National Health Insurance (NHI) is destined to fail in SA. This is not undue pessimism, nor fear talking. It is a realistic view based on nearly 30 years of data and experience.
Not only is the current public health system woefully under-resourced in medical personnel, support personnel and equipment, but it also has to deal with unsafe and inadequate infrastructure. These are things the NHI must seek to address over time, though it must be noted that the previous administration has been unable to do so for nearly three decades.
The big flies in the ointment are what the department of health has willingly failed to address — ineptitude in management and corruption. It is this unwillingness or inability to address incompetence and capture that makes the meeting between the health minister and the National Treasury to discuss using Public Investment Corporation (PIC) money to fund public health infrastructure so worrying.
The PIC is meant to invest in projects that will give investors a return on investment — projects that make a profit. This is not something that applies to public health infrastructure. The government has been trying for years to access pension funds for vanity projects and bailing out state-owned enterprises (SOEs). To use the PIC to prop up the NHI in this way would be disastrous.
The recent exposé that the Independent Development Trust (IDT), acting as a project manager for the health department, has appointed Bulkeng to install highly technical pressure swing adsorption oxygen plants at 55 government hospitals at a cost of R428m — despite the company not having the required SA Health Products Regulatory Authority accreditation, and not having a joint venture partner in the bid submission — is just the latest scandal in a long line of corruption and mismanagement claims plaguing the public health system.
The auditor-general determined that the R122m agreement between Brainwave Projects and the State Information Technology Agency (Sita) to provide satellite internet connectivity at health facilities was in violation of the Sita Act and Public Finance Management Act.
Former health minister Zweli Mkhize and his family were linked to the R150m Digital Vibes scandal at the height of the Covid-19 pandemic, for which there has yet to be any consequence management for the masterminds, including Mkhize.
Whistle-blower murdered
The Special Investigating Unit (SIU) recently revealed in parliament that the special tribunal is considering 105 matters concerning the procurement of personal protective equipment fraud and corruption to the tune of more than R4.35bn.
Last year former health minister Joe Phaahla admitted that “no department within the health sector have blacklisted any company”. This would include the companies Babita Deokaran blew the whistle on at Tembisa Hospital — an act of bravery for which she was murdered.
The SIU found that Tembisa Hospital was infiltrated by three main syndicates that had a hand in everything from fraud and fronting, to collusion, money-laundering and funnelling of funds, corrupt payments to hospital officials, overpricing and splitting of orders, and the use of shell companies.
Tembisa Hospital is not the only bad apple in Gauteng. According to the health ombud the 10 most serious complaints it has investigated were all in that province. Yet the department’s consequence management regarding corruption and mismanagement is woefully inadequate at best and nonexistent in most cases.
Among the auditor-general’s repeat findings have been a failure by the health department’s leadership to exercise oversight responsibility regarding financial and performance reporting and compliance, as well as related internal controls and management’s failure to implement controls over daily and monthly processing and reconciling of transactions.
The OHSC has admitted that ‘with its current capacity and centralised inspection model it will struggle to deliver on its mandate, including supporting the National Health Insurance Act’.
The fact that the department’s 2023/24 annual report reflects R434,000 in material loss through fraud, without reflection in detail on consequence management, is a grave concern. On that subject, the auditor-general “was unable to obtain sufficient appropriate audit evidence that disciplinary steps were taken against some officials who had incurred irregular expenditure as required by section 38(1)(h)(iii) of the Public Finance Management Act”. Yet again.
And this is the department that we’re meant to blindly trust not only with our healthcare but also vast amounts of public money. The health ombud informed parliament that “it is expected that there will be an increase in complaints with the implementation of the NHI, not only from users of healthcare establishments but also from healthcare establishments themselves when their activities are curtailed by the regulator, the OHSC [Office of Health Standards Compliance].”
The OHSC has admitted that “with its current capacity and centralised inspection model it will struggle to deliver on its mandate, including supporting the National Health Insurance Act”. Over the past year the OHSC inspected only 19.62% of public and 11.4% of private health facilities for compliance with norms and standards.
Taking this into account, and that 49.9% of public and private health facilities that were noncompliant when first inspected were still noncompliant on reinspection, and given the fact that the ideal clinic status of 69.8% of hospitals that submitted an assessment last year were unsatisfactory, it is not unreasonable to question how effective the NHI will be, nor to worry about the additional strain it will place on an already struggling public health system.
The DA has always advocated for universal healthcare, as well as universal access to healthcare, but we cannot support the NHI in good faith. To blindly trust that the department of health will magically become honest and competent at the stroke of a pen would be madness.
• Clarke, a DA MP, is the party’s health spokesperson.
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.