NHI under siege

Business lobbies and medical organisations have criticized the government’s approach to implementing its National Health Insurance (NHI) plan. They called it deeply concerning and unworkable.

Business Unity South Africa (BUSA) recently said it is deeply concerned about the inappropriate rhetoric directed at those who have raised legitimate concerns regarding the NHI Act in its current form.  

This comes after Health Minister Aaron Motsoaledi compared current coverage and criticism of the NHI to the “swart gevaar” scare tactic that was used under Apartheid.

Motsoaledi made these comments at the 82nd International Pharmaceutical Federation Congress in Cape Town.

He said that in trying to access the right to healthcare, “even the best-designed health policies and initiatives will struggle to meet their objectives in the absence of adequate healthcare financing strategy”.

This is where Universal Health Coverage comes in. However, in South Africa, “this has raised fire and fury by those who wrongly believe that the elevation of others is automatically a downfall of fortunes for those who have already arrived”.

Motsoaledi said the negative rhetoric around the NHI would spark memories for older South Africans who have seen this strategy – the ‘swart gevaar’ rhetoric – during the Apartheid era.

“It was used to scare those who are clamouring for freedom, never even to think about it because it was going to bring terrible things to them,” the minister said.

“The same strategy is being deployed today… the screaming headlines are designed to scare people off and make them angry about this NHI.”

However, BUSA CEO Cas Coovadia rebutted this claim, saying that concerns raised about the NHI are not only legitimate but appropriate.

He said it is the responsible and necessary course of action to ensure “the path that we choose as a country is both viable and sustainable”.  

“BUSA has never wavered from its genuine commitment to healthcare reform and our country’s objective of achieving universal health coverage,” Coovadia said.

“Our primary objective, in conjunction with government and other stakeholders, is to ensure that everyone in South Africa has access to quality healthcare and that the inequalities across the healthcare system are addressed in a responsible and expedited manner.”  

“This is not only a social necessity but also essential to driving the economic growth our country so desperately needs.”

BUSA has frequently and across every legislative forum made constructive proposals on how the country can do this without negatively impacting our economy, healthcare system and fiscal stability.  

“We have also been extremely clear in our position that the NHI, as is envisioned in the Act, is unaffordable, unimplementable and unconstitutional, and therefore requires urgent amendment,” Coovadia said.

“We are disappointed that despite commitments by the government to engage on the NHI Act, structured discussions have not yet taken place.”  

“It is only through formal, constructive engagement with the President, Minister of Health and National Treasury, focused on collaboration rather than division, that we will create a healthcare system that is equitable, effective and sustainable for generations to come.”  

He added that BUSA remains ready to participate in meaningful dialogue with the government. 

BUSA has not been alone in its criticism of the government’s NHI scheme in its current form.

Despite substantial opposition, the government recently signed the second Presidential Health Compact on Thursday, 22 August.

The Health Compact is President Cyril Ramaphosa’s attempt to get the government, businesses, and healthcare professionals to support the implementation of NHI in its current form. 

However, several business lobbies spoke out against the compact and announced their decision not to sign it.

The South African Health Professionals Collaboration (SAHPC), which represents over 25,000 dedicated private and public sector healthcare workers – said it would not sign the compact.

The SAHPC acknowledged that health reforms are necessary to address the challenges in the country’s healthcare system.

However, it believes the compact’s writing is fundamentally biased toward solidifying support for the NHI Act as the sole solution to achieving universal health coverage.

“The compact heavily focuses on the NHI, presenting it as the only viable option for the country, which we don’t accept,” said SAHPC spokesperson Simon Strachan.

“Health professionals, including general practitioners, specialists, dentists, and allied workers, are the cornerstone of health provision in this country. Our primary concern is, and always will be, the well-being of patients.

“We do not believe the NHI is a viable or workable model for universal health coverage. Our numerous proposals and concerns have not been acknowledged.”