From the desk of the President
24 February 2020
Dear Fellow South African,
The deliberations by Parliament on the National Health Insurance Bill are soon to enter a new phase as the Portfolio Committee on Health’s country-wide public hearings wrap up. These hearings, held in a number of places around the country, have shown that there is broad support for fundamental change in our health care system.
Participants have made a number of proposals and have spoken about their views on National Health Insurance (NHI), personal experiences of illness, trauma, disability and suffering – and the difficulties they have had in accessing health care when they need it.
It is these experiences that inform South Africa’s support for the global goal of universal health coverage. This goal has become a major aim for health reform in many countries and a priority objective of World Health Organization (WHO). It is instructive that WHO defines universal health coverage as a system that should ensure that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality while ensuring that the use of these services does not expose the user to financial hardship.
It is one of the greatest travesties of our time that access to decent and quality health care services is determined by one’s ability to pay.
South Africa has two parallel health care systems. Around R250 billion is spent annually on less than 20% of the population. This is the section of our population that has access to private medical insurance. On the other hand our country spendsR220 billion on rest of the population.
This flies in the face of the Constitutional right of access to health care for all citizens regardless of their socioeconomic circumstances. It is a situation that cannot continue. It is inefficient and unsustainable. It is unfair and unjust.
The introduction of National Health Insurance will be among the most far-reaching acts of social transformation this country has experienced since 1994. We have enough resources in this country to enable every man, woman and child to receive appropriate standardised quality health care.
Our past has taught us that we must never be a country that promotes the interests of the few at the expense of the majority. In 1713 the Dutch colonialists who had brought a smallpox epidemic to our shores imported medicines from Batavia to treat those affected. They used the medicine to treat their own, leaving the indigenous Khoisan to be decimated by the outbreak.
The segregation of health services brings back bitter memories. Back in the 18th Century it was on the basis of colonial settler status. Under apartheid it was on the basis of skin colour. Today it is on the basis of who can afford to pay.
The key fundamental principles underpinning NHI are equity, solidarity, the acceptance and recognition of the equal worth of every individual, as well as the right of everyone to receive the medical care they need cost effectively. This is something for which we must all fight.
The escalating cost of health care is affecting South Africans from all social strata where it hurts most – in their pockets. As the report of the Health Market Inquiry published last year has shown, even those who have private health insurance are buckling under the pressure of rising premiums and shrinking benefits. Out-of-pocket payments are on the increase, draining disposable incomes and making it even harder for many to make ends meet.
As a nation, a large share of our national expenditure goes to health care, yet there is a fundamental mismatch between what we spend and the health outcomes of our citizens. Just as we demand quality standards of health care for ourselves and our families, we should do the same for others. Just as we would not treat a relative or friend badly because they earn less than we do, we should care enough that they have equal access to treatment and care when they fall ill.
We must move away from a culture driven solely by self-interest and embrace the spirit of ubuntu, meaning solidarity. This is the vision of the NHI. It is the vision of our Constitution.
We cannot build a prosperous and economically thriving nation if a small minority of our workforce is healthy while the majority is vulnerable to ill-health and disease. In this respect, NHI is as much an economic issue as it is a fight for social justice.
I call on all South Africans to mobilise behind the National Health Insurance and to see it implemented. I call on NGOs, community organisations and civil society at large to rally around the NHI in the same way that they did in the fight against HIV/Aids.
I call on the National Department of Health to prepare adequately for the implementation of the NHI. This includes working with stakeholders to implement the Presidential Health Compact, ensuring that public health facilities have the personnel, medicines and equipment to provide the care that people need.
I call on the private sector to join government in seeing the NHI realised. To transform the health care landscape to make it more efficient, cost-effective and value for money requires that we forge strong public-private partnerships for the delivery of services. We remain committed to ensuring there is effective consultation and engagement with all sector partners at all stages of the process.
We will not be reckless in implementing the NHI. We will implement it in an incremental fashion and aim to cover the whole country by 2025. We will use an affordable approach to progressively move towards a comprehensive NHI environment.
I ask every citizen reading this to join us. It is in your interest that universal health care becomes a reality. It is in the interest of your family, your community and your children.
It is in the interests of a free, equal and prosperous future for all.
With best wishes,
Cyril Ramaphosa
