The SA government is fighting a “big war” against those opposing National Health Insurance (NHI), health minister Aaron Motsoaledi told world leaders at the World Economic Forum’s meeting on Wednesday.
NHI is the ANC’s fiercely contested plan for achieving universal health coverage and aims to ensure all eligible patients are provided with care that is free at the point of delivery. One of its most controversial proposals, contained in the National Health Insurance Act signed into law by President Cyril Ramaphosa last year, is that medical schemes will be restricted to only covering conditions that are not provided under NHI.
Three legal challenges to the act are already in play — two lodged by organisations representing medical schemes and healthcare professionals, and another by trade union federation Solidarity. It represents one of the biggest points of contention within the government of national unity.
Motsoaledi, a panelist at the “Health beyond healthcare” session, was responding to a question from Helen Clark, former prime minister of New Zealand, about what he sees as critical actions needed to improve health systems and ensure more equitable outcomes.
“It [the NHI] is a big war. There are already three court cases to stop it by big business, right-wing organisations, even, unfortunately, doctors’ groups who are saying we don’t want this universal coverage of yours,” he said.
Universal health coverage based on primary healthcare was SA’s “number one priority” under the Group of 20 presidency, he said.
“We are running two healthcare systems in my country: one is as good as you can find anywhere in Europe. The second is not equipped in terms of human resources and everything else,” he said.
SA had one of the world’s most inequitable health systems, he said. “I’m not exaggerating, our gross inequality is worse than in any country around the world when it comes to healthcare, our Gini coefficient is the highest and keeps on growing.
“The amount of money we’re spending on healthcare, not many countries can reach that. But 51% of it goes to only 14% of the population and the remaining 49% has to serve 86% of the population. I don’t think any other country on the globe can be described in those terms.”
The only way to change this, Motsoaledi told the panel, was universal health coverage — “to come with equity in healthcare and divide this money in an equitable manner”.
The panel also discussed the rising tide of communicable diseases, illnesses that can spread from one person to another, such as the flu, HIV, tuberculosis and Covid-19. In the past, these diseases were the biggest health challenges facing most countries.
Noncommunicable diseases are chronic diseases that do not spread from person to person and include conditions such as diabetes and cancer. The risk of many noncommunicable diseases is increased by lifestyle factors such as poor diet, lack of exercise and smoking.
We want less smoking. Much, much less smoking in the country, if possible, zero smoking if we could ever reach that.
— Aaron Motsoaledi, health minister
“We’re already looking ahead because we’re scared,” Motsoaledi said, noting the world was facing an “epidemiological switch” from communicable to noncommunicable diseases.
“Countries in the north have already entered that long ago. Many countries in the south are still at the level of communicable diseases. SA is in the middle, but about to switch over.”
The government had introduced a variety of measures to combat noncommunicable diseases, such as regulations to limit the salt content of processed food and reduce the sugar content of sweet drinks, he said.
“People believe we want their money. We don’t; we just want them to eat less sugar, and that’s why there is a tax.”
The health department had also moved to strengthen SA’s anti-tobacco legislation, he said, referring to the draft Tobacco Products and Electronic Delivery Systems Control Bill, now before parliament.
“We want less smoking. Much, much less smoking in the country, if possible zero smoking, if we could ever reach that,” he said.
With Tamar Kahn
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.