Policymakers cannot ignore our reality, and neither should Parliament. The ideal circumstances needed are unfortunately not our South African reality, and the National Health Insurance (NHI) Bill is not the appropriate vehicle to achieve universal care in any case.
Despite our context being painfully apparent, the NHI Bill has recently been pushed through Parliament’s National Council of Provinces (Ncop) without a single amendment. That the Bill was passed in this manner, even though it attracted fierce opposition and public critiques, unfortunately points to a legislative process which has been wholly deficient given the grave consequences that the legislation heralds for the country.
The NHI’s pilot projects, which ran between 2012 and 2017, were meant to lay the foundations for its implementation. They are widely regarded as having failed. A report released after the programme further highlights serious governance issues: clinics which couldn’t connect to the internet because of myriad challenges including a lack of IT staff; a lack of planning and funds to complete new infrastructure; the deterioration of infrastructure due to a lack of maintenance.
Read more in Daily Maverick: NCOP passes NHI Bill in face of widespread condemnation by health professionals, business and opposition
These are just some of the issues highlighted in the districts which were purposefully receiving attention to improve outcomes. In a painful irony, the report could not conclusively say whether the pilot’s initiatives had improved overall health outcomes, because of data quality challenges. Yet, a government which was unable to measure the success or failure of its own costly NHI pilot has now pushed ahead with the policy’s implementation.
In this context, far from achieving universal healthcare, it is widely believed the Bill’s enactment will plunge our country’s healthcare system into disarray. From setting prices for health services, determining patient medical choices and managing the purchase of medicines, to deciding which doctors can contract with the Fund, the NHI envisages the state playing the central role in the whole sector. In a country with rolling blackouts, water infrastructure collapse, and crumbling roads, rail and ports, it is clear that the NHI Bill’s implementation would signal a death knell to the health services — both public and private.
Financial and social disaster
The foreseeable consequence of this debacle will be massive disinvestment in the sector at a point when there is no scope for government investment to make up the shortfall. So rather than ensuring access for those who have not been able to receive quality healthcare, the only universality this Bill will achieve is adding the remainder of South Africans to the ranks of those receiving inadequate care.
This would also have a severe economic impact, including knock-on effects like the deterioration of the health of South Africa’s workforce. We can also expect an attendant skills exodus from the country as doctors, nurses, and other medical professionals emigrate in search of systems where they can help their patients. Ultimately, those who can will likely leave the country in droves in search of quality health care. This will decimate tax collection and leave South Africa contending with an even bigger skills deficit.
As worrying as its impact on health outcomes is, the fact that the NHI may also be the tipping point for an already immensely financially stretched state should sound alarm bells across society — even without the NHI Bill, our country’s financial position is tenuous. Implementing it, with estimated costs being in the region of R400- to R700-billion per year (depending on who you ask), would finally break the back of our severely strained fiscus.
Years of massive bailouts of failing State-Owned Enterprises, paired with high public sector wages, high unemployment and low economic growth which have shrunk government revenue, have already meant serious government budget cuts being tabled for the coming financial year. It is a secret to no one, except seemingly those who have voted to pass the Bill, that South Africa is in no position to fund the NHI.
With the strong, well-reasoned objections to the Bill, the manner in which this Bill made its way through our Parliament should concern every South African. It appears the Bill has been passed at all costs. In fact, recent media reports have cited calls by political leaders urging members of Parliament to pass the Bill through the Ncop without delay, encouraging those with issues to use litigation later to address its defects. This is tantamount to an admission that the work of the houses of Parliament in this case is not to refine legislation nor to ensure it is fit for implementation and constitutionally sound, but rather to simply act as a rubber stamp.
Unfit for purpose
It is now vital that every part of society, from the private sector and civil society to individuals to recognise that the window of opportunity to raise objections at this final stage in the Bill’s legislative path, before its assent by the President, is very close to being shut. This is not the time to mince words or embark on various forms of ‘quiet diplomacy’.
That every person deserves access to healthcare is indisputable. But we won’t improve the outcomes of all South Africans by destroying those systems that do work to serve political ends. Rather, the emphasis should be on improving and expanding what is already working as opposed to collapsing existing healthcare services.
We must not conflate opposition to the NHI Bill with a lack of support for better healthcare for all in our country. It does not mean a lack of care for those who have been left behind by the current system. But to break what works in an attempt to fix what is broken is illogical and cannot replace the serious systemic governance overhaul that is really needed in the public health sector. DM
Kabelo Kgobisa-Ngcaba is the Chief Operations Officer at Resolve Communications.