Issued by Daniela Ellerbeck on behalf of the FW de Klerk Foundation, on 05/04/2024

On 7 April 2024, the world commemorates World Health Day. Countries should “… ensure that everyone is exposed to accessible, available, acceptable and adequate healthcare quality”, according to the World Health Organisation (WHO). In addition, our Constitution guarantees everyone the right to access health care services (section 27).

The National Health Insurance Bill (“NHI”) – now only needing the President’s signature to become law – intends to achieve “Universal Health Coverage”. It seeks to ensure that no one is deprived of access to quality health care due to a lack of money by creating one public health fund with adequate resources to plan for (and to effectively meet) the health needs of the entire South African population.

However, “Rather than fulfil everyone’s right to access to healthcare the NHI is poised to undermine this right”, according to Daniela Ellerbeck, Constitutional Programmes Manager at the FW de Klerk Foundation. “The State simply does not have the money: It requires an additional R200 billion in taxes from an already strained (and shrinking) South African tax base. Even Finance Minister Enoch Godongwana admits it is unaffordable and that the proposed financing sources are unsustainable,” states Ellerbeck.

“The NHI will not narrow the gap between the private and public healthcare sectors, but only undermine everyone’s ability to access healthcare, because the State lacks the people and managerial power to implement it,” says Ismail Joosub, Legal Officer at the Foundation.

Speaking of its ramifications for the estimated 3,7 million South Africans suffering from rare diseases, Shaun Kinnes, an intern at the Foundation, states that, “They stand to be the most affected, due to the complex nature of many of these disorders, those affected often require specialised doctors, medical equipment, medications and diagnostic equipment. The NHI seeks to prescribe healthcare to citizens and places emphasis on primary healthcare services. It largely neglects the rare diseases community.”

“The NHI does not incorporate inclusivity or universality, but aspects of exclusivity”, states Siyakudumisa Zcina, an intern at the Foundation. “Rather than try to fix the public health care system with such an unaffordable law that cannot successfully be implemented, South Africans would be better served by the State, for example, converting more hospitals into university teaching hospitals.”

The Foundation urges President Cyril Ramaphosa to exercise the powers the Constitution gives him to send this law back to Parliament for reconsideration, lest we face insurmountable financial, human resources and managerial deficiencies challenges that will cripple everyone’s right to access healthcare. Fix the current public health system and ensure that the best possible (and corruption free) health care is provided to the public who cannot afford private health care. And support the private health care system as it serves as a platform for high-end technological innovations and advanced medical and surgical procedures.