NHI will not fix healthcare in South Africa

The government’s National Health Insurance (NHI) scheme is not a silver bullet that will fix South Africa’s problematic healthcare system.

This is the view of health policy expert Dr Bandile Hadebe, who told eNCA that the widespread criticism of the NHI Bill needs to be contextualised.

Hadebe’s comments come on the back of President Cyril Ramaphosa, who said that the NHI Bill will be signed into law despite the threat of legal challenges.

Ramaphosa joked during his 2024 State of the Nation Address (SONA) that he was looking for a pen to sign the Bill, indicating the government’s commitment to passing this Bill despite staunch criticism. 

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.

“I think we must contextualize the very concept of NHI being heavily contested,” Hadebe said. 

“I don’t think anyone is opposed to the NHI. Different stakeholders have reservations with particular clauses and with particular discussions that are coming out of the paper.”

For example, Business for South Africa (B4SA) and Business Unity South Africa (BUSA) are preparing to submit a petition to Ramaphosa, requesting that the Bill be referred back to the National Assembly for amendment. 

In its current form, the business groups said the NHI is unworkable, unimplementable, unaffordable, and unconstitutional. 

“The reality is that if President Ramaphosa signs the NHI into law as it is now, I suspect there are many people that are going to litigate,” B4SA Steering Committee chair Martin Kingston said. 

“It will effectively be stillborn and will not proceed until the courts have applied their minds. We think it does not even pass Constitutional muster.”

However, Hadebe said the biggest danger with this conversation is that “we’ve presented the NHI as the silver bullet that’s going to fix our healthcare, and it isn’t”.

Rather, he identified six areas that need to be touched on to strengthen a healthcare system –

• Service delivery
• Infrastructure
• Human capital
• Leadership and governance 
• Information systems 
• Technology 

“If we’re not fixing all those things together, the NHI is not going to fix them,” he said.

This echoes comments made by BUSA CEO Busi Mavuso, who said there is no way that, in its proposed form, NHI will work. 

“As it stands, it will leave all South Africans worse off in a system where state provision becomes impossible,” she said.

The Finance Minister has made similar comments, saying he would rather invest money in improving government-run hospitals and healthcare infrastructure than implement the NHI Bill.

“I am not worried about the number of people who are going to public hospitals. They did it today already. The system is already under pressure now,” he said.

However, the NHI may not be the best solution to this problem. 

“The mechanics of it are difficult. I would rather we invest more in upgrading our hospitals and our infrastructure to make them more attractive to everybody,” Godongwana said.

“In that sense, you can make private provision of healthcare irrelevant. For now, we have not done that.”

The Global Health Security Index ranks South Africa 56th out of 195 countries. 

While South Africa has a better public healthcare industry than many other African countries, it still has a long way to go in competing with the private sector.

Many public hospitals and clinics in the country are understaffed and underfunded and have inadequate resources and infrastructure. This leads to lower quality healthcare.