Government urged to reconsider NHI as workers threaten to leave South Africa

 ·26 May 2022

Civil society group Afriforum has sent a letter to health minister Joe Phaahla and president Cyril Ramaphosa requesting that the government reconsider the implementation of National Health Insurance (NHI).

This comes after Phaahla confirmed that the country has a shortage of doctors and a doctor-to-patient ratio of 0.32 to 100. In a statement on Thursday (26 May), Life Healthcare Group estimated that the country also has a shortage of between 20,000 and 60,000 nursing professionals.

AfriForum stated that the NHI is unaffordable for the already over-burdened taxpayer, who is taxed higher than in other countries with comparable GDPs and forced to pay “double taxes” for essential private services such as healthcare.

The organisation also argues that the centralised health fund will be susceptible to the exact same failures that have characterised nearly all state-owned entities.

Perhaps most worrying is a 2021 poll from the South African Medical Association pointing toward a mass emigration of healthcare professionals in the event of the implementation of NHI, it said.

“The recent confirmation by the minister of the severe shortages of doctors in South Africa is just another example of why a state-monopoly health sector will be catastrophic. This letter is an attempt to achieve a constructive dialogue with the government vis-à-vis NHI.

“However, if the letter falls on deaf ears, AfriForum will continue to oppose the proposed legislation with all the means available to us. Our fight against NHI is one of the most important battles on which the very future of this country depends,” said Reiner Duvenage, campaign officer for strategy and content at AfriForum.


Briefing parliament at the end of March, the Department of Health noted concerns around shortages, adding that the NHI will need skilled personnel to function. It said that this was not limited to healthcare professionals, but that general skilled human resources will be central to the health system going forward.

“This is a big ship that will need to be turned, but the framework is in place,” said acting director-general of health Nicholas Crisp. “We have heard the threats that there will be an exodus of personnel if the NHI is implemented and a brain drain.”

He said that the department is actively responding to this and that a framework is in place to ensure the country has the necessary skills, with his department developing a ‘Human Resources for Health strategy’ before the start of the Covid pandemic.

This framework sets out a multi-work implementation plan, but it requires money and investment in the health workforce to ensure the country is ready for universal health coverage, Crisp said.

“Every health professional has a place in the National Health Insurance – whether you choose to work in the public portion of the delivery system or the private portion of that delivery system.

“We do not think there needs to be a threat on anybody, or their viability, or their role to be played.”

Read: Government using Covid-19 as a jump pad for the NHI: minister

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