An NHI for the people is important and possible

An NHI for the people is important and possible

Minister Zweli Mkhize has presented the National Health Insurance (NHI) bill to parliament. The NHI is “ The National Health Insurance (NHI) is a health care financing system that is designed to pool funds to actively purchase and provide -access to quality, affordable personal healthcare services for all South Africans based on their health needs, irrespective of their socioeconomic status.” [1] 

It has been met with a lot of mixed negative reactions from medical aids and groups like Afriforum. Our reality is that every day, the majority of South Africans can’t access proper health services. 

Long waiting times, stock-outs of critical medication, shortages of equipment and staff are often the norm at clinics and hospitals.  And going to a private doctor or hospital is too expensive and does not guarantee quality care. A report by the competition commission has shown that even though you pay more for private healthcare, the service is less than satisfactory, and is run by greedy profit maximising monopolies [2]. 

If done well, the NHI could be an important step towards ensuring quality healthcare for all by availing doctors to clinics and primary health care sites, as well as providing community health workers. It is not without faults, as seen in the pilot sites, this is why it is important to add your voice to shaping it to best represent the health needs of a majority of South Africans. 

The NHI could mean an end to the impossible decision the majority of South Africans have to make, whether to put food on the table or get efficient healthcare.

The NHI must not be captured by medical aids or greedy capital. At the core of their disapproval, there seems to exist a dislike of accessing the same services as poor people. The government must also improve their ability to implement services, free from corruption or patronage, to make sure that their failures do not capture the NHI. 

Minister Zweli Mkhize must take into account that 84% of people living without medical aid have less data, time and money to do public submissions, even though they are the most affected by the NHI. 

The NHI bill is necessary,  must serve poor majority and these are some of the things it must include to do that:

  • A single-payer system with mandatory pre-payment:

The wealthy must pay their fair share and we must put an end to medical aids and private companies profiteering. A single-payer system with mandatory pre-payment will help achieve this by pooling all funds into a central fund from which all health services will be purchased and paid, to meet defined health goals. Mandatory pre-payment forces everyone to pay their fair share into this central fund. The majority of wealth in Mzansi was built on the exploitation of our land and people, so the wealthy should not be able to opt-out when it’s convenient. The government must increase the personal income tax and the corporate income tax. We the people had to shoulder a VAT hike.

  • Significant measures to stop corruption, increase accountability and stop capture

Inequality and corruption are linked, and in SA corruption is both a feature of the private and public sector. Austerity and conservative economic policies are not going to reduce inequality, but progressive ideas such as the NHI could reduce inequality. 

But this will only be achieved if the NHI fund is accountable and can’t be captured by either the public or private sector. Measures such as regulation can ensure the accreditation of service providers. The accreditation process needs to be in line with the NHI’s goal to serve people, and give satisfactory health services to shown health needs. Civil society must have enough mechanisms and representation to stop the NHI fund from being captured by greedy companies, fat cats, corrupt politicians or unaccountable bureaucrats. 

  • Bridging the two-tier health system

We support the removal of a two-tier health system that makes other people enjoy better health services than others. Also, support the NHI fund paying health facilities directly for services so there are no provincial or other middlemen to act as health service buyers. The government must table a plan of how it will fix current health facilities to make sure that they are equipped and able to handle the health demands of the population. The NHI must improve our public health sector through more resources, but also the National Core Standards and Ideal Clinic Programme.

  • The rural/urban health divide

Where you live should not affect the quality of your health services. The NHI must end the rural/urban health divide. Rural health services should, in fact, receive a major increase in funding.

  • No one is illegal

We support that the NHI makes provision for asylum seekers and immigrants receiving basic primary health care. It, however, leaves them vulnerable in the face of serious health complications, as well as being vague on undocumented immigrants. South Africa must not carry Xenophobic policies, and it is important that the NHI is not seen as another tool used to leave migrants vulnerable and in danger.

  • Prevention is better than cure

Implement Front of Pack Labeling and increase the Health Promotion Levy to 20% and expand it to cover all unhealthy drinks and food. Pass the Tobacco Control Bill now will reduce the burden on our health system and budget. This will make the NHI more financially viable

  • Increasing specialists and community health workers

We need more community health workers. Community Health Workers should be a key part of the NHI and where its funds go. A majority of specialists currently work in the private sector, and with the NHI there is a possibility to have access to a wider variety of specialists as the divide between the private and public health sector is diminished. I support that everyone will now have access to a wider variety of specialists as the divide between the private and public health sector is diminished.

  • Regulate the private health sector

With the recent report by the competition commission[3] showing the greedy monopoly existing in the private sector and its inflation of prices that robs patients of just care; it is important that the private sector is given stricter regulations. Access to services in the private sector for the rest of the population via the NHI must not be seen as championing the private sector as the superior alternative. This includes the pharmaceutical industry.



[2] You're paying more for private healthcare and getting less, Competition Commission investigation reveals, Laura Lopez Gonzalez for Fin24, 30 September 2019

[3] To have or not to have the NHI, Louis Reynolds and David Sanders for people’s health movement South Africa, August 2019