July 5 and June 14, 2023, were iconic dates that literally could determine the future health prospects if not the fate of two countries – the UK and South Africa – over the next decade or so.
In terms of health system dynamics, the two are far more interlinked than their promoters and detractors would deign to admit.
Last Wednesday the UK marked the 75th anniversary of its globally-admired National Health Service (NHS).
It was more an acknowledgement of the fact that in the ruins of World War II, a universal health service free at the point of need to all citizens and permanent residents regardless of wealth and status, was launched by Clement Attlee’s post-war Labour government after a campaign by Aneurin (Nye) Bevan, who was inspired by the Tredegar Medical Aid Society in his hometown in South Wales.
Nye Bevan, as minister of health, had the task of introducing the service following the cross-party “Beveridge Report” in 1942 which established the principles of the NHS.
He duly obliged on March 21, 1946 when he published his NHS Act in parliament, and within two years Bevan officially opened the first NHS hospital in Manchester on July 5, 1948, symbolically receiving the keys from Lancashire County Council to mark the creation of the NHS, with 13-year-old Sylvia Diggory becoming the first NHS patient to be treated at the hospital.
The antecedents of minimum state-funded provision of health and social care to the poor, infirm and elderly in England can be traced in over 400 years of English history going back to a curious mix of Henry VIII’s marriage to Anne Boleyn, England’s excommunication from the Catholic Church, the Poor Laws in 1601 under Elizabeth I, and the nefarious workhouses and almshouses of the 19th Century, which effectively acted as religious and charitable health-care providers, at a rudimentary level, which according to one Florence Nightingale, were under “atrocious conditions”.
Nye Bevan is rightly endeared in the minds and mythology of the NHS as its “Father and Founder” and by post-war generations. Just look at the cathartic outpouring in support of Bevan’s NHS from a majority of Brits on the anniversary. His dream to build a health service based on four principles: one that is free at the point of use, available to everyone who needed it, paid for out of general taxation and used responsibly, despite the current NHS funding and workforce crisis strongly lives on.
Post-pandemic, Brits, especially in this current pernicious cost-of-living crisis, have an emotional attachment to the NHS. No UK political party would dare upset that consensus. Any attempt to do so would mean certain electoral defeat.
While the NHS was born out of the inequities of laissez faire capitalism in imperial Britain which marginalised and punished the working classes, infirm and elderly at home simply because of their birth status and brutalised the colonised abroad, the idea of taxpayer-funded universal health care in democratic South Africa, after centuries of colonialist rule, gained traction in three decades of ANC rule.
The Covid-19 pandemic wreaked havoc on an already underfunded and fragmented public health system exposing serious shortcomings, a system that was at breaking point especially in the Eastern Cape and further exacerbated by pandemic profiteering and procurement corruption.
As if the polymorphic health crises society is burdened with is not enough – the highest HIV incidence in the world, one of the highest crime, gender-based violence and femicide rates in the world, high rates of drug-resistant Malaria and TB, and even a recent Cholera outbreak.
The historical and policy nuances for South Africa’s proposed National Health Insurance (NHI) are uncanny.
The ambition of the NHS and NHI have much convergence. Both are embedded in political and fear factors. When the NHI Bill was passed in Parliament on June 12, most South Africans sighed with relief.
For a beleaguered ANC whose own pollsters are predicting that the party of Madiba may lose its overall majority of the popular vote for the first time since the onset of democracy in 1994, the establishment of a universal health-care system could prove to be a “get-out-of-jail” card in next year’s general election.
If the DA-led opposition coalition decides to jettison President Ramaphosa’s NHI policy, a poll defeat could mean a terminal decline into near term political oblivion.
Nye Bevan rightly believed that the introduction of charges on top of general taxation and national insurance would be morally undesirable and politically dangerous for the Labour Party. Similarly in South Africa, as Health Minister Dr Joe Phaahla stressed in the Second Reading debate on the NHI Bill in Parliament on June 13: “The aspiration to create an equitable and just health system has been part and parcel of our Struggle for freedom and democracy.
Our forebears who led the Struggle for freedom in the 1940s and 1950s laid the path in declaring both in the African Claims and the Freedom Charter that there can be no real freedom without access to good quality and equitable health service.”
It is too premature to assess the full impact of the proposed NHI. It will take some time for Enoch Godongwana’s Money Bills on funding the NHI and Joe Phaahla’s delivery and regulatory architecture to materialise.
But this has not stopped the anti NHI scaremongering about droves of doctors poised to leave the country; doctors being nationalised; South African taxpayers revolting; the cost of the NHI burgeoning between R300bn to R400bn a year; and that it is unaffordable and impossible to implement effectively. Some of the extreme rhetoric on the side of the ANC and its coalition supporters similarly is out of order.
The reality is that at the core of the universal health-care discourse is a vicious ideological war – the one which sees universal health care as a right and service financed through taxation and national insurance and free at the point of need, and the other which gives succour to the “profit-maximisation at any cost” American model of privatised health provision governed not by the needs of the patient but the ability to pay.
The latter is the pernicious agenda of Big Pharma in cahoots with private medical groups which emanates from the US and is now desperately trying to get a foothold in the UK.
Underestimate them at your peril.
That the NHS is “a system in crisis ” is not in dispute. It’s not a question of a defeatist narrative of whether the “NHS will survive by the time it is 100 years old” – a pet narrative of the Far Right proponents of privatisation supported by their nefarious backers.
It is a question of what needs to be done to recover and make the NHS the sustainable “Jewel” that it is.
The problem with the NHS is that it has been severely underfunded compared with peer G7 countries.
What both the NHS and NHI need is a heavy dose of pragmatism, long-termism and adhering to the updated mandates set out by the likes of Nye Bevan, and our own Freedom Charter and Bill of Rights.
An important lesson for the ANC and Phaahla is that the NHI can never be a bottomless pit of taxpayers money.
If a sustainable funding model bereft of punishing especially middle-class taxpayers is not sorted out at source, then the NHI may be in danger of a stillbirth.
Parker is a writer and economist based in London
Cape Times