Palesa Phili is the chief executive of the Durban Chamber of Commerce and Industry File Photo: IOL
Palesa Phili is the chief executive of the Durban Chamber of Commerce and Industry File Photo: IOL

SA needs healthcare for all, but it requires more thought

By Palesa Phili Time of article published Feb 2, 2020

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DURBAN - Recently, the government opened the proposed National Health Insurance (NHI) Bill up for public comment causing a considerable furore and being labelled controversial even though many counties have adopted universal healthcare coverage with several others following a similar process as South Africa.

The legislation is aimed at creating a National Health Insurance (NHI) Fund that will finance is a national health care system that will allow all South Africa citizens to have access to essential healthcare products and services, regardless of their financial status, employment or their ability to directly contribute to the NHI Fund.

This proposed health-financing system will require those people who can afford to do so to contribute (through taxes) to the NHI fund, but all citizen will receive health services according to their health needs, effectively allowing the “haves”to subsidise the “have nots”.

There is a lot of controversy around the NHI bill, and there are many reasons why it has become a national hot topic with very divisive views across our country, many of which have been discussed in the Durban Chamber of Commerce and Industry’s Health Professionals Forum and our NHI submission to the government.

On the one hand, we have those who commend the government for drafting this proposed legislation as access to quality healthcare and health services is a basic human 

right,written into our Constitution, and should not be dependent on location and how much money one has. On the other hand, some believe that the government is once again overshooting and over promising what they are capable of delivering as South Africa does not have the funding, institutional framework and administrative capacity to deliver on the NHI bill using all the current failing state-owned enterprises as an example of this reasoning.

The truth is, at present, the South Africans who face the most health risks and suffer from the greatest ill health do not have access to good quality healthcare.

South Africa needs a functioning national health care system and NHI fund and we can afford it based on the current health spend versus gross domestic product ratio. However, the NHI’s legal framework needs to be clear and concise, empowering NHI administrators to have facility-level authority and control as well as accountability coupled with the mechanisms that will allow for good governance, proper risk management and legislative compliance.

The government needs to revise the proposed draft of the NHI bill as the current South African health system is faced with an array of challenges which include administrative, structural as well as South Africa’s overall diseases burden. The  government can refer to other low to middle-income countries such as Thailand, Ecuador and Georgia who are currently covering their entire populations, outperforming wealthier nations like the US in this regard. So clearly the main challenge with creating a viable universal healthcare scheme that includes the whole citizenry, especially those who are most vulnerable and at-risk, is not so much the level of financing but rather how the health system is financed.

The new health care system the NHI Bill proposes will also have varied risks and costs that will impact the private sector and medical professionals. If applied in its current form, it will fail but if the government adopts a practical, inclusive and systematic approach to legislating, implementing and administrating a national healthcare system, then the proposed bill needs to be redrafted after thorough consultations and input with all stakeholders that will be affected the new legislation such as medical insurance schemes, hospital administrators, private medical groups, health professional and ordinary citizens. Much more is needed from the government than just good intentions and organised business has a role to play in aiding the government to realise its NHI ambitions.

Palesa Phili is the chief executive of  the Durban Chamber of Commerce and Industry.


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