Government often gets criticised for a lack of planning, but is now under fire for doing planning, counsel for the government argued in the first NHI review application heard by the Gauteng High Court (Pretoria) last week.
According to a Beeld report, Advocate Charles Wesley SC, on behalf of the government respondents, insisted that the NHI structures already created and appointments made, merely formed part of “conceptualisation” of the NHI.
Advocate Greta Engelbrecht SC, on behalf of Solidarity, said the state’s NHI actions to date contravened the National Health Act in several ways, including centralisation of powers while current legislation decentralises power.
Solidarity seeks a review of several decisions already taken by the Health Department, while the NHI Bill has not yet been signed into law.
Judge David Unterhalter asked: “Where does one draw a line between preparation work and the execution of legislation that is not yet effective?”
Wesley said as long as the work was limited to “conceptualising”, the decisions do not run contrary to current legislation. He said the decisions are not regulated by the National Health Act, but rather the Public Service Act and the Constitution.
Unterhalter reserved judgment and indicated that he might give his ruling as early as next week.
The Solidarity Doctors’ Network, meanwhile, said there is bitter irony to the government doggedly pursuing its costly NHI goals while already struggling to find the necessary funds to employ medical graduates.
Solidarity’s medical sector lead, Peirru Marx, told BusinessTech that this crisis exacerbated the pressures on the overburdened health system and was contributing to the ongoing loss and flight of critical skills in the country.
He said the placement of doctors has “almost reached breaking point”, and this is all taking place as the government puts most of its focus on enacting the NHI Bill.
“The irony of the situation is clearly seen in the state’s inability to even address the immediate needs of … medical graduates, (all) while they are trying to implement a large-scale health insurance system,” he said.
“There are currently 33.3 doctors per 100 000 of the population available in the public sector. This means the doctor-to-patient ratio is 0.3 doctors per 1 000 people of the population, which is more than 10 times fewer than other countries that depend on state health systems,” he added.
The South African Medical Association Trade Union (Samatu) said that every year, the department cited budget constraints as a barrier to hiring qualified medical doctors, “but no substantial measures are evident to solve the funding dilemma”.
Meanwhile, Professor Alex van den Heever, from the Wits School of Governance, said the Department of Health received enough funding at the start of the year – but due to inadequate planning, it has now run out of money to hire new doctors.
Looming challenges in court
The funding and placement dilemma is made worse by the views that the NHI will not even be a reality for the foreseeable future.
While President Cyril Ramaphosa may sign the Bill into law in the coming weeks or months, the implementation plan is decades-long, even without the legal challenges it is guaranteed to face.
In his State of the Nation speech last week, the President devoted just one paragraph to NHI, saying that the plan was to “incrementally implement it, dealing with issues like health system financing, the health workforce, medical products, vaccines and technologies, and health information systems”.
Efficient Group chief economist Dawie Roodt recently noted that the NHI faces two major challenges – both of which mean it is unlikely ever to be implemented.
The first challenge is funding. A report by the Solidarity Research Institute found that an additional R295.93bn is needed to fund the plan. This is a conservative estimate.
Raising these funds is unaffordable because of the government’s deteriorating fiscal health in recent years, and the state is unlikely to be able to draw the funding from taxpayers without immense fallout.
The second challenge, Roodt said, is that even if the Bill is signed into law, it will face several lawsuits and be tied up in court for years to come.
Beeld article – 1ste hofsaak teen NGV: Staat ‘net besig om skelet’ te bou (Restricted access)
SA Government – SONA (Open access)
See more from MedicalBrief archives:
Solidarity takes legal steps over NHI ads for jobs that don’t yet ‘exist’
Crisp says Health budget has to be bigger if NHI goals are to become a reality
Solidarity dissatisfied with ‘irresponsible’ way NHI Bill is being dealt with
Income tax hike and payroll tax proposed for NHI funding