NHI:Ball now in Cyril’s court

Health Minister Joe Phaahla said the bill came a long way in transforming health services.

Health Minister Joe Phaahla said the bill came a long way in transforming health services.

Published Dec 7, 2023


In what Health Minister Joe Phaahla described as a historic day and achievement, the National Health Insurance (NHI) Bill passed another hurdle when the National Council of Provinces (NCOP)on Wednesday gave it the green light.

It now awaits the signature of President Cyril Ramaphosa to become law.

Provinces voted in support of the bill with the exception of the Western Cape “opposing the bill in strongest terms”.

“I, therefore, declare the bill agreed to in accordance with section 65 of the Constitution,” said NCOP chairperson Amos Masondo after the counting of votes.

Speaking during the debate prior to the vote, Phaahla said the bill came a long way in transforming health services.

“This is indeed a historic day and a historic achievement because here today we put in place into the statute a framework to create an opportunity we can really be able to transform the health services, create equality and make sure perpetual division in South Africa in the area of health comes to an end.

“Transformation of the health services has been part and parcel of our struggle for freedom,” he said.

Phaahla later told a press conference that the adoption of the bill marked an important milestone by the country to realise universal health coverage.

“Although there are still other processes to be followed before the NHI Bill is signed into the law, but as the Ministry of Health we are pleased with the progress made so far, especially the outcomes of today’s debate and voting process in the National Council of Provinces in favour of the NHI Bill,” he said.

Phaahla said significant strides have been made in advancing the necessary policy and legislative frameworks to support the implementation of NHI.

One of the key purposes of the bill is to establish an NHI Fund and to set out its powers, functions, and governance structures. The fund will purchase health-care services for all users registered with it. The bill seeks to ensure that South Africans will have the right to access comprehensive health-care services free of charge at the point of care at accredited health facilities, such as clinics, hospitals, and private health practitioners.

The NCOP’s decision received mixed reaction with some threatening legal action stating it was “fatal”.

Cosatu’s national spokesperson Matthew Parks said the federation remained convinced that South Africa’s myriad health-care crisis required the creation of the bill.

“Cosatu and the overwhelming majority of workers are in support of an NHI. It is a government policy and market failure that 29 years into democracy most South Africans, in particular the working class, lack access to quality and affordable health care.

“This is not due to lack of resources but to their blatantly skewed distribution.”

The South African Medical Association (Sama) representing nearly 13 000 medical doctors in both the public and private sectors said while it supports the broader objective of the bill they were concerned about several critical aspects of the current legislation which required extensive revisions to ensure its effectiveness in facilitating sustainable financing for universal health coverage in South Africa.

“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).

“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 middleclass 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),” said Sama chairperson Dr Mvuyisi Mzukwa.

Health Funders Association (HFA) said in adopting the bill in its current form, Parliament has failed to take proper cognisance of the implications for citizens’ constitutional rights, health care as a whole, and the South African economy.

Solidarity Research Institute’s (SRI) economic researcher Theuns du Buisson said should Ramaphosa fail to halt the bill, they will be heading to court.

“Solidarity is ready to launch a full-on assault against the NHI and is making an urgent appeal to the public to support its actions against this destructive scheme all along.

We have shown how the cost of the so-called ‘free health care’ will be recovered from South Africans as additional taxes, something that will no doubt ruin households financially. What the ANC promises cannot be executed, and Solidarity hopes as many people as possible will realise it,” Du Buisson said.

The DA and EFF were among the opposition parties that rejected the bill.

Cape Times