The 3 major problems with South Africa’s new NHI – and why some doctors want to leave

Public interest law centre, Section 27, has outlined its three major concerns with South Africa’s incoming National Health Insurance.

Open for public comment until 29 November, the National Health Insurance Bill aims to provide universal access to quality health care services across the country.

However, the bill has courted controversy since its inception with concerns raised about how it will be funded, the quality of care, and the future of private medical aid schemes.

In an analysis, Section 27 says that there are currently three major aspects of the NHI Bill that need to change.

These include:

  • Governance – The Minister of Health appoints the NHI Fund Board members (after appointing the ad hoc panel that interviews and recommends them), the Board Chairperson, and the CEO of the NHI Fund. In simple terms, decision-making is far too concentrated;
  • Transparency – To increase public trust in the NHI and to reduce the risk of corruption under NHI, it is imperative that all NHI-related processes and decisions are as transparent as possible;
  • Try before you buy – The NHI Bill introduces a range of new structures and administrations that are untested. We are bringing the establishment of these new structures into law, with no way to turn back if they fail, and without any transition provisions that could stagger implementation and allow for learnings.

Healthcare workers not happy

A recent report by trade union Solidarity has also warned that the incoming National Health Insurance (NHI) will have an impact on the healthcare industry.

Nicolien Welthagen, a research psychologist at the Solidarity Research Institute, said that the report is based on questionnaires sent to healthcare practitioners in the private as well as the public sector across the country.

The general feedback shows that healthcare practitioners have huge concerns about the proposed NHI.

“The findings indicate that there is distrust towards the government regarding the way they want to implement and manage the NHI. 80% of respondents are negative or sceptical about the NHI,” said Welthagen.

“According to the results of this report, the respondents do not believe that the NHI will succeed in improving the healthcare system and service delivery.

“Only 15% of respondents believe that it would be possible to successfully implement the NHI, and 84.5% are of the view that the implementation of the NHI could destabilise the healthcare system in South Africa and could harm the high-quality service already being provided by the private sector,” she said.

Welthagen added that the report further highlights the enormous risk that the emigration of health practitioners poses to the future of healthcare in South Africa.

“There are serious concerns about a shortage of healthcare workers, the more so in view of the fact that 20.8% of the respondents indicated that they had already taken steps to emigrate, and a further 41.06% would consider emigrating when the NHI is implemented,” Welthagen said.


Read: NHI roll-out to cost an additional R33 billion

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The 3 major problems with South Africa’s new NHI – and why some doctors want to leave