Home Opinion Special Reports South African Leader Signs into Law NHI Bill

South African Leader Signs into Law NHI Bill

South Africa
South Africa

South African President Cyril Ramaphosa on Wednesday signed into law the much-anticipated National Health Insurance (NHI) Bill, which seeks to transform the country’s “unequal” healthcare system.

“In signing this bill, we are signaling our determination to advance the constitutional right to access health care as articulated in Section 27 of the Constitution. The passage of the bill sets the foundation for ending a parallel inequitable health system where those without means are relegated to poor health care,” Ramaphosa said at the signing ceremony held at the Union Buildings in Pretoria, the country’s administrative capital.

In his speech, Ramaphosa described the NHI as “an opportunity to make a break with the inequality and inefficiency” that characterized the country’s approach to healthcare.

According to him, the real challenge facing the NHI would not be funding, as some have suggested, but the misallocation of funds that favored private health care.

The president further noted that the healthcare system would tackle healthcare costs.

“The NHI is an important instrument to tackle poverty. The rising cost of health care makes families poorer. By contrast, health care provided through the NHI frees up resources in poor families for other essential needs,” he said.

The signing of the NHI Bill came after it was passed by the parliament last year. Its key objectives were to transform healthcare by addressing some of the challenges it faces, including infrastructure decay and shortages of healthcare workers. According to Ramaphosa, the NHI’s implementation will be gradual and phased.

For years, South Africa has had a two-tier healthcare system, consisting of both public and private healthcare. Around 84 percent of the population relies on public healthcare, while those who can afford medical insurance use private healthcare.

Organizations within the healthcare sector, representing healthcare workers ranging from nurses to doctors and specialists, have reacted to the signing of the NHI Bill. Some welcomed it, saying it would overhaul the healthcare system.

The Democratic Nursing Organization of South Africa (DENOSA), which represents thousands of nurses who are the backbone of the public health system, said this would be a catalyst for change in healthcare.

Sibongiseni Delihlazo, the DENOSA’s national spokesperson, told Xinhua that nurses supported the NHI as they believed it would “dismantle” the unequal healthcare system.

“At last, South Africa will be doing away with the legacy of the two unequal systems. The concept of equal access to healthcare will finally be realized, where everyone has equal access based on their healthcare needs and not on how deep their pockets are,” Delihlazo said.

He further mentioned that the NHI would enable healthcare workers to work in an environment with adequate resources, adding that he supports the gradual implementation to address any “glitches” that might be encountered.

The National Education, Health and Allied Workers’ Union (NEHAWU) called the signing of the NHI Bill into law a “watershed moment” for the country.

“This means more resources will be pumped into the healthcare system to address all the outstanding issues,” Lwazi Nkolonzi, NEHAWU’s national spokesperson, told Xinhua.

However, following the National Treasury spending cuts in August 2023, which affected funding for various services, including healthcare, the NEHAWU expressed concern that this might impact the implementation of universal healthcare.

“It might hinder the proper implementation of the NHI. The president has to ensure that austerity measures are no longer in place,” Nkolonzi added.

While South Africa’s main opposition party, the Democratic Alliance (DA), vowed to do away with the NHI if elected into office in the country’s upcoming elections, most of the vigorous opposition to the NHI Bill has come from the business sector. Business Unity South Africa (BUSA) expressed “concern” in a statement about the signing of the bill into law.

“We fully support the objective of universal health coverage; however, the NHI Bill in its current form is unworkable, unaffordable, and not in line with the Constitution,” said Cas Coovadia, BUSA’s chief executive officer.

The South African Medical Association (SAMA), represented by its chairperson, Mvuyisi Mzukwa, said their legal team is preparing legal action in courts regarding the NHI Bill.

“The implementation strategy outlined lacks the necessary depth and practicality required to achieve meaningful and sustainable change. South Africa’s healthcare system is not ready for the NHI as it is currently articulated in the bill,” said Mzukwa.

“They have a problem with how the NHI would be funded,” he said. “The funding mechanism is flawed in its heavy reliance on general tax revenue, payroll tax, and surcharges on personal income, and in particular.”

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