The South African government continues to lay the groundwork for National Health Insurance (NHI) in the country, publishing the national framework for digital systems to manage the sharing of medical information between the public and private healthcare sectors in the country.
The Department of Health gazetted the National 2021 Health Normative Standards Framework (HNSF) for Interoperability in Digital Health on Friday (21 October), which details the government’s plans to establish a comprehensive national health information system.
According to the department, the HNSF is an enabler of “the efficient and safe flow of healthcare-related person-centred information across institutional and provincial boundaries”.
The document facilitates the setting up of such a system to be implemented and maintained by provincial departments, district health councils, municipalities as well as the private health sector, and is aligned with the National Health Insurance Bill, currently being deliberated by the National Assembly.
While being a technical document for the underlying protocols and frameworks to be put in place for such a system, the authors make it clear that the overall aim of the plan is to have medical and health data shared nationally, incorporating data from the private health sector.
“A federated architectural pattern will be followed to enable interoperability within a fully interoperable South African healthcare environment,” they said.
“In other words, some health information systems – such as clinical registries – are managed by local and provincial departments, while others – such as demographic registries – are managed by the National Department of Health. In addition, some health information systems are privately owned and developed by third parties.
“As the private health sector forms part of a fully interoperable South African healthcare environment, it will need to share the data with the national registery, as prescribed in the NHI Bill. This information sharing will be based on the standards defined within the most current version of the HNSF.”
The document is an ongoing project and is an evolution from the 2014 document of the same name. The frameworks within the document will remain in place until the next revision and form part of the health department’s 2019-2024 strategy.
The authors said that the HNSF is aligned to “an agreed level” of interoperability of functionalities of the NHI Bill, which aims to provide for the sustainability of funding for healthcare services in South Africa.
The NHI wants to pool funds together from the private and public sectors and set the government up as the primary purchaser of healthcare services in the country.
According to the NHI Bill, an information platform is vital to this plan, allowing informed decision-making on population health needs, and setting the parameters for the procurement of health services.
“For the NHI Fund to operate effectively and efficiently, it has to contribute to the development and maintenance of a national health information system…and accessible data should be available to the National Department of Health and the NHI Fund,” the authors said.
No stopping the train
The government has made it clear that its pursuit of the NHI will continue despite criticism from the private health sector, medical aids, and warnings from Treasury and the department of health itself.
South Africa’s health ombudsman, professor Malegapuru Makgoba warned earlier in October that the government’s plans to introduce universal healthcare through the NHI are fraught with hurdles and may not be implementable at the pace that the government wants due to poor service levels in the industry.
In September, minister of health Joe Phaahla said that the plans to roll out the NHI in phases will proceed, despite a High Court ruling declaring parts of the National Health Act unconstitutional.
Private healthcare groups believe that the scheme is unsustainable and unmanageable, given the scale of what the government wants to achieve against the backdrop of how it has already failed in the public healthcare space.
There are also concerns over an exodus of healthcare professionals who refuse to be subject to the scheme’s harsh conditions, as evidenced by the court ruling the department is appealing.
Medical aids have been fighting for their continued existence, given that the NHI scheme envisions a healthcare system with the state entirely in control and little to no room for private healthcare funding.
Treasury’s warnings come from a financing standpoint – there is simply no money to feed into the scheme without raising taxes.
Finally, the Department of Health has raised red flags over the scheme’s administration, conceding that it is vulnerable to maladministration and mismanagement.
Read: Health ombudsman says South Africa’s NHI is a ‘necessary evil’
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