Friday, 19 July, 2024
HomeSouth AfricaRamaphosa says that revision of NHI is 'far advanced'

Ramaphosa says that revision of NHI is 'far advanced'

The government is at a “far advanced” stage in the revision of a detailed National Health Insurance (NHI) plan for implementation, President Cyril Ramaphosa said in his third State of the Nation (SONA) address in two years.

Ramaphosa said most South Africans believe the state should now start to focus on implementation rather than talk. South Africa’s struggling economy must be a priority, he said, including a 50% youth unemployment rate which he called a crisis. According to a Business Insider report Ramaphosa said the state is at “far advanced” stage in the revision of a detailed NHI plan for implementation.

This includes accelerating quality of care initiatives, building human resource capacity, the establishment of the NHI Fund structure, and costing the administration of the NHI Fund.

The report says the NHI is a massive overhaul of South Africa’s health care industry which envisions that every South Africans become a member of a state-run medical scheme.

Also, 2m more South Africans will be receiving treatment for HIV/Aids by December 2020. HIV should not be a health threat to South Africa any longer, Ramaphosa said, and this will be achieved by the state implementing its 90-90-90 strategy.

To achieve this aim, Ramaphosa said the number of people in South Africa receiving treatment should increase by at least two million by December 2020. The report says the 90-90-90 strategy calls for 90% of all HIV-positive persons to be diagnosed, 90% of those diagnosed receiving antiretroviral therapy (ART), and 90% achieving viral suppression by 2020.


The government will accelerate its effort to address the country's health challenges by attending to the capacity of health facilities in the next five years, IoL reports Ramaphosa announced. “In the next five years, we will accelerate the provision of well-located housing and land to poor South Africans. To improve the quality of life of South Africans, to reduce poverty in all its dimensions and to strengthen our economy, we will attend to the health of our people. We must attend to the capacity of our hospitals and clinics,” Ramaphosa said.

He told Parliament about an 80-year-old grandmother and said they could spend an entire day in a queue waiting for medication. “An ill patient cannot be turned away because there is a shortage of doctors and nurses. A woman in labour cannot have her unborn child’s life put in danger because the ambulance has taken too long to come,” said Ramaphosa.

As part of the work, the government must urgently improve the quality of the health system, he is quoted in the report a saying. “We are finalising the Presidential Health Summit Compact, which draws on the insights and will mobilise the capabilities of all key stakeholders to address the crisis in our clinics and hospitals.”


Two civil society organisations had earlier called on finance minister Tito Mboweni and new health minister Zweli Mkhize to increase public sector funding for health, arguing that the government’s goal of achieving “a long and healthy life for all” cannot be met with the available resources.

Business Day reports that in an open letter to the ministers, the Institute for Economic Justice (IEJ) and Section27 said the implementation of austerity budgets in the previous administration severely undermined the public health system and the viability of the NHI.

“Spend per uninsured person increased only 1% (in real terms) on average annually between 2015-2016 and 2019-2020, despite a rising burden of disease and high medical price inflation. This is not enough to address the historical and current inequalities that persist in healthcare,” they wrote.

The organisations said the NHI white paper, which spells out government’s policy for universal health coverage, recognised that healthcare spending had to double, yet the February budget trimmed R700m from the spending plans set out in the October 2018 medium-term budget policy statement.

“Taking stagnant economic growth into consideration, the Davis Tax Committee’s projected R72bn shortfall in NHI funding by 2025 is likely to be significantly understated,” they are quoted in the report as saying. “Shortages of specialists and other staff in the public health sector have been at crisis levels for some time. These were exacerbated in the past five years due to budget cuts.

In May 2018, 38,000 public health posts were vacant as a result of the implementation of wage expenditure ceilings – one of the tools the Treasury has used to curb expenditure – at an avoidable cost to lives. Provincial health departments have faced difficult choices as a result: cut non-personnel budgets or reduce headcounts,” they wrote.

The report said the Health Department had not responded a request for comment at the time of going to press.

The February budget set aside R208.8bn for consolidated health spending in 2018-2019, with spending plans that grew by an average of 7% over the medium term to reach R255.5bn in 2021-2022. The Treasury projected at the time that inflation would rise by 5.2% this year. According to the report, the budget also saw the Treasury move R2.8bn in unspent money from the NHI indirect grant to fund critical healthcare posts over the next three years.


In his response to says Ramaphosa's SONA, Democratic Alliance (DA) shadow minister of health Siviwe Gwarube said the president should commit to fixing the broken health system.

His statement reads:
Madam Speaker,
On Thursday night we watched with great anticipation as the President delivered his State of the Nation Address. In truth the speech was big on dreamy rhetoric and thin on much-needed details. More concerningly was the absence of a plan to provide quality healthcare for our people.

Madam Speaker, each of us in this House is familiar with the deep despair and helplessness which comes with sickness. It is at those times that nothing is scarier than being dependent on a health system that has been neglected for decades and has been systematically unravelling at the seams. The reality is that millions of South Africans are too familiar with that scenario.

Several weeks ago, I too was reminded of the importance of the work that we do here. I lost a family member who was still in his prime following a short illness. His death impressed upon me why we need to improve the quality of healthcare in this country, not just for our family members, but for the people who rely of this government service.
The millions of South Africans who have no other choice but to surrender themselves to an over-burdened heath system are the people that the DA is fighting for.

Mr President, your address on the health system of our country was simply not good enough. There are urgent commitments that South Africa requires from you when you respond to this debate tomorrow.

Firstly, fixing the broken health system. That requires an honest reflection about what has gone wrong in the health sector of our country.

Speaker, the DA unequivocally supports universal healthcare for our people. However, in doing so we cannot destroy the economy, risk a brain drain and rampant corruption. The Presidential Health Summit last year was simply an admission that there are deep inequalities when it comes to access to health. This is a known fact.

The gap between those who have healthcare coverage and those who rely on the public health sector is huge. However, this is because of decades of neglect and poor policies by the ANC government. The rural Eastern Cape where I come from is visual representation of failure by this government. Nothing works.

Dedicated and hard-working healthcare professionals are thrown into areas that have not seen delivery in decades. These are men and women who want to serve but are hamstrung by the unavailability of medicine, crumbling infrastructure and no medical equipment.

In KZN thousands of patients died due to the oncology crisis which the ANC’s nominated chairperson for the health committee, Dr Sibongiseni Dhlomo presided over. Yes, the rising cost of private healthcare needs to be addressed and this can be regulated by using existing legislation such as the Medical Schemes Act.

However, the fact that pregnant women who use our health facilities are taking a gamble with their lives, is something that the ANC government needs to accept responsibility for.

The fact that the elderly are tied to chairs waiting for medical care as was done in Mamelodi Hospital is entirely on this government.

The fact that there is a lack of access to reproductive healthcare that leads to young women resorting to backstreet abortions and children under 5 die annually due to poor living conditions is an absolute indictment on this executive.

The National Health Insurance as it stands premises its entire existence on the need to level the field of access. It does not seek to improve the existing health facilities and level of care.

NHI, in its current form will nationalise healthcare. We cannot allow a piece of legislation that has neither been costed nor effectively planned for destroy the little that we have.

The DA will oppose this Bill until it places the patient at the centre of its conception.

We trust that the newly appointment Minister, Zweli Mkhize, will begin working on the basics. Some of our healthcare facilities are death-zones.

Madam Speaker, the President should use the opportunity tomorrow to assure the families who lost loved ones in the Life Esidimeni tragedy that they will receive their compensation. In addition, the President should ensure that the people who were responsible for the death of hundreds of mentally ill patients are held to account. Those who are guilty – both politicians and officials – must be fired and they must be held criminally liable for having played upuca with the lives of the most vulnerable. The fact that Qedani Mahlangu is still embraced in the ANC and enjoys a leadership position is an indictment on you and your organisation, Mr President.

Madam Speaker, the problems that we face as a country are not insurmountable. They can be resolved but they require us to go back to the basics of good governance like the DA has in the Western Cape.

When we come to this House and share the success stories of the DA, it is not in an effort to brag but to bring solutions to the table.

In the Western Cape we serve over 75% of the province’s population who rely on public healthcare – but the health outcomes and standards are objectively better than any other province in the country. This is easily confirmed by the fact that we have the highest life expectancy for both men and women. This is because we have used a combination of innovation, political will and commitment to the people.

Most critically, since the DA took over this government in 2009 we have invested over R6bn on infrastructure and maintenance of health facilities. This means we built new hospitals and clinics, ambulance stations and upgraded existing ones. This investment means we have drastically improved patient experience.

To manage waiting times and critical medication stockouts, we have invested in two major innovations. We have a central depot that manages the stock of medicines for the province. This is why when the national Department of Health bungled the tender to supply ARVs a couple of weeks ago, in this province we managed the crisis better because of effective planning.

In addition, the Western Cape is the only province which is at the advanced stages of digitalising patient records.

Speaker, the critical point to be made here is that if the DA can do this in the Western Cape, it is possible to do it across the country.

Mr President, we do not need any more summits, symposiums or imbizos, we need this government to do its work.
Failing which, we will hold you accountable.
We will ring the bell on corruption.
We will demand better healthcare for the people of this country.
We will fight against the disastrous NHI and put forward a credible plan that will bring about universal healthcare without placing the fate of all South Africans in the hands of the politically connected few.

The DA will never neglect our constitutional obligations. The people of South Africa deserve nothing less.


The time for debate was over and the NHI Bill would make its way to parliament soon. The Citizen reports that this was according to Health Minister Zweli Mkhize who was responding to DA leader Mmusi Maimane’s call on the president to “forget about the NHI” during the debate on the State of the Nation address.

“In this case, we want to just say clearly that universal healthcare coverage is the future and National Health Insurance will happen,” Mkhize said. “That’s the only way we are going to be able to address the issue of inequality. We can discuss different modalities but we should not go back to the question on whether we should or shouldn’t be implementing national health insurance or not. That debate is over.”

Mkhize said the approval of the NHI Bill in Cabinet and its introduction in parliament was imminent. The bill will outline how NHI will be funded. “National Health Insurance is therefore a health financing system that is designed to pool funds and to use these pooled funds to actively purchase health services for the population based on the principles of equity and social solidarity,” he is quoted in the report as saying.

“These pooled funds will provide for universal access to quality, affordable health care services for all South Africans irrespective of their socioeconomic status and I repeat, not on their ability to pay.”

According to the report, the minister said concerns of the quality of public healthcare would be addressed.

The DA was not convinced and insisted is would continue to oppose the bill until it “places patients at the centre of its conception”.

[link url=""]Business Insider report[/link]
[link url=""]IoL report[/link]
[link url=""]Business Day report[/link]
[link url=""]Statement on the Politicsweb site[/link]
[link url=""]The Citizen report[/link]

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