The National Assembly’s Health Committee will only consider how to manage the vast volume of written submissions it has received in response to the National Health Insurance (NHI) Bill in February, its chair, Sibongiseni Dhlomo, is quoted in Business Day as saying. At issue is whether MPs scrutinise each of the hundreds of thousands of submissions themselves or outsource some of the work to a third party.
Parliament’s rules are silent on the issue, according to University of Cape Town constitutional law expert Pierre de Vos, and it has recently faced controversy over outsourcing the submissions received in response to its constitutional review of land expropriation without compensation. Dhlomo said he did not know precisely how many written submissions on the NHI Bill had been received by the 29 November deadline last week, but Parliament indicated on 23 October that it had already received more than 100,000 written submissions. The Democratic Alliance (DA) said last week it had collected another 87,000 submissions.
In a parallel process, the committee is holding public hearings in the provinces and has already toured Mpumalanga, Northern Cape, Limpopo and KZN, and on Sunday wrapped up in the Eastern Cape. Dhlomo said the committee planned to complete its public hearings in the remaining four provinces early in 2020, finishing up in the Western Cape. It would consider the written submissions in Parliament’s first session in 2020, which will begin after President Cyril Ramaphosa delivers his State-of-the-Nation address, scheduled for 13 February.
DA health spokesperson Siviwe Gwarube said it is important that the committee agrees upon terms of reference for handling the written inputs, as well as the process for managing oral submissions. The DA is opposed to outsourcing the job entirely, and wants the committee to be involved in scrutinising the written input, she said.
Trade union Solidarity has intensified its war against the government's proposed NHI threatening to take the fight all the way to the Constitutional Court. Fin24 reports that the NHI, which is before parliament for consideration, is the government's plan to provide universal healthcare access to all South Africans. It is expected to be rolled out by 2026 and is estimated to cost R256bn.
“The NHI, should it come into effect, would bring an unprecedented disaster for South Africans," said Morné Malan, a strategic specialist at Solidarity. "We don’t know just how far government’s irrationality and insanity will go. We don’t know how many blows will be needed to stop the NHI, but we are ready to come up with as many blows as will be needed, and, ultimately, with even more as long as we can stop this disastrous policy,” said Malan.
"We are also ready to participate in all further processes, to lobby against the Bill and to resort to court action right to the Constitutional Court should this Bill ever be enacted." The trade union, which this week submitted its comments on the NHI representing a mandate of 30,000 people, reiterated its survey findings among health practitioners in the private and public sector.
The deadline for written submissions on the NHI Bill closed on Friday, but oral submissions remain open.
Desirable as the NHI may be, South Africa can neither afford it nor manage it properly because of the atrocious state of governance. Analyst Mary de Haas in the summary of her submission to the parliamentary Portfolio Committee on Health on the Daily Maverick site says that like the White Paper, the NHI Bill is badly written, and the research informing it seems inadequate.
De Haas believes the Bill should be rejected and – while the government takes urgent steps to deal with dysfunctional departments and stem corruption “a suitably qualified team of researchers and lawyers, taking into account public comment, should do some desktop research on appropriate NHI models for South Africa.” She adds that efficient bureaucracies are needed to manage national health insurance schemes.
Says De Haas: “No democratic country can afford to give a Minister the powers envisaged in this legislation, lacking as it does any meaningful checks and balances on that power. Since when can a Minister of Health appoint an Appeals Tribunal with powers of a High Court whose decisions are final? There has been an increasing culture of secrecy in government, including in the Department of Health, which even refuses to give patients copies of their own records – which they are the owners of.”
De Haas does not believe that NHI will “suddenly transform these authoritarian politicians into champions of transparency and accountability”.
A Sunday Times editorial says that South Africa’s health industry needs to support the fact that it will take time for our economy to recover and for us to build a thriving economy that employs more of our citizens and creates health and wealth for more South Africans.
It says to implement the proposed NHI within the next few years, considering our current fiscal reality, will be extremely difficult, if not impossible. Some commentators have said that the earliest we will see NHI is 2030.
But, the editorial says, South Africa cannot afford to wait that long and needs a more sustainable healthcare system for more South Africans long before then. It points to the private health-care system and its regulators, which, it says, can offer a better environment for improved, more innovative and cost-effective solutions and many innovative solutions have already been attempted and proposed.
The private sector would offer learning for the government while providing cover to more South Africans, while the economy grows, so that we can afford and implement a successful universal access system for all South Africans. In so doing, the editorial says, more South Africans would have cover for health in the private market, alleviating the burden on the current and future health system. It can also provide income if some benefits are contracted to state facilities. This would allow more health for more South Africans for less.
Finance Minister Tito Mboweni says the NHI will be implemented at a pace that is affordable to the country. Mboweni said this when Ministers in the economics cluster appeared before the National Council of Provinces (NCOP) to respond to oral questions on Wednesday of last week. “Given our current macro-economic outlook and our constrained fiscal environment, full implementation is likely to take longer than initially anticipated,” he said.
Responding to questions, Mboweni said the National Treasury is currently developing a financing paper on the NHI. “However, there is still a lot that is being discussed between the Minister of Health and myself in order to make sure that we live up to the expectations. We are all committed to the NHI and the functioning of the national health system. And therefore, we should do all that we can to support the pace and the timeframes for the implementation of the NHI,” he said.
Mboweni said the draft paper has not yet been published as it still requires a lot of internal conversations within the National Treasury. Once finalised, the paper will be taken to a Cabinet committee, after which it will go to Cabinet.
The FF Plus has, meanwhile, warned about the NHI process. Philip van Staden, FF Plus MP and chief spokesperson says in a report on the Politicsweb site that “it wants to warn that if there are any complaints about interference with the public participation process of the NHI, the party will be obliged to declare a dispute against the entire process at Parliament.
Van Staden writes: “This follows after it came to light in the media… that the MEC for health in the Free State gave permission for an official pamphlet to be distributed by the Free State provincial government which encourages people to support the NHI Bill. This is not the first time that something like this has happened.
“In October this year, it also came to light that the Pharmacy Council sent a ‘bully’ email to members in the pharmaceutical industry which requested that members must complete the attachment to the email which states that they support the NHI Bill. The FF Plus confronted the minister about the email in the portfolio committee for health and a day later, the Pharmacy Council apologised to its members for sending the email.
“The FF Plus is currently in the Eastern Cape to monitor the public participation process and serve as a member of the portfolio committee. The public participation process is specifically there to afford people the opportunity to give their input about a specific process or bill without any pressure or interference from the government, the people are, thus, given an opportunity to exercise their democratic right to be for or against a process or Bill.
“However, what some of the supporters and officials of the government are currently busy with amounts to undemocratic actions as they are manipulating the NHI process so as to bring about an outcome that will benefit the government.
“It will be disastrous for South Africa if the NHI is adopted and implemented as law, specifically if it was preceded by a manipulated process and if it does not reflect the democratic views of the people or the medical industry. The FF Plus is still of the opinion that all medical professionals in the country should be consulted regarding the NHI and if the government wants to do the honourable thing, it will announce such a process and reach out to the medical industry at once.
“The FF Plus acts in the best interests of all South Africans, whether in the private or the public health care system, and the party will not allow the government to further exploit the process for their own gain.”Business Day report Fin24 report Analysis on the Daily Maverick site National Health Insurance Bill (B11-2019) Sunday Times editorial Press release Report on the Politicsweb site