NHI corruption possibilities are endless

The possibilities for corruption in the government’s proposed National Health Insurance (NHI) scheme are endless as it will effectively put around R600 billion in funding under the control of a single institution – the National Department of Health. 

This is feedback from Wits School of Governance Professor Alex van den Heever, who told Newzroom Afrika that the NHI follows the design of many failed state-run institutions. 

Van den Heever’s comments come on the back of President Cyril Ramaphosa saying that despite the threat of legal challenges, the NHI Bill will be signed into law soon.

Ramaphosa joked during his State of the Nation Address (SONA) that he was looking around for a pen to sign the Bill. 

Parliament’s National Council of Provinces approved the Bill in December. It referred it to the president, who can either assent to it or ask lawmakers to amend it if deemed legally or technically flawed.

“If he finds his pen, we will have a series of court cases that will probably end up decimating the Bill,” Van den Heever said. 

He explained that the Bill seeks to collapse the provincial healthcare system and centralise it in a national institution that does not exist yet while collapsing private healthcare funding. 

“You are disturbing the entire current health system and attempting to create a third health system which you claim will be better. There is no rationale for that kind of move.”

“So there is no real reason for this. The concern is that the real reason for this is to consolidate power in one organisation that will result, in its ultimate form, in R600 billion being under the control of the health minister. That is just wrong.”

“It is the design that has collapsed pretty much everything that we have in the state at the moment.”

Van den Heever explained that the main concern many people have about the NHI is the potential for rampant corruption. 

“The possibilities for corruption are endless. People are largely concerned because they feel this is the purpose behind it. That this is not intended to improve healthcare.”

“It is about vested interests who have an interest in essentially capturing parts of the state.”

He added that it would be naive to think otherwise. 

“The state remains captured. It is not a state that has moved away from systemic corruption. It is deeply embedded in the way everything operates at the moment.”

NHI in ‘safe hands’

Health Minister Joe Phaahla has tried to downplay concerns over the NHI, shrugging off concerns from the private healthcare sector and those who believe the scheme will ultimately fall to government ineptitude.

He noted that fears that the government will be unable to manage nearly all healthcare in South Africa effectively are “overblown”.

“Those who fear that the NHI will become a state-owned enterprise, some say it will be an Eskom, let me tell you this – you can ask the Auditor-General, in this last audit, all public health entities either got clean audits or got unqualified audits, without exception,” he said.

“So, we can assure you that the NHI will be safe in our hands.”

Contrary to the minister’s comments, though, the Auditor-General’s (AG) report on national and provincial government performance assessment for the 2022/23 financial year – tabled in November 2023 – shows that Phaahla is being economical with the truth.

The AG’s report noted that a quarter of auditees in the year under review provided unreliable, incorrect or no evidence for the achievements they reported.

This included the National Department of Health, which had four disclaimed opinions and one outstanding audit out of 10. This is hardly “clean or unqualified audits, without exception”, as the minister posited.

In her report, the AG specifically called out the Health Department, noting that “health facilities are not coping with the demand for health services, and the safety and security of citizens and businesses are under threat”.

“We reported material findings on the performance reports of most departments in the education, health and human settlements sectors, with most of the worst audit outcomes – adverse and disclaimed opinions or conclusions – being in education and health.”