Johnathan Paoli
President Cyril Ramaphosa on Wednesday went right ahead and signed the controversial National Health Insurance (NHI) Bill into Law amid objections from opposition parties and threats of legal actions to stop what his critics say is an election ploy.
During the signing ceremony at the Union Buildings in Pretoria, Ramaphosa declared the signing into law of the NHI Bill as an opportunity to make a break with the inequality and inefficiency that has characterised the approach to health in South Africans.
He said this legislation illustrates a milestone in the country’s ongoing quest for a more just society and equitable society where quality healthcare will be accessible to everyone.
“The passage of the Bill sets the foundation for ending a parallel inequitable health system where those without means are relegated to poor health care. In signing this Bill, we are signalling our determination to advance the constitutional right to access health care as articulated in section 27 of the Constitution,” Ramaphosa said to much applause and ululation.
Ramaphosa said the provision of health care in South Africa was fragmented, unsustainable and unacceptable with the public sector facing budget constraints and the private sector suffering high costs without a proportional improvement in health outcomes.
He said a radical re-imagining of resource allocation as well as continuing commitment to universal healthcare would be required to engage the legacies of the past.
“The real challenge in implementing the NHI lies not in the lack of funds, but in the misallocation of resources that currently favours the private health sector at the expense of public health needs,” Ramaphosa said.
Defending the Act, Ramaphosa said it proposes a strategy that combines various financial resources, including both additional funding and reallocating funds already in the system; and ensures contributions from a broad spectrum of society, emphasising shared responsibility and mutual benefits.
“The NHI carries the potential to transform the healthcare landscape, making the dream of quality, accessible care a reality for all its citizens,” Ramaphosa said.
“We all need to embrace a future where healthcare is a shared national treasure, reflective of the dignity and value we accord to every South African life,” the President said.
Under the proposed legislation, all health facilities would be required to achieve minimum quality health standards and be accredited.
Ramaphosa also said the government would establish systems and governance structures to implement the NHI based on the primary healthcare approach and will be done in phases, rather than an overnight event; and despite the disputed reception of the legislation, the government would iron out the wrinkles in a spirit of cooperation and solidarity.
However, the NHI Bill has its supporters and detractors among South Africans, with critics arguing that it is rushed and there is not enough funding for its execution and that it could lead to further challenges within the already strained public healthcare system.
Among the critics is The DA’s John Steenhuisen whose party has threatened litigation and warned of serious tax implications for South Africans if the Law is enacted and said his party was ready to go to court to challenge what he has claimed to be a pre-election, political stunt.
While the fiscal details underlying the funding of the Bill have not yet been finalised, Steenhuisen said raising taxes was inevitable to fund an estimated R200 billion per year to run the scheme successfully.
“It is more comprehensive in scope, more corrupt in intent, and more deadly in impact than BEE, load shedding, cadre deployment, land expropriation, and nationalisation put together,” Steenhuisen charged.
He criticised both the Minister of Health Dr Joe Phaahla for being in charge of the fund, as well as what he predicted would be a “brain drain”, in light of the health professionals who are expected to leave the country.
ActionSA said that it was disappointed by the government’s apparent lack of concern over the possibility of corruption and state capture and its leader Herman Mashaba said the NHI, despite being a noble quest, would expose the health system to corruption and would only make the problems worse.
“The NHI will NOT fix South Africa’s broken healthcare system. Instead, it will worsen our healthcare crisis and open doors to more corruption,” Mashaba said.
And the NHI Bill was misleading the nation into believing that they would be taken care of, according to RISE Mzansi leader, Songezo Zibi.
“We must not allow the ANC to mislead us into thinking the NHI is a silver bullet, we need healthcare facilities that belong to South Africans, and are at least 15 minutes away from each home,” Zibi said.
The South African Medical Association (SAMA) also weighed into the fray and expressed its unhappiness with the Bill saying that the system was not ready for National Health Insurance.
SAMA Chair Mvuyisi Mzukwa said that while the association supported the objectives of the Bill, it remained problematic due to only concentrating on one facet of the healthcare problem in the country.
“If you are talking about NHI, it is not going to build roads, it is not going to build hospitals, it is not going to be hiring (and plug) the shortage of doctors and nurses. You are only attempting to fix the finances but you forget about other important pillars like ethical leadership and governance, staffing, shortage of vaccines and medicine and technology,” Mzukwa said.
The Hospital Association of South Africa (HASA) said that universal healthcare is a must, but that the facilitation of the Bill as it currently stands is a mistake.
HASA’s Mark Peach said the organisation has consistently supported healthcare, contributing both research and expert insights from experienced managers who have operated in systems.
“We sincerely believe the unfortunate consequences that this version will hamper, rather than promote access to quality health care,” Peach said, adding that the association’s contributions were disregarded and ignored by the drafters of the Bill, despite the experience and knowledge it could have brought to the process.
However, not every organisation is unhappy at the signing of the Bill into Law. The Health and Allied Workers Indaba Trade Union (HAITU) is one such entity that has praised Ramaphosa’s “first step towards transformation” and called for the nationalisation of all private hospitals to support the rollout of NHI.
HAITU said in light section 27 (1) of the Constitution which states that everyone has the right to access healthcare services, including reproductive healthcare, and the obligation to progressively realise the rights; private health care must be completely banned in the country so that everyone could access the same quality of care.
“The NHI can only work if it is the only option available to all of us. HAITU is also calling for all private hospitals and clinics to be nationalised so that the public can access these world-class facilities. By nationalising these facilities, we can speed up the process of allowing the public to access quality healthcare,” the union said.
HAITU General secretary Lerato Mthunzi said owners of private medical facilities were more concerned about earning profit than the collective well-being of the country.
“We have normalised the abnormal in this country, and the banning of private healthcare is the first step to normalising the situation and ending inequality,” Mthunzi said.
Challenges in the public system should not be used as an excuse to stop the government from implementing the Bill and beginning the work to genuinely transform the South African healthcare sector so that it finally lives up to its rights of universal access, as enshrined in the Constitution, Mthunzi said.
The South African Communist Party took matters a step further by picketing outside the Union buildings in support of the President, with party spokesperson Alex Mashilo saying that the SACP supported both Ramaphosa and Parliament in realising the law after extensive consultation.
“In our country, quality health care is an exclusive preserve of a minority who are opposed to the NHI. They want to be the only ones who have access to quality healthcare. The President will bring this to an end,” beamed Mashilo.
The Democratic Nursing Organisation of South Africa (DENOSA) also rallied behind Ramaphosa in support of the Bill which would help solve the problems of healthcare inequality in the country, spokesperson Sibongiseni Delihlazo said while pointing out that the union has been consistent in its support for the NHI.
“The concept of equal access to universal health coverage will finally be realised in the country, whereby everyone has equal access to healthcare on the basis of their healthcare needs and not on the basis of how deep one’s pocket is,” Delihlazo said.
Health Minister Joe Phaahla previously said that the Bill is expected to be implemented in two phases from 2024 to 2026, while between 2026 and 2028 the government will focus on establishing the board and CEO and several key committees of the NHI fund.
At the signing ceremony Phaahla said the government was confident that the innovative funding of infrastructure as stated by the President will also contribute to health facilities.
The minister said his department was strengthening key delivery areas, including healthcare benefits design, digital health systems, and risk identification and fraud prevention.
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