NHI masks corruption bleeding hospitals dry

The government’s intense focus on the implementation of the National Health Insurance (NHI) scheme takes time, attention, and resources away from fixing the root cause of South Africa’s healthcare challenges, which is widespread corruption. 

Existing governance loopholes in the public and private healthcare systems, which have remained unaddressed for 20 years, have resulted in declining access to healthcare and the quality of care. 

Prior to the enactment of the NHI, no major structural healthcare reforms had been made in South Africa over the past two decades, despite clear shortcomings. 

Now, the intense focus on the NHI is taking away from credible policy alternatives that have a greater chance of improving healthcare in South Africa. 

This is feedback from governance expert Professor Alex Van den Heever, who explained that NHI will not achieve its stated aims, even if it were unopposed legally. 

The scheme lacks a viable funding model and does not have the institutional design that could achieve the aim of universal healthcare, he said.

“Unless we have a government that genuinely focuses on this issue and proposes a credible universal coverage programme, this progressive deterioration will continue,” Van den Heever told Newzroom Afrika. 

This is the crux of the argument many NHI opponents are making, with none opposing universal healthcare as a concept. Rather, they are opposed to the NHI being the mechanism through which it can be achieved. 

Furthermore, they argue that the government has failed to address many of the issues in the public healthcare system that would provide a basis for the NHI. The primary issue is the widespread corruption within the system, draining it of resources. 

“What we have is that a lot of our funding for the public health system is being drained away through corruption,” Van den Heever said. 

“If we just look at the Tembisa matter, about R2.3 billion was extracted from one hospital in Gauteng. This is by no means a unique situation.”  

“The flaws in South Africa’s procurement system, which make them ‘capturable’ by political networks, are across the entire public system.” 

In effect, the money allocated for healthcare in South Africa does not end up in care being provided to patients, with a large chunk of it going towards politically connected individuals. 

“This is an enormous drain on the performance of our healthcare system, and it is not confined to Gauteng. It is something that is happening across the board,” Van den Heever said. 

Wrong focus

Rather than focus on clamping down on corruption or ensuring funds are more effectively used, the government has chosen to give its time and resources to the NHI. 

Van den Heever argued that it is far more important to understand what the government should have been doing instead of focusing on the NHI.

In this sense, legal challenges against the NHI are a necessary action, as they are likely to force the state to engage with what actually needs to be done to improve healthcare in South Africa.

“The closing of those governance gaps should have been the focus of a responsible government,” Van den Heever said. 

“The structural gaps that are allowing widespread corruption to occur are not being addressed at all, and that is because there is potentially a lot of vested interests involved.” 

Van den Heever said tackling this is not a vast reform that requires decades of planning. Rather, it is simply protecting the healthcare budget to ensure it is spent on patients. 

This is heavily reliant on the right people being in power at various levels throughout the state, with high-ranking government officials linked to criminal syndicates. 

“The quality of the leadership actually depends on fundamentally not having politicians who are trying to extract money from the system or put in place networks of extraction,” Van den Heever said. 

“Politicians have to be focused on the legal frameworks of our healthcare system, and our executives need to be professionals.” 

Van den Heever said this is well known, and the methods for implementing such changes are clear, but there is significant political opposition to such reform. 

“There is significant political opposition to doing that because it actually removes the political control that members of the executive have that are then tied into factions that are operating from within political parties,” he said. 

“It is a terrible dynamic that is harming much of the performance of our healthcare system across the board. It needs to change.”

“But, that is the one thing that is not on the table for discussion around the NHI.”