As the countdown to the signing of the highly contentious National Health Insurance (NHI) Bill gets under way, civil society organisations are gearing up for the fight of a lifetime to protect the country’s healthcare system from ruin.
Following the announcement that President Cyril Ramaphosa is expected to sign the NHI Bill into law on May 15, all in the hopes of transforming South Africa’s healthcare system and ensuring universal coverage for health services, a plethora of voices have come out to challenge this move.
Political party leaders, civil society organisations and industry leaders have in recent months pleaded with Ramaphosa, urging him to send the bill back to Parliament for further stakeholder engagement, however, those pleas appear to have come to nought.
The South African Medical Association’s (Sama) CEO, Dr Mzulungile Nodikida, said the association had said it could not support the NHI Bill in its current form as it failed to adequately address the critical socio-economic imbalances and inequities of the past that continued to plague the country’s health system and the limited access to healthcare experienced by most of the population.
Nodikida said while the intention behind the bill to transform South Africa’s healthcare system and ensure universal coverage for health services was commendable, the implementation strategy outlined lacked the necessary depth and practicality required to achieve meaningful and sustainable change.
“South Africa’s healthcare system is not ready for the NHI as it is currently articulated in the bill because the funding mechanism is flawed in its heavy reliance on general tax revenue, payroll tax, surcharges on personal income, and in particular, the potential financial hardships for poor and middle-class citizens due to the country's economic challenges,” he said.
“There are further systems and structural challenges such as ethical governance and leadership, poor human resource allocation resulting in understaffing, limited funding for vacancies and other resources, and poor infrastructure in public healthcare facilities in general.”
However, in light of the decision to forge ahead with the bill, Nodikida vowed that the association was prepared to fight for the protection of South Africa’s healthcare services in court – their legal team already preparing to launch a challenge.
Civil Rights organisation AfriForum has also signalled its intention to stop the implementation of NHI by not only bringing an application against the implementation, but also by suing the government for the unimaginable damage that bill stood to cause to South Africans’ well-being.
According to the organisation, their challenge will focus on the fact that there was no reasonable expectation that the bill would succeed in promoting access to healthcare, that it gives excessive power to the health minister and stands to infringe on health workers' right to freely exercise their profession.
AfriForum will also be challenging the lack of clarity and comprehensibility in the law, and that the fundamental rights of patients’ autonomy to be able to decide for themselves about the choice of the best treatment would be compromised.
“AfriForum is not opposed to reasonable measures to improve the existing health care for all citizens in South Africa but is opposed to this irrational way of achieving it and especially where it will encroach on private healthcare and where quality healthcare is still offered,” so said AfriForum campaign officer Louis Boshoff.
“Ramaphosa’s decision is based on 100% politics, 0% health and 0% common sense. NHI needs a hundred times as much money to function as was allocated to it in the Budget and yet Ramaphosa decided to hastily ratify it two weeks before the election. This is clearly just the next step in the ANC’s election campaign.”
Trade Union Solidarity’s Dr Dirk Hermann said the union had, on the eve of this signing, sent a letter of demand to Ramaphosa, warning him that it would fight the bill at every level should he proceed with signing it.
Hermann said the union had warned him (Ramaphosa) that it would ask the court to make an order as to costs in the personal capacities of the president as well as the Minister of Health, Dr Joe Phaahla.
“If the president signs the NHI Bill knowing that it contains substantial flaws, he is certainly also responsible for the consequences thereof, because the reality is this piece of legislation will be detrimental to all South Africans. The bill is populist, irrational and unaffordable; and to put the entire country’s health at risk for the sake of votes is extremely reckless,” said Hermann.
The Star