NHI plans 'delayed'

Health Minister Aaron Motsoaledi has poured cold water on the possibility of a national health insurance (NHI) scheme being up and running soon, saying it could take as long as five years.

Cosatu and Nehawu have called for implementation of the NHI to start in March next year. Both were involved in the ANC’s controversial NHI document, released earlier this year, which advocated speedy implementation of the NHI and the scrapping of medical aids.

Planning for an NHI will now have to start from scratch following the government’s appointment of a ministerial committee to advise it on the scheme. Motsoaledi told the Mail & Guardian the committee would help him get the scheme off the ground, but an NHI “is not like election day, it is a process”.

Despite trade union pressure for speedy implementation, the dilapidated state of the country’s public health system has put brakes on the plan.
“When I came into office I was shocked at the state of the health system,” Motsoaledi told the M&G. “I heard horror stories when I went around visiting doctors.

“It is not just about money—the system has deteriorated. Therefore you can’t just put the NHI [in place], you have to look at the whole system.” He could not provide clarity on exactly how much money will be needed for the NHI: “I would just be guessing if I had to say how much it will be.”

But Motsoaledi remains confident that the NHI will be implemented within the next five years—as promised by the ANC during the elections. “I don’t see anything yet that says it is impossible [to implement the NHI]. If I do, I will go to the NEC [national executive committee] of the ANC and will ask them for guidance.”

ANC secretary general Gwede Mantashe told reporters this week that although the NHI is not budgeted for, it is expected to feature in the next medium-term budget, scheduled for October next year. Finance Minister Pravin Gordhan made no provision for the NHI in his recent medium-term budget.

The 25-member ministerial advisory committee covers several bases, incorporating members from government, the ANC, the private healthcare sector, civil society and the World Health Organisation (WHO).

Two national treasury heavyweights, budget head Kuben Pillay and health policy director Mark Bletcher, indicate a commitment to sensible financial advice on the system. The only union represented is the newly formed South African Democratic Nurses’ Union.

Health Sciences Research Council (HSCR) head Olive Shisana, who steered the writing of the ANC’s NHI report, will chair the committee.

Three other people who assisted in drafting the ANC document are also committee members—Dr Humphrey Zokufa, chief executive of the Board of Healthcare Funders, Charles Hongoro of the HSCR and Board of Healthcare Funders’ lawyer Debbie Pearmain.

Committee members who support an NHI but have been extremely critical of the ANC’s proposed model include the Aids Law Project’s Mark Heywood, the South African Medical Association’s newly appointed chair, Dr Norman Mabasa, and Medi-Clinic director Roly Buis.

The committee includes international experts such as the WHO’s Dr Joseph Kutzin.

But health experts who preferred not be named told the M&G the committee lacks critical minds with in-depth knowledge of South Africa’s public healthcare system and NHI systems in the developing world.

Such expertise is needed to take on dominating personalities such as Shisana, who has set ideas about what South Africa’s NHI should look like, the sources said.

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