South Africa

NHI funds should not be in government’s hands – Profmed CEO

Joe Phaahla

Profmed CEO Craig Comrie said the NHI Bill lacks a proper funding model and gives too much control to the Health Minister.

Comrie told Newzroom Afrika that Profmed’s opposition to the government’s NHI Bill lies largely with its funding model.

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

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.

Many of the Bill’s critics have pointed out that it has yet to provide an adequate funding model for NHI in South Africa.

Comrie said the lowest estimate for NHI currently is around R450 billion, which could go up to around R800 billion.

“We have around R260 billion already in the public sector healthcare budget. There’s no real move to budget for the additional at least R160 billion,” he said.

The CEO said he is also concerned that if this money is raised, the NHI Bill dictates that the control of that money will be under one minister – the Health Minister.

“We don’t believe the Minister of Health should have total control over that single pot of money,” Comrie said. 

“The easiest example to explain it is probably the example of Eskom – the fact that you have a single provider and distributor of electricity is exactly the template that the government is moving away from in terms of electricity provision.”

“Yet, in the healthcare sector, we’re doing exactly the opposite.”

Profmed CEO Craig Comrie

Comrie’s concerns mirror Wits School of Governance Professor Alex van den Heever, who said the possibilities for corruption in the government’s proposed NHI scheme are endless.

“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,” Van den Heever said.

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

He 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 recently tried to downplay concerns over the NHI, shrugging off criticism 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.”


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