Government pushes ahead with NHI – but still can’t answer the big question

 ·11 Nov 2022

The Department of Health says that South Africa’s courts have given it the green light to push ahead with recruitment processes to fill positions within the proposed National Healthcare Insurance (NHI) scheme.

This comes after the Gauteng High Court dismissed an application from trade union Solidarity to halt the process this week.

The department has been trying to recruit 44 specialist positions for placement within an NHI pilot branch currently being set up within the scheme. The appointments are for competent technical specialists to assist with the preparations for the functioning of the NHI Fund.

Solidary took exception to the process, arguing that it is unlawful for the government to forge ahead with hiring people for jobs in a system that has not yet been passed by parliament and signed into law. It launched an urgent court bid to stop the process.

However, the high court dismissed the application, saying the matter was not urgent.

Health department spokesperson Foster Mohale said that the court’s decision had given the department the green light to continue the recruitment process.

He said that the specialists the department is looking to hire and place in the NHI branch are not exclusively for the NHI scheme and will be part of strengthening national healthcare whether the NHI Bill is passed by parliament or not.

“Whether the NHI moves ahead or not, these positions need to be filled,” he said.

The NHI Bill is currently before the National Assembly, with the portfolio committee on health going through the proposed laws clause by clause. This will be followed by another public participation process where stakeholders can engage with the bill, and different sectors will be called to make contributions.

Mohale said that unions like Solidarity and other stakeholders like private healthcare providers who have concerns over the bill should make use of this participation process instead of trying to use the courts to block the scheme.

“Let them make inputs to ensure that it is successful instead of dismissing the intervention,” he said.

The big question: how much will it cost?

Speaking to NewzroomAfrika, Mohale said that there is currently no cost estimate for the scheme because it will be rolled out in phases and is dependent on National Treasury for funding guidelines.

He said R30 million has been budgeted for the latest recruitment drive, which he justified by noting that the new hires will be specialists that the department is trying to lure and keep in the system for a long time.

According to outdated estimates, the projected cost of the NHI would be R256 billion. Other estimates peg the system at over R350 billion, with some going to the extreme at over R1 trillion.

However, there has been no official projection from the government, with National Treasury itself saying that these costs still need to be calculated.

Despite the lack of cost detail, Mohale said that NHI pilot projects and the public-private cooperation during the Covid-19 pandemic with the vaccine rollout proved that universal healthcare in South Africa could work.

As the parliamentary process continues, the Department of Health is continuing to lay the groundwork for the system.

In October, the department gazetted the National 2021 Health Normative Standards Framework (HNSF) for Interoperability in Digital Health, which details the government’s plans to establish a comprehensive national health information system.

The technical document lays out a clear path for South Africa to have medical and health data shared nationally, incorporating data from the private health sector.

The Department of Public Works and Infrastructure (DPWI), meanwhile, has laid out its plans to improve healthcare infrastructure across South Africa for the next few years, which includes leaning heavily into the private sector to help, including through the NHI.

The government’s push for the NHI comes amid a cacophony of warnings and dissenting voices, saying the scheme is unaffordable, unmanageable and unsustainable.

Private healthcare groups have been the most vocal on this front, saying the system is being set up for failure given the scale of what the government wants to achieve against the backdrop of how it has already failed in the public healthcare space.

There are also concerns over an exodus of healthcare professionals who refuse to be subject to the scheme’s harsh conditions, as evidenced by the court ruling the department is appealing.

Medical aids have been fighting for their continued existence, given that the NHI scheme envisions a healthcare system with the state entirely in control and little to no room for private healthcare funding.

Read: Big changes for hospitals and clinics in South Africa – leaning heavily on the private sector and NHI

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