The release of President Cyril Ramaphosa’s blueprint for fixing SA’s health system in the next two weeks has been delayed among growing disquiet that the government wants to create the impression that the high-level health summit participants at which it was announced have endorsed NHI plans.
Business Day reports that the Presidency has delayed the signing of this “health compact” until the end of January, spokesperson Khusela Diko confirmed. Healthcare professionals had complained that the deadline was unworkable.
The report says the commitment to crafting this plan emerged from a two-day health summit convened by the president in late October, which drew 600 delegates from the public and private healthcare sector as well as labour and civil society organisations. The gathering was cast as a high-level meeting to thrash out ideas for tackling the crisis confronting South Africa’s public health system, which is grappling with corruption, staff shortages, and stock-outs of even basic medicines such as contraceptives.
However, the report says, there is growing disquiet and suspicion that the government is seeking to spin the event to create the impression that participants endorsed its National Health Insurance (NHI) plans.
NHI is its flagship policy for achieving universal health coverage, and its first piece of enabling legislation is due to be tabled in cabinet next week. Health minister Aaron Motsoaledi is quoted as saying earlier in November that the summit had given NHI the green light. “Everybody endorsed NHI and said it must go ahead,” he said at the time.
Fazel Randera, a member of the Progressive Health Forum, said focus should be rather spent on multiple crises facing the health service, rather than the NHI. “At the end of the summit we were given a slide session summary of what had come back from the various commissions. One read that there should be one health service for one country and that NHI was no longer a debate. Now there was no discussion on those particular points,” said Randera, who is a member of the summit task team chaired by presidential advisor Olive Shisana.
The report says the SA Medical Association (Sama) was so concerned about the 10 December deadline that it convened a meeting of more than 60 associations representing healthcare professionals a fortnight ago, at which they resolved to seek a four-month extension.
Sama chair Angelique Coetzee said the deadline had been unrealistic as the views of more than 100 healthcare associations and societies needed to be canvassed. The health system had to be fixed before implementing NHI, she said.
Motsoaledi has defended the government’s approach to crafting the contentious National Health Insurance (NHI) Bill, a vital step in achieving the government’s ambitions of providing universal health coverage, reports Business Day. The government has promised that NHI services will be free at the point of delivery, but exactly what benefits will be covered and how they will be funded has yet to be spelt out.
The report says the Bill is now mired in controversy, after a leaked Treasury letter revealed that its officials were butting heads with the president’s adviser, Olive Shisana, over a host of measures she and her team had changed after the public comment period on the bill closed on 21 September. And political tension over the Bill rose last week after health director-general Precious Matsoso disclosed that she had been side-lined and had not had sight of the Bill since it was released for public comment in June, despite being the department’s accounting officer. At the time, Shisana confirmed that Matsoso had not been involved, saying Motsoaledi had assigned that task to deputy director-general Anban Pillay and his adviser, Aquina Thulare.
But, the report says, Motsoaledi said he rejected “with contempt” recent media articles alleging irregularities in the manner in which the NHI Bill was being processed by the government. He said there was nothing sinister in the presidency’s involvement in the NHI process. There had been extensive consultation between Treasury and his department, facilitated by the presidency, he said.
“Sometimes these consultations took place through exchange of letters. There was hence nothing untoward with the letter written by the National Treasury on this matter. What is sinister, however, is the leaking of such letters to the media by some unscrupulous officials pretending that they uncovered some hidden evil lurking in governmental departmental exchanges,” he said.
The report said he did not offer an explanation for why the director-general had not been included in revising the NHI Bill. Motsoaledi said the Presidency had the right to “facilitate, direct and unblock obstacles in the process of legislation and policy making.
“We have no doubt that the enemies of NHI will do everything possible to try to stop NHI from becoming a reality, failing which, they will try to cast doubt and aspersions on the integrity of the process. We wish to assure the nation that no law is being breached nor any illegality or irregularity committed in the manner in which the legislative process towards realisation of NHI is being conducted between the department of health, its officials, the Treasury, the presidency and the rest of government,” he said.
Meanwhile, the Democratic Alliance (DA) plans to seek legal advice on the Bill, reports Business Day. “If the ANC government continues to push through the NHI Bill without proper public participation and consultation, the DA will seek legal advice regarding the highly irregular process followed in revising the NHI Bill,” DA deputy health spokesperson Lindy Wilson said.
“The minister’s backdoor dealings subsequent to the closure of public comment period, effectively mutes any input from the public, as the proposed changes are substantive, and the public and other stakeholders have not had an opportunity to raise their concern.”
Wilson said the revised NHI Bill should be made public, and the public participation process reopened.