'NHI is about ubuntu,' says Phaahla as bill gets the nod

The much-talked-about National Health Insurance (NHI) is one step closer to being a reality after the National Council of Provinces (NCOP) passed the controversial NHI Bill on Wednesday. But some opposition parties and private healthcare sector players, including the Hospital Association of South Africa (Hasa), were not happy about it. 

Hasa, the umbrella body for the country’s private hospitals, noted with “disappointment and concern” the decision by the NCOP to pass the bill without engaging with the many constructive suggestions and proposals “that we, business representative organisations, and many other healthcare stakeholders have tabled”.

 “We firmly believe the legislature has missed an opportunity to address several fundamental and critical issues that threaten the healthcare system's efficacy and that, therefore, urgently require resolution.” 

The hospital body said not only is there lack of clarity regarding the future role of medical schemes and the need to incorporate a multi-payer approach as opposed to a single-payer regime, but “there needs to be far more detail regarding funding our country's most consequential initiative ever”. 

“Moreover, solutions to the deepening nurse and doctor shortage and the desperate need for adequate public health facilities to strengthen healthcare delivery remain elusive.” 

During a parliamentary debate before eight of the nine provinces voted in favour of the bill, health minister Joe Phaahla described it as a “landmark moment” for the country’s healthcare system “as we move towards realising universal health coverage through the phased-approached implementation of NHI as a mechanism to ensure equitable access to quality healthcare for all citizens.” 

He said the bill not only represented a transformative approach to healthcare delivery in South Africa, but the NHI was about “ubuntu” as it created a healthcare system that is “fair, efficient and accessible to all”.

“It is founded on the principle that every South African, regardless of their socioeconomic status, should have access to a comprehensive set of health services without facing any financial barriers.” 

The Western Cape is the only province that did not vote in favour of the bill which will now be submitted to President Cyril Ramaphosa, who is likely to sign it into law, starting the process of establishing the single NHI fund proposed by the bill. 

The legislation proposes a single state-run medical fund that will purchase health services on behalf of all patients from public and private sector service providers. While it has been claimed the rich will subsidise the poor, it is not clear how the scheme will be financed.   

Some critics of the NHI argue this will not only reduce the role of medical schemes, but having a government-run fund opens it up to widespread corruption as has been seen in state-owned businesses such as Eskom, Transnet and SAA. 

Phaahla said the initial point of action after the draft law is promulgated would be establishing the national health insurance fund — an autonomous public entity as outlined in the Public Finance Management Act.

This provision requires the establishment of a board and other governance structures critical for accountability. 

The health department will prepare detailed regulations, which will then be published by the health minister, “encouraging transparency and inclusivity in shaping the governance of the NHI Fund”. 

Phaahla said once regulations are finalised, his office would proceed with the establishment of the NHI Fund, a process that Is expected to take between six to 12 months post proclamation of the NHI Act, with subsequent phases involving additional regulations and implementation . 

“As we reflect on the positive outcome of the NCOP vote, it is important for us to remember the significant strides we have made in advancing the necessary policy and legislative frameworks to support the implementation of NHI. There have been positive and negative experiences we have encountered in our taxing journey for us to reach this point. 

“As we move forward, we remain steadfast with the implementation of NHI, guided by constitutional values and the principles of social justice and the right to health,” Phaahla said.

The DA has labelled the passing of the bill as a worthless resolution to the healthcare challenges.  Gerrit Pretorius, DA MPL and chairperson of the Western Cape standing committee on health and wellness, said apart from implementation of the NHI requiring substantial funding, “there have been serious questions raised regarding the feasibility of the funding model proposed in the bill”.

“The concerns are not merely about the cost, but also the potential strain on an already stretched national budget,” he said. 

During the parliamentary debate Pretorius said: “The ANC has stolen the soul of South Africa with the passing of the NHI Bill, and they have eaten it. How dare they?” 

Pretorius said from 10 public hearings held by his committee across the Western Cape it became clear that some believed the fallacy that the NHI “would introduce immediate, superior healthcare for all, especially those in far-flung rural areas”. 

“What I find incredibly sad, is that these members of the public had been deliberately misled. Imagine the indignation when the NHI version sold to them never materialises. Imagine the anger when, instead of a utopian system of free and quality healthcare, our people find themselves trapped in a system devoid of funds, skills, and proper management.” 

Last week Business Unity South Africa (Busa) and Business for South Africa (B4SA) called for the NCOP to disregard the bill, accusing the committee of not following proper processes and failing to consider amendments made by stakeholders.

A doctor body, the SA Health Professionals Collaboration (SAHPC), also labelled the hasty adoption of the bill by the NCOP select committee on health and social services as “deeply concerning” because of the unintended consequences it could have on patients and the economy. 

One of the controversial aspects of the bill is section 33, which states that medical schemes may only provide cover that “constitutes complementary and does not overlap with the personal health care service benefits purchased by the NHI”. 

Many have said this would reduce the role of medical schemes to that of a gap cover, which provides for the shortfall when doctors and specialists charge above normal medical aid rates . 

Limpopo health MEC Phophi Ramathuba said despite South Africa's painful transition from apartheid where there were multiple health departments, including those in the former homelands, which often discriminated against patients according to the colour of their skin and geographical location, the country’s current two-tier health system also needed to be abolished. 

While the private sector is often celebrated over a public sector that is grossly under-resourced, Ramathuba said “we want to argue today that private health care is equally broken and it also equally has got its own challenges, just like the public health care has got its own challenges”. 

She said some medical professionals who were opposed to the NHI were “double-dipping” as they worked both in the public sector and benefited in the private sector too. 

 “These are some of the medical specialists who are working full time in government ... because government is progressive. We even allow them to do remunerative work outside public service. They leave the public patients, poor patients, and go to private. And when they get to private work, who pays them? It's double-dipping because they get paid by the same medical aid, which is subsidised by the same state.”

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