The discussion was opened by Ms Christine Botha, Manager of the CFCR. Ms Botha gave an insightful background to the proposed NHI and the need to find urgent solutions to the stark inequality in healthcare services in South Africa. She explained that  the NHI Bill proposes the establishment of the NHI Fund, described as the single payer and  single purchaser of all healthcare services and that the pilot phase of the NHI expired in 2017. Drafting and tabling of the NHI Bill is part of the next phase of the NHI.      

The first speaker, Mr Settas, outlined what UHC is and what the basis for the NHI Bill is. He questioned the statement by the Minister of Health, about the apparent shortage of public sector medical personnel. Mr Settas spoke about the annual Inspection Report of the Office for Health Standards Compliance (OHSC), an independent statutory body within the Department of Health. The Report revealed that of the 696 facilities inspected in 2018, only five qualified to contract with NHI. To qualify to contract with the NHI, medical facilities need 80% on the OHSC accreditation scale. On the opposite end of their accreditation scale, 26% of facilities were scored as being ‘Critically Non-Compliant’, 36% as ‘Non-Compliant’ and 23% as ‘Conditionally Compliant with Serious Concerns’. This means that 85% of these facilities are not meeting basic standards of care. 

Mr Settas shared that South Africa’s medical malpractice liability currently sits at R98 billion for 2018/2019, which means that medical malpractice suits account for 43% of the total Department of Health budget (R226 billion). The NHI Bill does not deal with this important aspect of funding. Mr Settas asked whether government should have a monopoly on healthcare on South Africa and further, whether government should have more involvement in healthcare? He compared the rationale for the NHI to the British National Health System (NHS), where under the NHS, citizens choose the funder and provider, so effectively, the money follows the patient. This creates competition amongst healthcare providers and therefore an improved service. 

Mr Settas concluded by highlighting the fundamental flaws of NHI – the creation of a monopoly on healthcare; the centralisation of procurement and accreditation; the lack of separation of powers; and the lack of technical or policy analysis. A realistic option for UHC, would be to fix both sectors – private and public. 

The second speaker was Mr Russel Rensburg, Executive Director, Rural Advocacy Project. Mr Rensburg emphasised  the deep inequality in South Africa. He highlighted that there has been an increase in poverty and the lack of job creation by the private sector, as well as challenges, perspectives and narratives on NHI. He stated that unemployment is our biggest problem and needs urgent attention. 

According to Mr Rensburg, South Africa spends billions on training medical personnel but the health sector is unable to absorb them. Mr Rensburg noted that investments in health in South Africa have stayed the same, when adjusting for inflation. Only a small percentage of the Department of Health’s annual budget is spent on mental health. Mr Rensburg emphasised the need for progressive realisation of UHC versus regression for South Africa, and that government’s role should be more than just oversight of healthcare. Mr Rensburg advocated for the prioritisation of comprehensive delivery for needy groups under NHI, and that NHI could be an investment in social solidarity. He concluded by saying that NHI is a progressive Bill and that South Africans should not be driven by fear.

The speeches were followed by a lively question and answer session, where the speakers were asked about the lack of public knowledge around NHI, the option of keeping private healthcare but having to pay a tax towards NHI, what is wrong with the present system, and more. 

Issued by the Centre for Constitutional Rights 
7 December 2019