How The State Shot Itself In The Foot

Rushing universal health coverage through the legislature threatens SA’s already teetering healthcare sector.

- Mariam Isa

South Africa is on course to launch its hotly debated National Health Insurance (NHI), an ambitious but controversial plan to bring free quality healthcare to all South Africans, by pooling the resources of the public and private sectors and establishing a single state entity to procure and pay for their services.

While there are no arguments against the ultimate goal of improving healthcare for the majority of South Africans in a deeply unequal society, there is widespread alarm at the sweeping reforms proposed in the NHI, which critics say could collapse the country’s entire health system.

An overriding concern is that there is huge scope for corruption in a monopolistic entity that will be run by political appointees, particularly as the existing public health sector has already become a hotbed of corruption, inefficiency and mismanagement.

The looting of money that was made available by government to purchase personal protective equipment (PPE) and other materials in response to Covid-19 has only reinforced those fears, and the government’s bid to identify and bring culprits to book have so far failed to restore public trust.

Many of the country’s top health professionals warn that the NHI overlooks – perhaps deliberately – the crisis in the public health system, which has deteriorated rapidly over the past decade.

They argue that the new entity will fail to achieve what is most important – rehabilitating public healthcare and regulating private healthcare, which is becoming increasingly unaffordable. Money paid to private medical aid schemes will be channelled into the NHI, threatening their survival.