The health department has defended the governance structure for the National Health Insurance (NHI) fund proposed in draft legislation currently before parliament, despite the extensive critique levelled against it during recent public hearings.
Parliament’s portfolio committee on health is currently considering the NHI Bill, the first piece of enabling legislation for the government’s ambitions for universal health coverage. The government’s NHI policy proposes sweeping reforms that aim to ensure everyone can access healthcare services that are free at the point of delivery, and are based on social solidarity principles in which the rich subsidise the poor, the healthy and the sick.
The bill was introduced to parliament more than two years ago, in August 2019. The committee has since conducted public hearings in all the provinces, received extensive written submissions and concluded oral submissions on the bill in February. The health department responded to some of the criticisms levelled against the bill on Tuesday, including concerns expressed about the proposed governance arrangements for the NHI Fund, which will purchase healthcare services from accredited public and private sector providers. Critics say too much power is accorded to the health minister to make key appointments, including board members and the CEO, leaving it vulnerable to corruption.
The governance arrangements for the fund have received heightened scrutiny in the wake of recent corruption scandals in the health sector. These include rigged Covid-19 tenders for the purchase of personal protective equipment and the Digital Vibes communication scandal, which cost former health minister Zweli Mkhize his job.
The department’s deputy director-general for NHI, Nicholas Crisp, defended the bill’s governance arrangements, saying the constitution accorded the minister of health executive responsibility for health in SA. The minister should therefore have the power to make key appointments to the NHI fund, just as the minister did for statutory bodies such as the Council for Medical Schemes and the Health Professionals Council of SA.
“The NHI fund will also be accountable to parliament, but this does not imply that the role of the minister in exercising oversight over the NHI fund must be diluted or removed,” he said.
The governance proposals were the most problematic element of the NHI Bill, said Sasha Stevenson, head of health at public-interest law organisation Section 27.
“The approach of the health department is really regrettable, particularly given the alternative governance options proposed by various stakeholders,” she said. Section 27 said in its submission on the bill that it failed to provide adequate checks and balances for the exercise of power.
Crisp emphasised the government’s intention to prohibit medical schemes from offering services provided by NHI. Further details would be provided in regulations, he said.
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