Health minister Aaron Motsoaledi has published the first set of draft regulations for the National Health Insurance (NHI) Act, the ANC’s contested law for universal health coverage.
The NHI Act was signed into law by President Cyril Ramaphosa in May 2024 but it has yet to be brought into effect. Nevertheless, Motsoaledi has flighted draft regulations to section 55 of the act, setting out a plan for the governance structure and processes of the NHI Fund. Under NHI the government-controlled fund will the sole purchaser of healthcare services, which are to be provided free at the point of delivery to eligible patients.
The draft regulations were published in the Government Gazette on Thursday and interested parties have three months to comment.
As was widely anticipated, all key appointments are to be overseen by the minister. While this is not unusual for government entities it was a point of contention when the NHI Bill was before parliament, with critics urging legislators to make the NHI Fund independent of the executive to shield it from political interference.
The draft regulations say the minister will issue a call for nominations to the board of the NHI Fund, each of whom must be nominated by at least five people. A nomination committee established by the health director-general will then draw up a shortlist of recommended candidates.
The shortlist will then be scrutinised by an ad hoc committee, comprising between four and eight members appointed by the minister and chaired by a retired judge. It will recommend its chosen candidates to the minister, who will then submit the names to the cabinet for approval. The ad hoc committee will be appointed for a term of up to four years.
Once the board has been appointed, it is to recruit a CEO subject to ministerial and cabinet approval.
The CEO will then recruit candidates, subject to approval by the ad hoc committee and the minister, for a benefits advisory committee and a healthcare benefits pricing committee. Each advisory committee is to have between 16 and 24 members and a chair appointed by the minister.
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