Q: How much is NHI going to cost?
A: Less than 8.5% of GDP.
Q: Recent estimates suggest about R700bn?
A: No chance.
Q: In 2019 health minister Zweli Mkhize said more than R470bn a year. Where will the money come from?
A: We spent R277bn the year before last in the private sector. If you add that to the R265bn we spend in the public sector, the money’s already there.
Q: So there’ll be no steep increase in taxes?
A: Why steep? A hell of a lot of that money is already paid for in tax. It’s just going through different channels. If we don’t waste and duplicate ...
Q: That’s a big “if”, isn’t it?
A: It’s not a big “if”. I’m sure you’re familiar with section 32 of the NHI Bill and how it’s going to solve a lot of the duplication in the public sector.
Q: Can you build NHI on top of a thoroughly broken public health system?
A: Yes, absolutely. When other countries have built their NHIs, they’ve largely built them in devastating circumstances.
Q: An example closer to home is Ghana, which started its NHI in 2003.
A: Yes, I was part of the team.
Q: Hasn’t it been characterised by poor quality services, ineffective governance, corruption and the failure of “strategic” purchasing to curb costs?
A: It’s a completely different model from ours.
Q: So we can go ahead in spite of our public hospitals being disasters from infrastructure to management to governance?
A: I’d like you to list all 400 and tell me which ones are a disaster.
Q: Isn’t this what health ombud professor Malegapuru Makgoba said about them?
A: I’ve known him for the last 30-something years and he does shoot from the hip.
Q: Didn’t your own pilot projects show years ago how broken our public hospitals were?
A: Yes.
Q: Why haven’t you fixed them?
A: I don’t see how it's possible to fix things spending R5,200 per person per year.
Q: Is it about money or capacity?
A: There are parts of the country where management is abysmal, where political interference is seriously problematic, where there is devastating abuse of the system and high-profile theft and fraud, but ...
Q: How are you going to prevent corruption from destroying NHI?
A: That’s like me asking how you’re going to prevent patients from stealing from their medical aids.
Q: How are you going to protect a R500bn-R700bn central NHI fund from the organised, often politically connected, criminal networks rife in South Africa?
A: As I said, there’s no way it can be R700bn, I doubt it will be more than R400bn in the fund.
Q: How are you going to prevent it being a feeding trough for criminals?
A: You work really hard to simplify the systems and make them transparent. You intervene when you flag these things.
Q: How are you going to prevent political influence in the fund?
A: The same as in any board, you make it as autonomous as possible.
Q: You’re confident that accountability will be paramount?
A: Yes.
Q: Weren’t these the famous last words of health minister Zweli Mkhize when he submitted the NHI Bill to parliament before the Digital Vibes scandal broke?
A: Well, it was. That’s why he lost his job.
— This article was first published in the Sunday Times in June 2023. It is being republished on the announcement that the bill will be signed into law this week by President Cyril Ramaphosa.
