided with a brief description of the NHI

Summary

Introduction

The National Health Insurance (NHI) is a proposed health policy in South Africa that aims to change the structure of the current health system. Public involvement in policy making is important and it is a constitutional requirement in the legislation development process in South Africa. The South African National Health Insurance (NHI) is health legislation that is under development. The World Health Organisation (WHO) has identified key stakeholders of the health policy making process which include government and private sectors, community groups and importantly, patients [5]. These stakeholders ought to be engaged at the different stages of the policy process [4, 5]

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