The Constitutional Court recently ruled the Certificate of Need (CoN) sections of the National Health Act unconstitutional, and in a Sunday Times Q&A last weekend, Chris Barron put Health Minister Aaron Motsoaledi on the spot over the impact of the judgment.
On whether the ruling would weaken the NHI, Motsoaledi replied: “No, not at all,” and said he didn’t remember having said that the CoN was “a central pillar of NHI”.
Asked if its invalidation undermined the principle of central control on which NHI relies, he said the certificate “is not necessarily about central control,” and was not about the State “dictating to doctors and other healthcare professionals where they can practise and what services they can provide”.
“All it does is it tells the country where facilities must be situated. If a doctor doesn’t want to go there, nobody can force him or her to go,” he said, and NHI private doctors would be free to operate anywhere they like.
“The certificate of need is just for distribution of facilities around the country so that NHI serves the population very well.”
Quizzed by Barron on how it can do this without forcing doctors to go to under-serviced areas, the Minister said: “Universal health coverage needs the state to put facilities where the people are. But no doctors are forced to go there.”
The certificate “makes it convenient, but it doesn’t mean if it is not there, then you cannot run NHI”.
Asked why so much much time and money was poured into challenging the 2024 High Court ruling against the CoN at the Constitutional Court, Motsoaledi replied: “Because a certificate of need is convenient for any healthcare system… whether NHI or not, it makes it much better. It’s a convenient tool but it doesn’t mean NHI can’t run without it.”
Barron suggested the essence of NHI was central control, but the Minister retorted that he didn’t know what was meant by that.
While it involved a central fund and central procurement, he agreed, this “is not the essence”.
“The essence is an equitable healthcare system that will cover everybody regardless of their economic status. You can do procurement in a centralised way or not, it does not stop NHI. We want central procurement to stop corruption and for economies of scale.”
It was not because “we want complete control over every aspect of the healthcare industry”, he replied. “I don’t know what you mean by ‘complete control’. We’re already controlling the healthcare system.”
Asked if that was why private doctors believed that under NHI, there would be control over where they practiced, he said: “At the moment they are going to practise where they want to because there is no Certificate of Need. Until we find another method.”
He described it as “a tool governments use to distribute health facilities equitably and geographically”.
Despite the Constitutional Court finding it unconstitutional and undemocratic, the Minister justified it: “We put it there because it would help us distribute health facilities around the country. By no means were we going to force any doctor to go there.”
Sunday Times article – Q&A with Aaron Motsoaledi, minister of health (Restricted access)
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Minister’s powers in NHI ‘unconstitutional’
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