It’s rather understandable that different sectors of our society have had such different reactions to the launch of the NHI. Those with money fear an increase in tax, with no return. Those without money fear already pretty desperate things will not change. Everyone fears the NHI will simply lead to more problems in a health system that just cannot cope. It's time to think outside of the box. By STEPHEN GROOTES.
Health is symbolic of the problems we face. Some of us have lots of money and we pay for our services privately. Many of us have some money, a Cosatu card and the largest proportion of us have nothing. With the exception of food, health is the biggest divider between our different groups. If you do not have proper healthcare you are one broken bone away from financial ruin. If you have a medical aid, a broken leg means an inconvenience for a couple of months. If you don’t, it means you may never work again. This life-changing fact haunts you from birth. Some worry about the availability of a private room at the Park Lane when their progeny comes along, others have to cry for help from other patients because the nurses can’t be asked to help us off the floor.
The NHI wants to level the playing field. The problem is stark. We don’t have enough money to help all of those who need it. There is no quick way to generate more (except by unleashing the capitalist economy – Ed). For the Left it’s a classic time to eat the rich.
But surely the NHI will be far more sustainable if we can come up with a system where everyone can give something to the system. Let’s not just think about cash money, about how one contributes financially. We all know that there are millions of people with nothing on their hands but time. We know that because of that, alcohol and drugs wreak havoc. It’s time to use those hands in a non-cash way. We have armies of people who can donate their time to hospitals. Why do we have patients lying in wait for help when there are millions of young able-bodied people who can act as porters. Many more could perform other menial jobs, cleaning, cooking, just helping out patients in the other important ways that go beyond the simply medical. Hell, surely it wouldn’t be the hardest thing in the world to give every medically trained nurse a young assistant. Literally someone who spends the day getting their nurse coffee, anything to ease the load.
And if nurses have one assistant, a doctor could have one as well. You could have a system where you start out as an assistant to a cleaner, then to a porter, then a nurse and then a doctor. People are better motivated if there are targets and positions for them to aim for. And it can be quick, people can be promoted over the course of a month or two, until they reach their place of competence.
The beauty of this little scheme (if you do say so yourself, as its creator – Ed), is that people will be giving their time and getting three things. The first is credit in the NHI bank. They will be earning treatment. This leads to responsibility, it will help to bring an end to the idea of people just waiting for the state to provide, the concept that society must do everything. At the moment it seems people are just dependent on government services, not on themselves. This little system will help people to stand on their own two feet. It would give them a sense of mission, of purpose, a reason to get up in the morning. There is a medical precedent for this. The Blood Service currently gives you a pint of blood for free if you have donated in the last month. The idea is that they’re just giving you your blood back. So this is just an extension of this concept.
The second benefit is that people will learn basic skills and discipline. They will work together in teams, there will be hierarchical structures of which people will feel a part. Little things like how to answer a phone, how to tell when a situation is urgent, how computer systems work. It will, hopefully, be a way of introducing people to the working world. As an employer someone who has worked in a hospital, actually done something no matter how menial, will be more attractive than someone who has done nothing since leaving school.
The third benefit is that this will really spread the net of being tapped. The NHI Green Paper itself points out that for this all to work, the number of people that can contribute to it needs to be large. This would certainly help on that score, by bringing in people who cannot contribute financially.
There are, of course, some drawbacks. For one, can you discipline someone who is giving their time and energy, but not their money? What happens if they misbehave, can you sack someone you don’t pay? Management of this will be crucial. The unions, of course, will go through a period of incandescence over it, but surely a case of national interest can be made here.
Should our little scheme work, there’s no reason it has to just involve the medical sector. You could, for example, allow people to work in some variation of a government service, to build up their hours there. In some ways, maybe they should start at public works, before working up to health. We can see many other intangible benefits. A properly managed scheme such as this would give people a real stake in the country, it would play a role in national cohesion. But perhaps the most important benefit is that it would remove the sense of hopelessness that so many of our fellow South Africans must surely suffer. And with hope, so much more is possible. DM
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Grootes is an EWN reporter.
Photo: A member of the South African National Defence Force (SANDF) holds a newborn baby at the King Edward VIII hospital maternity ward in Durban, August 25, 2010. The strike by about 1.3 million state workers that includes nurses, teachers and clerks, has shut schools, delayed treatment at hospitals and the delivery of other services to those who rely on government help. REUTERS/Rogan Ward
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