Full-steam ahead for NHI in South Africa

President Cyril Ramaphosa and his Government of National Unity (GNU) are moving ahead with implementing the National Health Insurance (NHI) Act despite strong opposition from within and outside of the government.

The NHI Act, which Ramaphosa signed into law on 15 May this year, promises a complete overhaul of the country’s healthcare system.

This plan aims to establish a universal healthcare coverage system, ensuring all South Africans have access to essential medical services.

Under the NHI, a single public fund will act as the sole purchaser and payer for healthcare services, drawing from both the public and private sectors.

“We have highlighted the social and economic value of affordable, accessible, quality health care that is available equally to all South Africans,” Ramaphosa said in a recent speech at the closing of an ANC policy meeting.

“We will, therefore, proceed with the implementation of the National Health Insurance.”

Health Minister Dr Aaron Motsoaledi said the section of the Bill which outlines transitional mechanisms would be implemented “immediately”, Reuters reported. 

This includes setting up advisory committees and amending other health-related laws to align with the NHI.

According to Motsoaledi, the poor people who are set to benefit from the Bill still “haven’t spoken”. “Nobody’s carrying their voice.”

He explained that he would embark on a roadshow to consult with stakeholders, listen to their concerns, and help people understand the NHI – a suggestion that has been met with significant pushback.

Business Unity South Africa (BUSA) CEO Cas Coovadia said the organisation was willing to engage with the government on NHI but did not consider a roadshow the right way to do it.

“While we have indicated that we will look at going to court to contest the constitutionality of the act, we are still committed to engaging if such engagement is structured and if the engagement is serious,” he said.

“A roadshow is not engagement: engagement is sitting down and looking at what the issues are in the Act, whether we can reach agreement on those and how we can move forward.”

The Bill has faced a myriad of challenges over the last few months, with a number of parties expressing strong opposition against the legislation. 

This includes local health insurers, who say the proposed funding model won’t work.

A report from Momentum Health Solutions warned that it would cost more than R1.3 trillion per year for the NHI to provide each South African with the same quality of care as received under the private health system. 

Momentum Health chief marketing officer Damian McHugh showed that even when cost savings and other revenue measures are taken into account, the scheme would cost the country at least R900 billion per year.

In light of this report, DA Spokesperson on Health Michele Clarke said that in its current envisaged form, the NHI will not give universal healthcare to all and can bring a collapse of South Africa’s healthcare sector. 

The pro-business party, which formerly led the opposition, has now joined the ANC in government, further complicating the Bill’s implementation.

DA leader John Steenhuisen said last month that the NHI continued to be a sticking point for the coalition government and that discussions on it would continue.

The NHI has also faced legal opposition, with several parties threatening to challenge the legislation in court.

For example, trade union Solidarity filed court papers shortly after the Bill was signed, seeking to overturn the NHI. 

“Solidarity believes the NHI is unconstitutional as well as being unworkable and unaffordable,” the labour union said.

The union recently achieved a major breakthrough in its fight against NHI when a core pillar on which the state’s centralisation of health care rests was declared unconstitutional in the Supreme Court.

“Even if the Constitutional Court elects not to intervene at this stage, further objections may be brought in time as the NHI Act begins to be implemented in its various stages,” Cliffe Dekker Hofmeyr’s joint heads of the Healthcare and Pharmaceuticals sector, Susan Meyer and Roxanna Valayathum, said.

Motsoaledi explained that the Bill would be implemented in phases over the next few years and acknowledged that legal challenges could delay its roll-out.