IRR cautions against the implementation of NHI Bill

26 May 2023

The approval of the National Health Insurance (NHI) Bill by Parliament’s Portfolio Committee on Health is deeply concerning.

The government spends billions on public healthcare each year, but, despite the best efforts of many dedicated professionals in the sector, the country gets little “bang” for its substantial “buck”.

Instead, public healthcare is plagued by poor management, gross inefficiency, persistent wastefulness, and often corrupt spending.

Minister of Health Joe Phaahla admitted as much during the Presidential Health Summit earlier this month when he said: “Many of our public health facilities could perform better if it was not for inefficiency, poor management, neglect of duty due to poor supervision, and unfortunately even outright corruption.”

Yet, the NHI Bill makes no attempt to remedy these defects. It assumes that throwing more resources at the public sector will provide a cure-all, whereas poor skills, cadre deployment, and a crippling lack of accountability lie at the heart of the malaise and need urgently to be overcome.

Many South Africans cannot afford to pay for services in the private healthcare sector. But that does not mean that the proposed NHI is the best path forward, either in terms of fiscal responsibility or of delivering better outcomes for more people. Given the record of corruption during the period of state capture and the Covid pandemic, it is also prudent to ask whether enough – indeed, whether anything – has been done in terms of policy reform and government transparency to reassure the country that the NHI would not be abused.

Much could be done to reform both the public and private healthcare sectors. To monopolise the management of all healthcare in the hands of the state, as the NHI would effectively do, is no solution. At least, not if the goal is to improve healthcare outcomes.

South Africa needs to be innovative in aiming at providing quality healthcare for all, but disabling excellence in the private healthcare system will not match that goal.

Said IRR Campaign Manager Mlondi Mdluli: “The IRR remains resolute in opposing the implementation of the Bill. South Africa’s growth fundamentals, from education to gross fixed capital formation, are pointing downward – the consequence of anti-growth, anti-business policies. Social compacts and promises are no longer enough. Furthermore, the focus should now go beyond just getting ‘implementation’ right. Policies and ideas that are fundamentally flawed from the outset will deliver negative outcomes no matter how well they are implemented, or who happens to be tasked with implementing them.”

Issued by Mlondi Mdluli, IRR Campaign Manager, 26 May 2023