Issued by the FW de Klerk Foundation on 25/01/2024

In the midst of a healthcare crisis, South Africa faces a perplexing paradox – a surplus of over 800 unemployed doctors juxtaposed with escalating medical negligence claims in state hospitals. The situation underscores the constitutional implications of the National Health Insurance (“NHI”) Bill, which, far from being a solution, appears to exacerbate the challenges at hand.

The alarming unemployment figures within the medical profession raise profound questions about Government’s ability to manage its healthcare workforce. The mismatch between a surplus of qualified medical practitioners seeking employment and understaffed hospitals hints at a systemic failure. This crisis directly contradicts the Constitution’s commitment to the right to access healthcare (section 27 of the Constitution).

South African Medical Association Trade Union’s (“SAMATU”) ongoing protests highlight the urgency of addressing this issue, urging the Government to prioritise the appointment of over 1,000 qualified and registered medical practitioners currently without employment. A 2023 memorandum presented to the Health Department stressed the need for permanent employment contracts, a swift filling of vacant registrar posts, and a comprehensive review of the salary structure for doctors, aligning with constitutional principles of equality and fair labour practices. Sadly, these pleas have gone unnoticed. 

However, the potential remedy proposed by the NHI Bill seems questionable at best. Business groups, including Business Unity South Africa (“Busa”) and Health Funders Association (“HFA”), have expressed concerns over the Bill’s constitutionality and viability. Both have even petitioned President Ramaphosa to not sign the Bill into law, citing significant threats to citizens’ constitutional rights embedded in the NHI Bill.

Critics argue that the NHI Bill, rather than addressing the current challenges, poses a risk to the healthcare system’s integrity. The Bill’s infringement on the right to access healthcare, particularly through restricting the role of medical schemes, raises constitutional red flags. The lack of meaningful changes, despite extensive requests for such changes by the public in consultations, also questions the legitimacy of the procedure followed to pass the Bill.

Moreover, the NHI’s financial implications, requiring an additional R200 billion in taxes, cast doubts on its affordability and feasibility. Business groups contend that the Bill, in its current form, may lead to disinvestment in the healthcare sector, exacerbating the country’s economic fragility.

The private sector, in stark contrast, stands as a beacon of effective healthcare delivery. Business groups emphasise that meddling with a functional private sector, which actively contributes to the well-being of citizens, could have devastating consequences. The potential disinvestment, delays in universal health coverage, and a strained public sector could further compromise the quality, management, and governance of healthcare in South Africa.

Additionally, the public sector’s failure to absorb and employ these skilled doctors represents a significant loss of talent for the nation. The untapped potential of over 1 000 qualified doctors sitting idle at home is not only a personal tragedy for these professionals, but also a loss for the public healthcare system and the communities it serves.

In conclusion, the juxtaposition of unemployed doctors and the NHI Bill underscores the need for a nuanced, constitutionally sound approach to healthcare reform. Rather than signing an unamended NHI Bill into law, President Ramaphosa must consider the pleas of business groups, health professionals, and trade unions, ensuring that the constitutional rights of citizens are preserved, and the healthcare system remains robust, accessible, and embraces the positive contributions of the private sector.