COSATU Central Executive Committee calls on President Jacob Zuma to intervene and stop the attacks on NHI especially from inside government

25 May 2016

The Congress of South African Trade Union’s Central Executive Committee is deeply concerned that National Health Insurance is departing from the framework that was developed by the Alliance ,through the ANC Education and Health Subcommittee, Alliance Summits, and the 2009 and 2014 manifestos.

The CEC is calling on the  country’s, president, Cde Jacob Zuma to intervene and take the lead in the implementation NHI ,because this is one of those projects he must leave behind as his legacy for the working class.

There is an urgent need to arrest this deterioration and the deviation from the initial conceptual framework that the NHI was founded on. The NHI is under sustained threat inside the government, mainly from the Treasury and vested interests at provincial government level. There are also outside threats coming from the four private hospital monopolies, the Free Market Foundation and others, such as the foreign-funded NGOs.

The president cannot afford to sit on the sidelines and watch this ANC policy being watered down and handed over to big business interests by his own government departmets. The NHI is the only programme of the ANC government, since 1994 that proposes to radically redistribute resources on a mass scale to the poor, directly from the rich, ensuring access to all and also breaking down class differentiation in the quality of access.

We have not forgotten that the delay in the release of the White Paper was largely caused by persistent attempts on the part of the Treasury to undermine the NHI, as it favoured the continuation of the current fragmented multi-payer system, which excludes 84% of the population.

The federation feels that government is deliberately dropping the ball with regard to the NHI and there is a lack of commitment, clarity, consistency and decisiveness from responsible departments. We are deeply concerned that progressive people, who have been very key in driving the NHI are being sidelined by the department of Health and replaced by World Bank approved consultants. COSATU calls for the reinstatement of these officials and for government to stop allowing the NHI to be hijacked by business interests. 

The fact that the NHI was only allocated R4.5 billion over the next three years is a confirmation for us that the NHI remains under threat not only from private monopolies and other opponents, but also from the Treasury itself through austerity measures.

The CEC is concerned that last year the Treasury stated that the implementation of the NHI depends on economic growth. In April this year, the Treasury circulated some problematic and sceptical documents ,within government ,on obstacles that may allegedly make it impossible to implement the NHI. They pointed to the shifting of some functions from provinces to the NHI Fund and central hospitals to the national government. This move by Treasury was is intended to mobilise provinces against the NHI.

The government should remember that the ANC Manifesto that committed to providing the people of South Africa with universal healthcare through the NHI, received an overwhelming mandate of 62% in the 2014 elections. What is currently taking place goes against the ANC’s electoral mandate to pool all health resources into a single publicly administered NHI Fund.

We expect this fund to act as both the payer and purchaser that will help us realise universal health coverage, through cross-subsidisation of health risk and costs from the wealthy to the poor and from the healthy to the sick.

Currently, the cost of private health care in South Africa is ranked as the most expensive in the world, even higher than in the USA. In addition to the influence of the profit motive this is also caused by the structural issues in the absence of a public mechanism of setting tariffs or prices on private hospital groups.

When the Health Market Inquiry was launched ,under the auspices of the Competition Commission in 2013, the Minister of Health, Dr Aaron Motsoaledi, said that “the artificially high private health-care costs need to come down as one of the two major conditions necessary for the successful implementation of the NHI”. Basically, the inquiry ‘s mandate was to look at the pricing of private health care with the view to reduce the current extremely high costs that are caused by distortions or abuse of monopoly power.

COSATU is therefore concerned that in the revised terms of reference, the panel of the Health Market Inquiry have made it very clear that they are not going to look at breaking down the hospital group monopolies, which means that the status quo will remain. We are also troubled that the Health Market Inquiry is also considering coming up with a counter to the NHI in a form of a Social Health Insurance.

The CEC expects an urgent intervention from the president and the ANC and we are ready to mobilise South Africans if nothing changes. COSATU affiliates will be rolling out a campaign demanding the absorption of the community health workers into the public service. Most of these workers are highly exploited by various NGOs that are contracted to provincial governments and are used by government to substitute for the filling of vacant posts in the public health sector. We will fight against the imposition of austerity by Treasury as part of our campaign on the filling of vacant posts and the recruitment of more nurses and doctors to ensure the successful implementation of the NHI.

Currently many functions in the public health sector are outsourced, these include the ambulance services , security, catering, cleaning and others, which often leaves health institutions in bad conditions and unsafe for health workers and patients.

We call on COSATU members and health workers in general to play their role in improving services in our health facilities in preparation of the NHI implementation.  We also need government to ensure that Ketlaphela, the state pharmaceutical company is strengthened because the private pharmaceutical companies are too greedy ; and they cannot be relied upon to demonstrate any level of developmental consciousness. The CEC fully supports the COSATU public sector unions and is ready to push back against the offensive that is currently directed at them.

Issued by Sizwe Pamla, COSATU National Spokesperson, 25 May 2016