A controversial ‘NHI-focused’ change could hit South Africa – as doctors look at leaving

Trade union Solidarity has slammed proposed regulations that will introduce a ‘Certificate of Need’ for healthcare practitioners in South Africa.

In terms of the new regulations, all healthcare practitioners must apply for a certificate that will enable them to practice. They will then be prescribed where and how they may practice, the union said.

Solidarity said it vehemently opposess these regulations which, as a result of the implementation of the certificate, will threaten ownership rights of private practices.

“The state only has one goal in mind and that is to centralise health care in its entirety,” said Henru Krüger, sector head of the professional guild at Solidarity.

“In its latest regulations, it even goes so far as to threaten the right of ownership that vests with practices through the implementation of its certificate of need.

“With this, the state wants to appropriate the sole right to itself to decide who may provide health care and what health care may be provided.”


Solidarity said that around 70,000 existing practices are affected by the new regulations.

The union argues that the government does not have the capacity to manage the administration, nor is it competent to decide on the nature of care patients may need or are entitled to receive.

It further warned that the implementation of this certificate is nothing but an attempt by the government to centralise the health system, paving the way for National Health Insurance (NHI).

In the process, the government does not take the rights of health practitioners into account at all, it said.

“The government wants to totally control health care. It wants to limit health practitioners in the services they may render, and it wants to subject them to its power.

“Not only does the government deprive them of their constitutional right to choose and practise in their field of specialisation, but it also undermines the rights of members of the public to access the health care of their choice,” Krüger said.

Solidarity is also of the opinion that the publication of the regulations is part of the government’s strategy to enable it to implement national health insurance.

The government’s view that no private health care should be provided, and that the entire private health sector should be absorbed by the public health sector is widely known, it said.

“The way in which the state is dealing with the Covid-19 pandemic has already proven that the state is not competent to manage the current health system.

“By incorporating private health practitioners into the public sector in what basically amounts to forced labour will result in an exodus of skilled medical professionals.

“South Africa’s health care will not improve but will rather deteriorate to such an extent that good medical services would almost not be unavailable.

“The state poses a threat to health practitioners and to the health of all South Africans and this must be stopped at all costs,” Krüger said.

Doctors to leave because of NHI 

The South African Medical Association (SAMA) has warned that thousands of doctors will leave the country ahead of the planned introduction of the NHI.

The not-for-profit group, which represents the interests of more than 12,000 medical doctors in South Africa, said that its members cannot support the NHI in its current form.

This is because of a deep-rooted lack of confidence in the capacity of government and its financial ability to ensure the success of the service, it said.

A survey published by SAMA in June shows that as many as 38% of its members plan to emigrate from South Africa due to the planned introduction of the NHI.

6% of members said that they plan to emigrate for other reasons, while 17% of doctors said that they were unsure about leaving the country.

Other points that were raised by doctors surveyed include:

  • There is doubt that national government is capable of running the system;
  • The NHI will not address the failings in infrastructure and management in the public sector;
  • The NHI is extremely open to corruption and the minister of health has too much power;
  • It is not affordable.

A number of doctors said that the focus should first be on fixing the public sector to a point where it can begin to appeal to private sector patients.

They added that there should be engagement with private doctors to provide additional services funded by the state. The group also called for a proper pilot of the proposed systems and payment mechanisms.

“SAMA is committed to the cause of universal health coverage in South Africa,” it said.

“We have actively engaged in discussions and projects for the improvement of the conditions for patients in both the public and private sectors, quality initiatives, policy discussions and advocated where crises have manifested in service delivery to the country.”

Read: The end of an era for South Africa: Ramaphosa

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A controversial ‘NHI-focused’ change could hit South Africa – as doctors look at leaving