26 MAY 2023
The National Health Insurance (NHI) Bill is at the centre of debates and concerns raised by all healthcare stakeholders, including the South African Medical Association (SAMA). It has been stated many times that the implementation of the NHI Fund alone is insufficient to embody the principle of universal health coverage (UHC) as enshrined in the South African Constitution and thus while SAMA supports the principle of UHC it does not support the Bill in its current form. This statement is not a detailed critique of the Bill but general comments based on recent engagements the SAMA Board has had with the NHI Directorate.
The NHI Bill has been developed with disregard to the legitimate concerns and recommendations of experts, particularly on critical issues such as the introduction of Contracting Units for Primary Healthcare (CUPS), Benefit Packages and Reimbursement Models, amongst others. Accordingly, there are significant concerns with regard to the provision of healthcare services to patients in the country should the Bill be taken forward.
Trust in the government's capability to manage the over R500bln budget efficiently is severely eroded in particular given inter alia the mismanagement of COVID-19 funds. Misappropriation of funds in various state-owned entities casts doubt on government’s ability to handle the healthcare budget responsibly. The public, alongside healthcare stakeholders cannot simply entrust their lives to a government with an established history of financial mismanagement.
While UHC as envisaged in the objectives of the Bill intends to improve the health and livelihoods of the citizens of South Africa, the NHI Bill, in its current form sets up the healthcare system for failure at the expense of further deterioration of the health and wellbeing of all who live in the country.
SAMA believes that a robust approach to health systems strengthening is indispensable, as it would rectify the current deficiencies and overcome the challenges posed by the NHI. This approach seeks to enhance the efficiency, effectiveness, and resilience of the healthcare system, ensuring the delivery of optimal care to all individuals. Governance within the healthcare sector must be strengthened, with transparency and accountability at its core. Effective management of funds and meticulous budget allocation is imperative to rebuild trust and demonstrate responsible stewardship of public resources.