Forging ahead with NHI ‘tantamount to national and economic suicide’

STAFF at Kalafong Hospital protest over a number of issues, among them the lack of equipment and their inability to service patients. Picture: Jacque Naude/Independent Newspapers

STAFF at Kalafong Hospital protest over a number of issues, among them the lack of equipment and their inability to service patients. Picture: Jacque Naude/Independent Newspapers

Published Feb 25, 2024


WITH the reality of the National Health Insurance (NHI) seemingly closer to becoming reality and a billion rand being pumped into making it work, critics in and out of the medical field have yet again raised concerns on the real impact it will have.

The NHI has been decades in the making, during which time the government has slowly but surely ploughed forward with plans to implement it.

Geared to being a universal health plan, one which, in its ideal form, would ensure that every citizen of the country has access to equal and quality health care, the plan entails bringing private hospitals and medical aid providers into a partnership with government to close the divide between the haves and the have-nots.

But, as pure as the intentions behind it, a large percentage of South Africans have dissected the plan in as far as it concerns the government’s ability to ensure its proper implementation, with many expressing the fear it would hit hard on the pockets of those who had the means and money to use private health care.

This has been coupled with criticism of the actual drawing of the plan, where experts have pointed out that there was no way the government, known for running health and other institutions with the barest minimum service, could ensure the poorest of the poor accessed the health care laid out by the plan.

“We have lived in a country where public hospitals and all public institutions have failed to stand up to the needs of the multitudes who deserve service. How then government would toy with the very idea of something as important as the health and lives of large populations desperately in need, not because they chose to but because they find themselves in situations of life or death, remains the most cruel thing a country can do,” Gauteng activist Dr Rajeesh Prinsloo said.

Last week, following a Cabinet meeting at the Union Buildings, reports emerged that President Cyril Ramaphosa had plans to sign the bill into law before the elections in May.

Gauteng Premier Panyaza Lesufi, during his State of the Province Address, also spoke on plans to buy back 18 private hospitals to facilitate the plan.

This announcement was followed by disbelief from experts, some who asked which hospitals these were, and questions as to why the money ‒ an estimated R7bn ‒ would go into a plan which faced major challenges rather that it being put towards fixing the health facilities, many of which were in a shambles.

Lesufi said: “We will convert these into public hospitals so that we are ready for the implementation of the National Health Insurance scheme,” to which responses included the money rather being used to fix and upgrade, and build facilities, in addition to providing medication and transport for the millions in the province who struggled daily.

These announcements were followed closely by Finance Minister Enoch Godongwane, who yesterday announced a R1.4 billion injection to the Department of Health in preparation for the NHI.

Again, the uproar came from far and wide, with many asking why so much money was being set aside for a project that had no proper support.

“Throwing money to the wind, is what this is,” Cape Town doctor Professor Sam Bryan said. Weighing in was the chief executive of Business Unity SA, Cas Coovadia, who said: “The allocation, although modest, is of concern as it indicates that government is pressing ahead with implementing a piece of legislation that is fundamentally flawed.”

He said they held the belief that it was essential to address the issues raised by various stakeholders in addition to business to give the NHI a realistic chance of being implemented.

Saying that already health in the country was in a mess due to mismanagement, Alex van den Heever from the Wits School of Governance said it was strange that Lesufi spoke of hospitals to be set aside for NHI, and that Godongwane spoke of money to fund it.

“The Gauteng Department of Health has been in financial shambles for years due to massive irresponsible expenditure and internal mismanagement,” he said, calling it all bizarre.

He said the NHI, in its current form, faced legal challenges that could last for many years. He and others predicted pushback from medical aid providers and hospital groups, who would be forced to share their resources with a government which, they said, would not lift a finger for the many who depended on it.

But not everyone had a negative reaction about the possible implementation of the plan. The South African Medical Union was among those who applauded the announcement, saying the earmarking of R27.3bn for health-care infrastructure was a welcom development. “It not only takes us a step closer to being National Health Insurance (NHI)-ready, but also furnishes the much-needed impetus for renovating our medical facilities.”

That development would drastically transform and enhance the calibre of public health-care services, they said.

The Public Service Association (PSA) said they expected that funds allocated to the health sector would ensure that government departments would be able to fill vacant funded posts to support much-needed service delivery.

They said they supported the funds meant for the health sector, which would improve salary increments. They said the budget for the NHI would improve health-care services, including district facilities, improve access to healthcare, and more doctors and nurses would be hired. “The PSA is, however, of the view that in order for the NHI to be effective when signed into law, much more funding will be required to cater for the most vulnerable.”

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