Imagine graduating from medical school and diving headfirst into a healthcare landscape that is completely transformed. While the full impact of South Africa’s proposed National Health Insurance (NHI) is still unfolding, medical students remain understandably curious about how the NHI will affect their future careers, considering both the challenges and opportunities it may present.
The NHI is a health financing system designed to pool funds to provide access to quality affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status.
Currently studying medicine at Sefako Makgatho Health Sciences University in Pretoria, Sphesihle Hlatshwayo believes the government should focus on strengthening the public health system. This includes employing more healthcare workers, improving infrastructure, and investing in research.
‘What will the NHI mean for me?’
“There’s a lot of uncertainty I have as a future healthcare provider around the NHI. As it stands, the bachelor of medicine and surgery (MBCHB) is no longer what it used to be in terms of opportunities.
Sphesihle Hlatshwayo
“I think it will get worse in the future, especially if the uncertainty continues and if the health sector collapses. I hope enough money is allocated to improve the healthcare system and to employ more doctors so that everyone receives quality healthcare,” she says.
Pursuing medicine at the University of Witwatersrand in Johannesburg, Mmakgwiti Khahlane mentions that NHI is a system designed to provide good, quality health services to all, irrespective of their financial background, and supports this as it brings inclusiveness.
“As a medical student, I fully support the NHI because its mandate falls under the Hippocratic Oath (when treating patients, we should not permit consideration of social standards, politics, race, etc.), and the NHI will make it easy to follow those oaths. And as someone doing clinic rotations in public hospitals, I am looking forward to the system being implemented,” says Khahlane.
“I don’t think NHI will lead to fewer people studying medicine, as I am a firm believer that most of the people who apply for medicine want to help South Africans. I just hope that NHI will not deviate and will stick to its main objectives that meet the health needs of all South Africans.
“Even though it is a good system, my concern is regarding those who will be supervising the whole system. If they are reliable people who will put other people’s needs first. I hope the NHI won’t fall into those steps.”
Mmakgwiti Khahlane
Professor Nathaniel Mofolo, the dean of medicine at Sefako Makgatho Health Sciences University, underlines that the way the NHI is implemented, is crucial.
“How the implementation of the NHI is effected, is what will impact the perceptions of medical students. This will determine if they immediately look abroad for further training or work, or if they will rather choose to stay.”
Furthermore, Mofolo stresses how NHI’s reliance on the country’s economic performance raises concerns about reduced funding for medical education. He says that this may mean that medical schools will struggle to maintain their training platforms, and the concomitant effect is that it will see the exodus of doctors to other countries.
“Medical training is likely to continue as it is at the undergraduate level. Most medical schools have adopted community-based medical education and community-oriented primary care, which are the focus of NHI,” he explains.
“Postgraduate training might significantly change based on what is comprehensively covered by the NHI fund vs. what will be covered by the medical aid schemes and top-up medical cover.
“Postgraduate students will likely take areas of specialisation based on what is mostly applicable and funded by the NHI vs. medical aids; aesthetic/cosmetic and bariatric surgery might not be funded by the NHI fund.”
Professor Nathaniel Mofolo
Mofolo concludes that there should not be much difficulty for medical students adjusting to the new system; however, the biggest impact might be felt in the work environment.
“The adaptation to the NHI will be gradual but will not be too difficult, in the sense that the needs of public and private patients remain relatively the same to a greater extent. It is the working environment that will likely change, as it will depend on the contracted service providers.”
Overall, he underscores that the NHI presents both opportunities and challenges for aspiring doctors in South Africa. The ultimate impact will depend on how the system is implemented and how medical education adapts to the changing healthcare system.
ALSO READ: Explainer: How the NHI will impact South Africans
Get the Health For Mzansi newsletter: Your bi-weekly dose of kasi health, wellness and self-care inspiration.
