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Is the KZN pilot of the National Health Insurance making a difference?

A discussion was held on Wednesday 25th March, facilitated by the NHI Research Team, to reflect on whether the proposed National Health Insurance (NHI) is making a difference to people living in uMgungundlovu District – a pilot site for the NHI. Participants in the process had taken part in a discussion on the public health care system two years ago and particularly around how the NHI as an instrument to deliver improvements was constituted.

The discussion was located in if people are noticing any changes which can be attributed to the NHI. There was broad consensus that there are still massive problems in the public health care system however, people are noticing improvements and the NHI is making a difference:
• There are definitely more nurses in clinics and hospitals
• The accessibility of chronic medications, including ARVs is much improved and the waiting times are much shorter
• The queuing process and management of files is much better in some places
• Many facilities are being renovated
• Some clinics have been converted to 24hour
• Some of the cancer wards are much improved
"Now when you go to the pharmacy you at least get one pill even if it is not the pill you need."
"Yes, there are definitely more nurses everywhere, now when it is tea-time at least some nurses are still available to help you."
However, these improvements identified were cautious as people were saying that although there are more nurses, the training of these nurses is not adequate – with many young nurses not knowing enough to do the work and the attitude of nurses is still (in most cases) very poor. Although access to chronic medications is better; there are still major shortages in the access of medication for minor ailments like back pain, headaches, stomach aches etc. People identified that one of the core improvements that they would like to see is:
• That each clinic has proper management through a strict, highly competent and no-nonsense clinic matron and that nurses must be qualified, well trained, supervised and supported more;
• That medications must be available and correct (covering all medical needs);
• That nurses at clinics must do comprehensive check-ups and give proper and comprehensive diagnosis (not rely on the patient to diagnose themselves)
• There need for more Doctors – across hospitals and clinics – but particularly at clinics