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HomeSouth AfricaConfusion over Ramaphosa's NHI remarks in his SONA address

Confusion over Ramaphosa's NHI remarks in his SONA address

President Cyril Ramaphosa created confusion with a remark about the proposed National Health Insurance (NHI) during his State of the Nation address, health experts are quoted in The Times as saying. The report says those surveyed said his comments about the NHI appeared to contradict what the NHI Bill states – but it could also just be proof of the incoherence of the NHI policy.

Elsabe Klinck, a lawyer who specialises in healthcare, said in the report that the president’s remarks that NHI will be rolled out while clinics and hospitals are improved, was different from what the bill states. Up to now it was understood the NHI would only be rolled out once clinics and hospitals had been upgraded, not during the upgrade process. “The draft bill said a facility must be quality accredited before NHI will contract or appoint. This is different,” said Klinck.

The NHI pilot sites all had additional NHI infrastructure and funding. None of them had hospitals and clinics that passed the Office of Health Standards and Compliance (OHSC) inspections. So, the report asks, if focused effort and funding does not even fix the system, how do they plan to do it?

Health consultant Johan Serfontein said in the report that quality improvement needed to take place before the NHI was rolled out. “The NHI pilot sites all had additional NHI infrastructure and funding. None of them had hospitals and clinics that passed the OHSC inspections. So, if focused effort and funding does not even fix the system, how do they plan to do it?”

The report says asked if fixing the system while rolling out the NHI contradicted the NHI Bill, Professor Alex van den Heever of the Wits School of Governance said the NHI policy was not coherent. “To ask for consistency is a tough call.”

The report says a day before the State of the Nation address, the head of health at Section27, Sasha Stevenson that the NHI policy was unclear. They haven’t come up with a coherent NHI plan in 10 years. Changing offices won’t fix that.

Stevenson points out that the NHI is a fund that will buy health services, but this would not fix problems in the health system such as crumbling infrastructure and staff and drug shortages. “People are losing their lives every single day while we fixate on the passage of an NHI Bill that says little about quality and instead is focused on the creation of a fund. Health financing is a vital component of health system improvement, but the creation of a fund does not itself improve the health system.”

The report says Ramaphosa also mentioned a war room set up to design NHI policies. “Realising the magnitude of the challenges in healthcare, we have established an NHI and quality improvement war room in the presidency consisting of various key departments to address the crisis in the public health system while preparing for the implementation of the NHI,” he said. The war room is led by Dr Olive Shisana and is in the presidency buildings.

However, the report says, van den Heever was critical of the war room process. “ Russel Rensburg, spokesperson from the Rural Health Advocacy Project, questioned why the national Health Department was not driving the warn room.

Van den Heever said the NHI, as it stood, was like Brexit: a policy that did not have an implementation plan and “undermined the very health system” it planned to fix.

The report says neither the Presidency nor the Health Department responded to requests for comment.


Solidarity’s Occupational Guild for Health Practitioners has expressed their deep-seated concern about Ramaphosa’s statement that the NHI Bill will be submitted to Parliament soon. This follows after a version of the Bill was rejected by the cabinet at the end of last year due to various deficiencies. It also provoked heavy criticism with regard to funding, especially from the Treasury.

Morné Malan, senior researcher at the Solidarity Research Institute, explained that despite the fact that the final version of the bill is not yet available, one can reject such a policy from the outset. “The fact remains that nationalised healthcare is not workable. It is not economically viable, nor is it practically feasible. The shortcomings in the previous versions of the bill were profound and omnipresent. It is unthinkable that all the issues could have been solved in this version” Malan said.

Solidarity advises Ramaphosa to do away with this backward policy that has led to poorer health outcomes time and time again, irrespective of where attempts have been made to implement it. “The NHI will make South Africans as a whole sicker and leave them poorer. Health practitioners who choose not to emigrate will be even more adversely affected under the NHI system.”

Malan concluded: “Mr Ramaphosa proudly announced several figures and details about investments and government spending. However, very little information was given about the expected costs and realities regarding the NHI. South Africa is experiencing a crisis in health care. This crisis stems from the government’s inability to manage health care. Obviously, it is madness to think that the solution for this crisis lies in the state taking over the responsibilities of the current outstanding private healthcare sector. Incompetence cannot be cured by laying claim to more power for yourself. People cannot be cured by means of pretty words and pseudo-saintliness.”


Rampaphosa said in his address that key NHI projects targeting society’s most vulnerable people would begin in April. Business Day reports that he also announced that the government would launch a major cancer campaign within the next three months, similar to the government’s massive HIV/Aids counselling and testing campaign. It would draw on the private sector, he said. “We need to mobilise all resources to fight this disease,” he said.

He also emphasised the government’s commitment to combating South Africa’s HIV/Aids epidemic, promising to provide treatment to another 2m people by 2020.


The South African Communist Party (SACP) said it welcomed the announcement to decisively press ahead with the introduction of the NHI scheme on a report on the Politicsweb site. The SACP said: “We fully support the solidarity model announced by the President; namely, that the young should subsidise the old, the well-off should subsidise the needy and the healthy should subsidise the sick. In particular, the National Health Insurance should uproot inequalities in, and equalise access to quality healthcare.”


Meanwhile, Ramaphosa’s ambitions of devising a plan for fixing the health system have once again been delayed, as participants from last year’s health summit say they need more time to do a proper job. Business Day reports that Ramaphosa convened the two-day summit in late October, where delegates discussed ways to tackle the crisis in South Africa’s health system.

The report says the summit ended with a promise to craft a health compact by 10 December, but late last year that deadline was pushed out to the end of January 2019 after some stakeholders, including healthcare professionals, said the time-frame was too short. It has now emerged that work on the compact, which is expected to contain concrete steps for improving South Africa’s health system, is still under way.

“We have given ourselves more time to do this properly, because we think it is important to find solutions we all support and can action. We are looking for tangible, action-oriented outcomes,” Business Unity SA (Busa) CEO Tanya Cohen is quoted in the report as saying. Busa is one of the key constituents represented on the steering committee driving the process to craft the compact.

“What we haven’t done is engage on the legislation that is before the National Economic Development and Labour Council (Nedlac) and will go to parliament. We have been focusing on the crisis,” she said, referring to the National Health Insurance (NHI) Bill, which contains the first legal steps for realising the government’s ambitions of universal health coverage.

The report says Cohen made her remarks at a press briefing called by the presidency to report back on the work of the health summit. In a speech delivered on his behalf by health minister Aaron Motsoaledi, Ramaphosa said improving the health system and introducing NHI went hand-in hand, describing them as “two sides of the same coin”.

NHI aims to provide quality health services to everyone that is free at the point of delivery and is founded on the social solidarity principle that the rich and healthy subsidise the poor and the sick.

“Repairing our national health system is an endeavour that requires the input, involvement and innovation of all role-players who understand that good health makes for a good life and a good economy,” said the president.

[link url="–how-cyril-got-it-wrong-on-nhi/"]The Times report[/link]
[link url=""]Business Day report[/link]
[link url="—sacp"]Report on Politicsweb site[/link]
[link url=""]Business Day report[/link]
[link url=""]Presidential Health Summit report[/link]

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