An analysis of the nurse managers' interpretation of the National Health Insurance Policy, its implications for implementation in healthcare facilities in the eThekwini district.

Abstract

Background: The government of South Africa has focused on Primary Health Care and implementation of the National Health Insurance (NHI) as part of the plan to reform the South African health care system. This is based on the principle of the right to healthcare and the right to access health care facilities. Aim: The aim of this study was to analyse the Nurse Managers’ interpretation of the National Health Insurance Policy and, its implications for implementation on their roles and responsibilities in health care facilities. Methodology: The sequential mixed method approach was conducted. There was direct interaction (semi structured interviews) with the Nurse Managers as well as a survey (questionnaires) for both qualitative and quantitative phases. Qualitative data was collected and analysed first, and an instrument was developed based on the analysed data from the qualitative phase to collect quantitative data. Setting: EThekwini district comprising of two district hospitals, three Community Health Centres (CHC) and four Private healthcare facilities were selected. Participants: Nurse Managers in the public Primary Health Care facilities and private hospitals in the EThekwini district. These were Nurse Managers (top middle and lower levels) from the public healthcare facilities (district hospitals, Community Health Centres, primary health clinics) middle and lower levels in the private facilities. Data Analysis: A thematic analysis was used in the qualitative phase. Descriptive statistic was used in the quantitative phase to describe and synthesize data (Polit and Beck 2004) as well as inferential numeric analysis (Creswell 2009). Findings: The findings in both the qualitative and quantitative data revealed that the participants demonstrated a general impression on the NHI rather than specific understanding; hence the researcher believes that there was more general than specific knowledge and interpretation of the NHI policy. The participants’ display of lack of knowledge and understanding of the concept NHI and the implementation process was an indication that there was lack of personal development in relation to expectations from the nurse managers concerning NHI though there is a lot of publicity in this respect from the government and media. There are national policies and guidelines for all citizens to access. Recommendations: The recommendations were made for sharing with the policy makers and seniors in the healthcare facilities in order to improve nursing management, nursing education and nursing research.