Health professionals are worried that the NHI will become the ‘Eskom’ or ‘SAA’ of healthcare in South Africa

The National Healthcare Professionals Association (NHCPA) have questioned the establishment of South Africa’s new National Health Insurance (NHI) and the government’s ability to run it.

Presenting to parliament on Wednesday (26 May), NHCPA president Dr Benny Malakoane said that the organisation broadly supported the bill and its objects. However, he raised concerns around the NHI Fund and how it will be run – citing the failure of other state-owned companies in recent years.

“Unfortunately following the finalisation on NHI it will be the biggest parastatal in the country and given government track record with parastatals, one has to be really concerned,” he said.

“One shudders to think what will happen with the NHI Fund and the NHI’s governance and leadership.”

Malakoane said that there were also concerns around the independence of the fund’s board as it will be appointed by the minister of health.

He added that South Africa’s poor health infrastructure means that the NHI will face an uphill battle from the start.

“There is very little improvement of public infrastructure at the moment, meaning that we will still see inequality in patients who are allocated to public facilities as their designated service providers.

“The ageing community is getting bigger and always poses as a significant threat for a model such as NHI. They need more healthcare while paying less taxes.”

The NHI Bill was presented to and approved by cabinet in July 2019, and has been presented to parliament’s health portfolio committee.

It has since been subjected to an extensive public consultation process through committee roadshows and is scheduled for further parliamentary debates before it is presented to the president for promulgation.

At the start of May, the Council for Medical Schemes (CMS) said that the government’s planned National Health Insurance is in full development, with plans to move to phase 3 of the programme from next year.

In its 2021/2022 annual performance plan, the CMS said that phase 3 will include mandatory pre-payment of the new scheme, contracting for accredited private hospital and specialist services, and finalisation and implementation of the NHI Act.

“This (current) period coincides with the beginning of the second phase of the implementation of the NHI,” the CMS said.

“The CMS sees its role as playing both a supportive and a direct role in the delivery of all the activities according to the Act that should occur in the private sector.”


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Health professionals are worried that the NHI will become the ‘Eskom’ or ‘SAA’ of healthcare in South Africa