MIXED reactions have been expressed over the National Health Insurance (NHI) Bill which President Cyril Ramaphosa signed into law on Wednesday.
Signing the bill, Ramaphosa emphasised the importance of the health plan in providing equal access to health-care services and addressing inequality.
According to the Health Department, NHI is South Africa’s strategy to achieve universal health coverage.
The NHI is a fund from which the government will buy health-care services from health-care providers both in the public and private sector.
Ramaphosa said It is aimed at making healthcare more affordable, by reducing the cost of healthcare for all.
The Health Department said NHI will act like a medical aid for everyone, and everyone will contribute to the fund through taxes and special contributions in line with what they can afford.
The department emphasised that it will ensure that everyone is entitled to free healthcare when they need it.
It said there would be no fees charged at the facility because the fund would cover the costs of care.
While there have been many voices opposing the enactment of the bill, the United Nations in South Africa welcomed the signing of the bill and said it considered it a significant milestone in the journey towards universal healthcare that leaves no one behind.
“In line with our Co-operation Framework and advocacy interventions with the government, the UN believes that the implementation of the NHI law stands as a beacon, guiding us towards the realisation of the Sustainable Development Goals, particularly Goal 3.8 which aims to achieve universal health coverage, including financial risk protection, access to quality essential health-care services for all, and promote health and well-being across all ages,” said Nelson Muffuh, the UN Resident Co-ordinator in South Africa.
Dr Fabian Ndenzako, Officer-In-Charge for WHO South Africa, said: “The signing of the NHI law reaffirmed South Africa's commitment to prioritise the health and well-being of its people.
“This has come in the wake of the country’s earlier endorsement of the most ambitious and comprehensive political declaration on health at the UN High-Level Meeting on Universal Health Coverage in September 2019 and again in September 2023.”
However, Momentum Metropolitan Health CMO Damian McHugh said the implementation of the bill would take some time.
He said implementation of the bill in its current format was not sustainable, and he expected the already documented challenges made by numerous stakeholders to become more vocal, particularly around the constitutionality of the bill.
Another key consideration he raised was that the country’s economy did not have the required funds to support the implementation of the bill.
He added that, based on these factors, the current private and public systems should collaborate to better utilise the experience and infrastructure of the private industry to augment the public offering.
According to McHugh, this will also ensure the country does not lose critical, experienced resources from its health economy.
“Critically, even though President Ramaphosa has signed the bill, the current status quo remains in effect, as the implementation of the bill will take some time.
“So, our message to our members and the wider South African community is to continue with your current health-care arrangements,” said McHugh.
Among other opposition parties opposing the bill, the EFF said the signed NHI Bill, presented as a solution to universal health coverage, was “misguided, disingenuous and opportunistic”.
“We warned that the bill ignores all systemic challenges facing public healthcare and is an admission that the ANC government has failed to build a national health system that is inclusive, free and which prioritises prevention, education and care. Instead, the ruling party, desperate to hold on to power by hook or by crook, has signed into law the outsourcing of healthcare to the private sector,” the EFF said.
The party said the most practical solutions to fixing public healthcare started with the de-commodification of healthcare, because healthcare could not be sold for profit and should be provided by the government as a public good.
“Secondly, South Africa’s public healthcare must shift its focus to primary healthcare and prioritise preventative measures instead of waiting for people to get sick and then treat them later at inflated costs that benefit private hospitals, not patients,” the party said.
Research and policy institute Freedom Foundation CEO, Leon Louw, said it was impossible to understand the bill’s intended outcomes, other than unprecedented incompetence, bureaucracy, waste and corruption.
Health Funders’ Association chairperson Craig Comrie said its members were “deeply disappointed” that the opportunity to review certain flawed sections of the NHI Bill had been missed.