South African Medical Association




07 December 2023

Introduction T- he South African Medical Association (SAMA) reaffirms its commitment to the principles of Universal Health Coverage (UHC), recognising the importance of equitable, accessible, affordable, and quality healthcare for all South Africans. As a non-statutory professional association representing nearly 13,000 medical doctors across various disciplines in both the public and private sectors, SAMA plays a crucial role in advocating for the health of the nation.
Support for Universal Health Coverage (UHC) - SAMA unequivocally supports the goal of achieving Universal Health Coverage, as defined by the World Health Organization. We believe that every citizen should have access to essential healthcare services without facing financial hardships. Universal Health Coverage is not only a matter of public health but is also essential for addressing social justice concerns and historical disparities.
Cautionary Notes on the NHI Bill - While SAMA supports the broader objective of the National Health Insurance (NHI) Bill as a means to achieve UHC, we must express our concern regarding several critical aspects of the current legislation. The NHI Bill B 11B—2019, recently passed by the National Council of Provinces, requires extensive revisions to ensure its effectiveness in facilitating sustainable financing for universal health coverage in South Africa.
Unintended Limited Access to Healthcare - While acknowledging the noble intentions of the National Health Insurance (NHI) Bill, SAMA expresses grave concern regarding certain provisions that may inadvertently limit access to healthcare for the population. It is crucial to highlight the potential ramifications of these aspects, which, if not addressed, could undermine the very essence of UHC. (Clauses 4;41; and 38).
Readiness of the Healthcare System - SAMA emphasises that the current state of the healthcare system is not adequately prepared for the implementation of the NHI. The Office of Healthcare Standards and Compliance (OHSC) report indicates significant compliance challenges in public healthcare facilities, highlighting issues such as understaffing, limited resources, poor leadership/management, and poor infrastructure. The readiness of healthcare facilities, both public and private, is a critical factor for the successful implementation of the NHI.
The Impact of Exclusion of Healthcare Workers in the Development of the NHI - SAMA notes with concern the exclusion of medical doctors and other healthcare professionals from significant contributions to the practical aspects of the NHI Bill. The absence of their input in decision- making processes, including the composition of the NHI Board, poses a risk of a healthcare workforce exodus. In order to ensure the success of the NHI, it is imperative to include healthcare professionals in all relevant boards and decision-making processes.
The exclusion of healthcare practitioners, particularly medical doctors, from significant contributions to the practical aspects of the NHI Bill poses a dual challenge. Not only does it risk a potential exodus of healthcare professionals, but it also limits the co-creation of the healthcare system. SAMA underscores the importance of including healthcare professionals in decision-making processes to ensure the practicality and sustainability of the proposed healthcare reforms, while also preserving the clinical autonomy of medical professionals.
Financial Hardships for the Poor and Middle Class - One of the primary concerns lies in the chief source of income proposed by the NHI Bill. SAMA cautions that the current funding mechanism, relying heavily on general tax revenue, payroll tax, and surcharges on personal income tax, may lead to financial hardships, particularly for the poor and middle-class citizens. The small tax base and existing economic challenges in South Africa may limit the affordability of the proposed funding model. (Clauses 48 and 49).
SAMA's Commitment to Correction and Improvement - In response to the identified concerns, SAMA reiterates its willingness to work with all stakeholders, including the government, to improve the NHI Bill. We commit to participating in the correction of errors within the bill and influencing progressive regulations that support its implementation. Ethical considerations, transparency in price determination, and comprehensive healthcare service benefits are among the key areas where SAMA will actively contribute.
a. Investment in the public healthcare system to render private healthcare purely optional.
b. Strengthen private-public partnerships in healthcare to improve the financial sustainability of public hospitals and clinics.
c. Implementing a human resource for health policy that promotes the retention and upskilling of the healthcare workforce.
d. Inclusion of healthcare workers of all categories in all boards and decision-making processes
e. Invest in socio-economic development programs to promote healthy and disease preventative behaviour.
f. Redaction of clauses that determine how healthcare will be delivered and appropriately transferring their consideration into the National Health Act of 2013, as amended.
Conclusion - SAMA acknowledges the importance of the NHI Bill in advancing South Africa towards Universal Health Coverage. However, it is our responsibility to caution the public and the government about the need for extensive revisions to ensure the bill's success. S
AMA stands ready to collaborate with all stakeholders to address the identified challenges and work towards a healthcare system that truly meets the needs of all South Africans.

Dr M Mzukwa - SAMA Chairperson                    
Dr RE Ngwenya - SAMA Vice-Chairperson

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The South African Medical Association - Postal Address-The South African Medical Association P O Box 74789,Lynnwood Ridge Pretoria 0040, South Africa Physical address The South African Medical Association, Block F Castle Walk Corporate Park Nossob Street Erasmuskloof Ext3 Pretoria 0181,
South Africa

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