Motsoaledi slams NHI critics for ‘apartheid tactics’
Minister of Health Aaron Motsoaledi has slammed much of the coverage of the National Health Insurance (NHI), labelling it as reminiscent of the “swart gevaar” tactics seen during apartheid.
Speaking at the 82nd International Pharmaceutical Federation Congress being held in Cape Town, Motsoaledi said that in trying to access the right to healthcare, “even the best-designed health policies and initiatives will struggle to meet their objectives in the absence of adequate healthcare financing strategy.”
“This is where Universal Health Coverage comes in.”
However, he claimed that in South Africa, “this has raised fire and fury by those who wrongly believe that the elevation of others is automatically a downfall of fortunes for those who have already arrived – those who are clear beneficiaries of the present grossly unequal system.”
Motsoaledi said that the negative rhetoric around the NHI would spark memories for older South Africans who have “seen this type of strategy some years back during the era of Apartheid…. ‘Swart Gevaar’.”
“It was used to scare those who are clamouring for freedom, never even to think about it because it was going to bring terrible things to them.”
“‘Swart Gevaar’ was so successful in scaring people off that white people started hoarding essentials like tin food, candles, matches, etc, waiting for the doomsday when (Nelson) Mandela becomes the first black democratically elected President of South Africa.”
Motsoaledi told the international audience that this “type of strategy” is being focused on universal health coverage, “which in South Africa, we like to call NHI”.
“The same strategy is being deployed today… the screaming headlines are designed to scare people off and make them angry about this NHI,” said Motsoaledi.
He referenced an article “by a prominent South African who likened NHI to Communism,” asking whether that means that countries like the United Kingdom are, in essence, communist countries.
It is worth noting that while the UK has national healthcare through the NHS—as do many other countries the government has used as an example to justify the implementation of the NHI—it still allows for private healthcare insurance.
The NHI Act in South Africa explicitly moves to all but abolish private medical insurance in the country—one of many concerns raised about the scheme, which the health department has ignored or simply disregarded in its engagements with stakeholders.
The other question has been funding—how much it will cost, who will pay, and how—which has also been sidestepped and only vaguely addressed in the laws.
Not everyone on board
In August, President Cyril Ramaphosa hosted a summit where a compact was to be signed by representatives of government, business, labour, civil society, health professionals, unions, service users, statutory councils, academia, and researchers.
This was to develop “sustainable and inclusive solutions to challenges in the national health.”
However, the 2024 compact took an explicit stance of having the National Health Insurance scheme underpin the strategy—which many stakeholders rejected.
The South African Health Professionals Collaboration (SAHPC)—a national group of nine medical, dental, and allied healthcare practitioners’ associations representing more than 25,000 dedicated private and public sector healthcare workers—said it will not sign the compact, blaming the NHI.
While the SAHPC acknowledged that health reforms are necessary to address the challenges in the country’s healthcare system, it believes the way that the Health Compact has been written is fundamentally biased towards solidifying support for the NHI Act as the sole solution to achieving universal health coverage.
“The compact heavily focuses on the NHI, presenting it as the only viable option for the country, which we don’t accept,” said Simon Strachan, a spokesperson for the SAHPC.
“Health professionals, including general practitioners, specialists, dentists, and allied workers, are the cornerstone of health provision in this country. Our primary concern is, and always will be, the well-being of patients.
“We do not believe the NHI is a viable or workable model for universal health coverage. Our numerous proposals and concerns have not been acknowledged.”
The boycott from healthcare workers follows a segment of businesses’ rejection of the compact on the same grounds.
Business Unity South Africa (BUSA) CEO Cas Coovadia said that the group does not support the NHI in its current form and has made that explicitly clear throughout the various government processes leading up to Ramaphosa hastily signing it into law ahead of the 2024 elections.
Coovadia said that these inputs were ignored, and questions around funding, coverage, implementation and administration have also been left unanswered.
In addition, BUSA said there has been no consultation on the new compact’s updated wording, which transforms it from a health-system-strengthening focus to a focus on implementing the NHI.
“Add to this the context of legal challenges around the NHI Act, and the government’s recent public statements indicating an openness to engagement on the NHI, (it) makes it all the more bewildering that the Health Compact document has been unilaterally amended and altered in its essence,” the group said.
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