Comments were received from a variety of stakeholders and citizens. As is normal practice, the Department of Health reviewed the comments and considered them in revising the NHI Bill. In addition to public comments, further stakeholder consultations took place. These included a consultative meeting in which the president himself engaged with more than 300 participants at the CSIR on August 24.
It is at this consultative meeting that the president announced that he was going to lead the NHI process as head of state. The media did raise questions about this. The minister of health explained that he had personally requested that the president lead this process because ushering in NHI is a huge, seismic event that will need the guidance of the head of state.
Hence there is nothing sinister at all for the Presidency to get involved in this NHI process. It is designed to be so. The president is the head of state, and hence the Presidency has a legal right and authority to oversee government work - all government work, including legislation.
NHI is not just an ordinary government programme. It is a flagship programme of the state which is designed to ensure that we deliver on our constitutional mandate of health as a right of all citizens, regardless of their station in life.
Ever since the UN adopted the concept of Universal Health Coverage (UHC) as one of the world’s 17 sustainable development goals in all major democracies of the world, heads of state have taken over the responsibility of being the major advocates and drivers of the process towards the achievement of Universal Health Coverage, which in our country is NHI. It will be remiss for our Presidency to stay aloof from such a major world endeavour.
After that consultative meeting referred to above, the minister went around the country addressing civil society organisations, academic institutions, deans of health science faculties, traditional leaders, labour unions and professional medical associations about the NHI Bill, the Medical Scheme Amendment Bill and the report of former chief justice Sandile Ngcobo’s public market inquiry into the cost of private healthcare.
There has been extensive consultation between National Treasury and the Department of Health, which as planned was facilitated by the Presidency.
Sometimes, these consultations took place through the exchange of letters. There was hence nothing untoward with the letter written by National Treasury on this matter. This type of exchange will continue to happen unhindered, as is normal practice between government departments in legislative and policy-making processes.
What is sinister, however, is the leaking of such letters to the media by some unscrupulous officials, who then pretended that they uncovered some hidden evil lurking in government departmental exchanges.
The types of discussions within interdepartmental co-ordinating structures like NHI War Rooms and Department of Health and National Treasury Technical task teams are always robust to ensure rigour and coherences, and will always be welcome the in government.
The responsibility of the Presidency is to bring departments together so that various perspectives are taken into account before policy recommendations are taken to the Cabinet.
As the Ministry of Health, we will always welcome, support and appreciate the role played by the Presidency in ushering in a new era of NHI.
Through the work of the War Room, the Department of Health and National Treasury have been able to address the concerns and jointly plan the way forward. The same applies to submissions made by other government departments.
Furthermore, we note media commentary about documents submitted to the Cabinet. We wish to state that the Cabinet is not a secret organisation. It is a legitimate structure empowered by law to conduct the affairs of the state and by the same laws, its documents are classified. As such, contents may not be released until authorised by the Cabinet itself.
We wish to restate once again that the Presidency has a right to facilitate, direct and unblock obstacles in the process of legislation and policy-making. The enemies of NHI will do everything possible to try to stop it from becoming a reality, failing which they will try to cast doubt and aspersions on the integrity of the process.
We wish to reassure the nation that no law is being breached nor any illegality or irregularity committed in the manner in which the legislative process towards realisation of the NHI is being conducted between the Department of Health, its officials, the Treasury, the Presidency and the rest of government.
It is unfortunate that some anti-NHI individuals or entities have decided to personalise, isolate and attack some hard-working and dedicated presidential support staff, particularly Professor Olive Shisana, who is employed to help drive government priorities in the social sector, health included.
NHI is bigger than individuals. It is the ultimate expression of social justice and fairness, and as the former director-general of the World Health Organisation stated, it is an equaliser between the rich and the poor.
We are hence not surprised by the type and calibre of people who are working around the clock to undermine NHI. Equalising between the rich and the poor is a revolution that will automatically scare those who flourish under conditions of inequality. It is expected that they will club together in a desperate bid to stop this inevitable revolution, whose time has arrived.
There is no single individual, be it an adviser, a director-general or a minister who has the sole monopoly or right to determine the fate of NHI. That is the sole preserve of the Cabinet, and ultimately the citizens of this country through the parliamentary process.
The allegation that we ignored calls to extend the period of public participation beyond three months is pure mischief. This issue was raised at the consultative seminar held on August 24, 2018, and the minister of health explained to the meeting why it would be undesirable to grant an extension.
Furthermore, he explained that whatever outstanding issue that could not be raised through public participation within that period of three months would still be achieved when Parliament conducts public hearings throughout the length and breadth of our country Such public hearings are still coming.
South Africa has been driving the introduction of NHI since 2009. Since that period, there have been individuals and/or organisations who always made it their duty to find one reason or other to argue that we were not ready for it. We believe these individuals will go on forever and will stop at nothing to continue that line of argument. At no stage will they ever declare that we are ready.
One of the reasons always put forward is that the public healthcare system needs to be fixed first. To mask their intentions we note that in recent days they have now added the fixing of private healthcare as a prerequisite.
Fixing the quality of the public healthcare system and dealing with the exorbitant costs of private healthcare have always been our goal, and is a strong recommendation of the National Development Plan.
The government fully endorsed this recommendation without any reservation. But this fixing of the system has never been mutually exclusive with the implementation of NHI. In fact they go hand in glove, and reinforce each other.
We shall never agree to be put in a no-man’s land of a chicken and egg situation.
We are doing everything in our power to resolve the challenges of infrastructure, human resources and availability of health commodities.
Any individual or organisation who will use such challenges as a good reason to delay NHI smacks of dishonesty and hypocrisy because the plans to improve the quality of healthcare were unveiled at the consultative meeting of August 24 and consolidated and adopted at the Presidential health summit held at the end of October 2018.
We are calling on all stakeholders and social partners to join hands with us on this journey to usher in Universal Health Coverage where no one will be left behind.
Maja is the spokesperson for the Ministry of Health