The implementation of the contentious National Health Insurance (NHI) Act is now the responsibility of President Cyril Ramaphosa’s ministerial advisory committee (MAC), with organised business remaining sceptical of the legislation.
Business Leadership SA CEO Busi Mavuso says there is still no clarity on how the NHI, which is the government’s plan for achieving universal health coverage, will be funded.
“Until that is clarified with feasible options, we cannot support this legislation,” Mavuso said.
A last-minute deal was struck between the ANC and the DA on the eve of Ramaphosa’s state of the nation address (Sona) on Thursday to amend sections of the legislation and to allow for the protection the private healthcare sector in the rollout of NHI. This deal also ensures that the NHI does not feature in the medium-term development plan (MTDP), which is the government’s growth blueprint until 2029.
The yet to be established MAC will comprise government officials and cabinet ministers, and is also likely to have representatives from private medical scheme providers, said planning, monitoring and evaluation minister Maropene Ramokgopa.
“This matter [NHI implementation] belongs to the MAC, where everything else will be thrashed out including how the medical aids will feature and how other benefits of the NHI will be handled,” Ramokgopa said shortly after Ramaphosa’s Sona.
The NHI aims to ensure everyone has access to quality services that are free at the point of delivery, regardless of their socioeconomic status. It aims to scrap the current health system, which sees those who can afford medical scheme cover accessing costly but generally high-quality services in the private sector. The majority of the population, meanwhile, depends on largely free but uneven services provided by public hospitals and clinics.
“This year, we will proceed with the preparatory work for the establishment of NHI. This includes developing the first phase of a single electronic health record, preparatory work to establish ministerial advisory committees on health technologies and healthcare benefits, and an accreditation framework for health service providers,” Ramaphosa said in his Sona.
“It should be noted that in his speech, the president referred to preparatory work for the NHI and not its imminent implementation. Considering this, it is unlikely that the Treasury will make room for the NHI in its February budget,” the Bureau for Economic Research (BER) says.
Ramaphosa’s address highlighted other key economic reforms and reaffirmed SA’s international relations policy stance in response to the diplomatic fallout with Rwanda over the conflict in Democratic Republic of Congo focused on key economic and governance reforms while indirectly reaffirming SA’s sovereignty in response to US President Donald Trump’s recent comments.
Key to the growth plan is the R100bn infrastructure fund, which will pool financing from local and international financial institutions and investors.
“A project preparation bid window has been launched to fast track investment readiness. This includes revised regulations for public private partnerships, which will unlock private sector expertise and funds. Government will spend more than R940bn on infrastructure over the next three years,” Ramaphosa said.
Political parties remain divided over Ramaphosa’s address, which also focused on the need to deal with the water crisis and a new funding model for local government, with official opposition the MK party rejecting the address. EFF leader Julius Malema said Ramaphosa failed to account for his previous Sona commitments.
GNU partners have rallied around the president’s calls to protect SA’s sovereignty following Trump’s comments.
DA leader John Steenhuisen called for a diplomatic solution to the matter while Rise Mzansi’s national organiser, Makashule Gana, said Trump’s comments stemmed from fear mongering and misinformation.
“They are strategically important for us but we are also strategically important. From a minerals perspective but also from our position in Africa and I think it’s important that we repair those relationships as quickly as possible.”
“In so far as what has been coming out from the [US], I must say that this is a result of all this fear mongering and misinformation that has been peddled by those who are against the democratic Republic of SA,” Gana said.
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