Government now wants to ‘consult’ on the NHI – while rolling it out

Minister of Health Aaron Motsoaledi has opened the door for consultations on the National Health Insurance (NHI) by promising to embark on “massive roadshows and workshops,” to engage stakeholders who continue to voice their concerns.

Motsoaledi said that while more engagements around the NHI are in the pipeline, the government still has full intention of implementing Section 57 of the NHI Act, which relates to the “transitional arrangements” for the timelines for implementing the laws.

“We are going to implement Section 57 immediately to make sure that we get going with transitional mechanism,” Motsoaledi told journalists at the end of the ANC’s three-day policy lekgotla on 6 August 2024.

Broadly, Section 57 lays out the transitional mechanism of rolling out the NHI between 2023 to 2028. Initially, from 2023 to 2026, it plans to establish the NHI Fund.

From 2026 to 2028, it will focus on “mobilising resources” for the NHI Fund to purchase healthcare services through mandatory prepayment.

As indicated by the bill’s wording, this would ostensibly put the requirement for tax changes and other funding mechanisms into effect from 2026 onward. However, this responsibility lies with National Treasury, not the Health department.

Motsoaledi said that Section 57 deals with establishing institutional arrangements, such as the appointment of a ministerial advisory committee.

“But simultaneously [to implementing Section 57], we intend to run massive roadshows and workshops to meet all the relevant stakeholders and hear their concerns,” said Motsoaledi.

“[Despite] the war raging about NHI, you will never hear anyone say they are against universal health coverage (UHC).”

“They all say they accept UHC, but then there is a big but, and they will say they don’t support it in the form [of the NHI Act]. So, our job is to find out what form they want it in. What is it that if it was on the table, they will go for it?” added the minister.

Prior to this announcement, as well as the signing of the NHI by President Cyril Ramaphosa on 15 May 2024, the government held consultations through public hearings by both the National Assembly and NCOP, as well as intense lobbying from stakeholders.

However, various stakeholders who have supported UHC argue that many of their inputs fell on deaf ears, leading to no real substantial amendments to the laws, which were then rubber-stamped through parliament and onto the president’s desk.

The laws were assented two weeks before the elections.

The NHI Act, although signed by Ramaphosa, has not yet been promulgated. It is possible to promulgate sections of the act at a time. 

The true cost of the NHI and how to fund it remains among the biggest points of contention with the whole scheme.

Estimates from Momentum Health show that delivering comprehensive, quality healthcare to all South Africans through the NHI will carry a massive cost—a conservative estimate of R900 billion.

With the current public healthcare budget at R270 billion, there’s an estimated R630 billion gap that needs to be filled.

Section 33 is another key objection likely to be raised by stakeholders relating to medical schemes.

Section 33 states that once NHI is fully implemented, medical schemes will be able to cover only those services that are not covered by NHI.

Additionally, now that the NHI Act is law, Motsoeledi said that “at least 11” other pieces of legislation —the Health Professionals Act, the Medical Schemes Act, the Dental Technicians Act, the Mental Health Act, and the Traditional Health Practitioners Act among others—need to be amended.

Despite the department’s intentions to roll out the scheme, it is likely to get caught up in litigation, with several groups, including healthcare bodies, unions and businesses organisations, preparing legal challenges, with the intent to take the matter all the way to the Constitutional Court on several grounds.

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