In his 2025 State of the Nation address the president promised improved healthcare access and infrastructure. (Photo by Guillem Sartorio/Getty Images)
It has been a week since the National Assembly approved the National Health Insurance (NHI) bill that has sparked debate about how it will be implemented and whether it will bring quality care to all South Africans — but many people who rely on the public health system know little about the scheme.
An explainer on the parliament’s website says the objective of the NHI is to narrow the gap between the rich and poor in terms of the standards of healthcare, bringing equality in terms of provision as enshrined in the Constitution.
The Mail & Guardian spoke to people about their experience at public hospitals and clinics and what they thought of the NHI.
Nobuhle Thwala, who lives in the township of Tembisa in Gauteng’s Ekurhuleni metro, talked about her experience at Tembisa Hospital over the weekend. She had rushed her uncle to the hospital after he was involved in a fight and was bleeding. The family was worried because he had recently suffered a minor stroke.
“My uncle was swiftly given a drip and left unattended in casualty with many other patients for a little while,” Thwala says. Although she was taken aback by the service, being there made her understand why patients were treated that way.
“I don’t really want to complain about the service because, to be honest, the nurses here work very hard with the little resources they have. If I am not mistaken, Tembisa Hospital services many sections in Tembisa and a few other areas outside of Tembisa, it must be difficult,” she said.
Asked about her knowledge of the NHI, Thwala said she has never heard of it. After listening to a brief explanation, she said she didn’t think it would work.
“It sounds too good to be true. Firstly, no one will opt to go to public hospitals anymore, meaning there will be more strain on private hospitals. I believe the nurses and doctors from public hospitals have the same skills and knowledge as those private hospitals, but people won’t see it that way. Instead they will flock to private hospitals,” Thwala said.
Ashley Mzati described giving birth at Leratong Hospital in Krugersdorp, which she said was a near-death experience. Her doctor had booked her at the hospital but she started feeling labour pains a day before her appointment.
“It must have been seven at night when I got to Leratong, I was in pain. I got to the reception and there was no one there. I asked the security guard where the labour ward was and he directed me there. I got there and told the receptionist my situation, to which she responded, ‘Okay,’” said Mzati.
The doctors and nurses at Leratong Hospital in Krugersdorp on the West Rand also work hard with very little resources available. (Photo by Gallo Images/Fani Mahuntsi)
She was then left to sit on a chair, in a cold corridor, with nurses passing her until 4am. Every time she tried to speak to nurses, she was met with hostility and told to wait.
When Mzati was finally attended to, she was told there were no beds and was put on a stretcher. After being checked by the nurse, Mzati was left unattended.
“I was in labour … under the worst service and treatment you could ever imagine.”
Mzati said a doctor then arrived, saw there were complications and rushed her to the theatre but there was no one there to assist with the birth. The doctor tried to get some of her friends to help and finally got through to her former lecturer, who arrived with his whole team to deliver Mzati’s baby.
Mzati said she had no knowledge of the NHI prior to her conversation with the M&G. She wants to believe that the government “may get it right, but the government is failing with the most basic tasks for South Africans”, especially in healthcare.
“They can’t clean up the mess at the bottom, how do they think they can clean up the mess at the top?” she said.
Lindiwe Chonco, who lives in Alexandra township in Johannesburg, said she is reluctant to go to the Alexandra Health Centre & University Clinic because of long queues and poor service.
“I go to the clinic every two months because I have a chronic illness and I need to fetch my medication. The service is always bad, from medication not being available, to nurses’ bad attitude and working slowly.”
When asked about the NHI, Chonco said this was the first time she had heard about it.
“I am not even going to get excited about it because everything in this country only works when it’s still new and everyone is excited about it. Three months down the line we will be back to our struggling norm,” Chonco said.
Nonhlanhla Maseko, who is a nurse at the Alexandra Health Clinic, told the M&G that there is no awareness of or education about the bill, especially in the township.
“As health practitioners we spark conversation with our patients and, to make an estimate, one out of 10 patients I treat know about the bill,” she said.
Maseko said she thinks the government “is just shifting its problems in the public health sector to the private sector”.
“I really do not think this bill will end the problems that the health sector currently has. This [will] just penetrate the peace that the private hospitals have. I believe fixing our own problems will be a better option,” she said.
Dimakatso Galane was recently admitted at Tembisa Hospital after collapsing at work because of a panic attack. She said the admission process took from 7pm to 3am.
“I was sent to what they call a consolidation room where there were so many doctors. They were passing my file around, ordering me to go to X-rays and at no point did anyone tell me what the issue may be. It was absolutely terrible,” she said.
Galane spent five days in the hospital but she and a few other patients in her ward had to take care of each other because the nurses would disregard their calls, “as if we were irritating them”.
“I remember one of the ladies we were with started vomiting. I had to clean up the vomit because no one was coming to help, I got frustrated when she vomited again. That’s when I approached the nurses and told them they can’t treat us like this.”
Galane said she had briefly read about the NHI and did not think it would work.
“I understand what the government is trying to do but this will only create more problems. Private facilities will now turn to public facilities and it’s not fair on those who pay thousands on medical aid. Also, instead of doctors fighting to save lives, they will be fighting to get paid by the government, which is not fair,” Galane said.
When Health Minister Joe Phaahla briefed parliament’s select committee on health and social services on Tuesday, he said it was “no surprise” that the NHI has received the negative reactions from those with “vested interests”.
“This bill provides an enabling framework for massive reforms to the entire health landscape in our country, so it is no surprise that it has generated this massive and varied reaction, especially from those who have got ‘vested interests’”.
Parliament’s website states that the cost of the healthcare system, which is the most expensive in the world, will be reduced.
No fees will be charged at healthcare facilities, because the NHI fund will cover the cost of people’s medical expenses in the same way that private medical aids do for their members.
Many professionals from various sectors have questioned its affordability and said it could negatively affect the private healthcare sector.
A nurse running a private clinic under the CareKahle network, who did not want to be named, said she did not want to have to fight with the government when it failed to pay for claims, which she believes is highly likely.
“We offer quality, affordable healthcare services to all South Africans at a [low] cost and take almost all medical aid payments. We work very well with these reputable medical aid companies and I really cannot trust the government to pay us for our services,” she said.
“People come to us because they cannot stand the bad service [at public health facilities] and then now all those problems [will now] follow them to the private sector.”