President Cyril Ramaphosa signed the NHI Bill into law on Wednesday. (@Presidency_ZA/X)
President Cyril Ramaphosa signing the controversial National Health Insurance (NHI) Bill into law has been labelled a PR stunt to help the ANC salvage its dwindling power ahead of one of the most contested elections since 1994.
Whatever the reasons might be, it is imperative that South Africans scrutinise the Act. It is the duty and right of every citizen regarding any decision affecting their lives and the fiscus.
It cannot be disputed that South Africans should all have access to quality primary healthcare. Healthcare facilities should not be the privilege of the few — all should have access to them. In fact, this right is contained in the preamble of the NHI Act and in section 27 (1) (a) of the Constitution. The government, by law and according to the Constitution, has a duty to provide healthcare to its citizens.
Universal health coverage is something many yearn for. In fact, despite the mixed reaction to the NHI, there has been little opposition to universal health coverage, including from major players in the medical sector.
Given the cost of living, and the cost of healthcare, anyone would choose to have affordable, accessible care — if the government provided this. However, as it stands, we have a strained healthcare system made worse by corruption, ineffectiveness and lack of systems of accountability.
During the Covid-19 period, South Africans witnessed mass looting and a lack of accountability on the part of health officials. One of the proposed methods of managing the fund, in terms of chapter 4 of the Act, is to appoint a board. This responsibility would lie exclusively with the minister of health.
This method of administration has been justifiably received with pessimism or utter dismay. The country has seen a great deal of political friction between ministers and boards, resulting in instability, non-compliance to fiduciary duties and the catastrophic appointment of people who are grossly incompetent, without broad consultation.
Adding to the concern is the funding model. South Africans are severely strained by taxation and the model is not sustainable. In the absence of broader buy-in from the private sector, and an expanded model of funding, the NHI will invariably strain the fiscus.
Beyond this, the government has not been able to present a clear, systemic oversight plan on how these funds will be managed. There are fears that there will be a repeat of the problems besetting the Unemployment Insurance Fund.
To ensure universal health coverage, the government must remain committed to the development of a public health system which offers high-quality care to all citizens.
To achieve universal health coverage, South Africa needs the eventual convergence of the public healthcare sector, which is marked by high patient volumes, underfunding, corruption and, in some instances, poor skills, with the private healthcare sector.
This will require a partnership between the public and private sectors and must initially focus on doing the basics correctly — better health promotion and disease prevention, maternal and early childhood health and primary healthcare provision.
South Africa’s health system is chronically under-funded, poisoned by corruption, and in administrative disarray. It has also lost many experienced practitioners to other countries. Those who remain are often poorly managed, overworked and under mental strain due to their working conditions. This compromises the quality of care South Africans deserve.
Another dire concern is the “population coverage” as outlined in chapter 2 of the NHI Act. This is a national bone of contention, echoed by the Limpopo health MEC Dr Phophi Constance Ramathuba, who cautioned that the healthcare system is already strained without the addition of the NHI.
It becomes imperative to ensure that South Africans are prioritised in the provision of healthcare.
It goes without saying that healthcare is costly, and disparities exist between the private and the public systems, however the government must first fix the healthcare system, administer it effectively and ensure that, even in the most remote areas, people have access to quality healthcare.
Merely having health insurance, which will be administered by politicians who have proved to have no regard for citizens, will regress the healthcare system even further.
Gugu Ndima is a social commentator. Follow her on @Mandima_writer.