The National Health Insurance (NHI) Act, Act 20 of 2023, aims to establish a National Health Insurance Fund to provide universal access to quality healthcare services in South Africa. The Act intends to create a system where the government purchases healthcare services from both public and private providers. It also aims to ensure equitable, effective, and efficient use of the Fund’s resources to address the population’s health needs.
The NHI Act is a significant piece of legislation aimed at transforming South Africa’s healthcare system. It aims to provide universal access to quality healthcare services. It is an Act of Parliament; it is here, and those opposed to its implementation can best be described as selfish.
》Those opposed to the NHI are like the apartheid killers in the military and police force and their political leaders who enjoy the fruits of freedom in luxury whilst freedom fighters are facing abject poverty on a daily basis.
》Those opposed to the NHI are similar to freedom fighters who sold the masses to capital for the material luxuries earned from state coffers.
》Those opposed to the NHI are like the judges who question political decisions made by Parliament and yet they do not want their own decisions questioned.
South Africa of today is not the country enjoying the freedom that Chris Hani died for. Hani was clear that his greatest fear is that once freedom arrives, the freedom fighters will be assimilated into the system at the expense of the masses. Those freedom fighters whom he knew very well have not disappointed Hani…
I digress… South Africa is a country in the world with the highest number of people infected by HIV. This is nothing to celebrate. It must make us all cringe and push us to ask the question – senzeni na? We are doing all we can to triumph against HIV, but our efforts are not enough. Whilst we want to treat ourselves out of HIV by using the roll-out of antiretroviral treatment as prevention, we are doing very little on prevention. When we deal with the plethora of choices available to us, especially the youth, and see them as part of the extension of the objectives of apartheid architects of conquering the minds of the oppressed, we will win. By the way, sadly, South Africa is the most unequal country in the world. Another blemish to who we are as a nation that had so much hope, dreams and wishes in 1994!
This digression is important for us to understand that apartheid didn’t end in 1994. Since 1994, through the Reconstruction & Development Programme, we wanted universal health coverage. The NHI is South Africa’s choice of universal health coverage. It took us 30 years for the NHI to be enacted as an Act of Parliament, and that is a disgrace – that with political power, our freedom fighters in control of the levers of state power were powerless to deliver to us what they promised 30 years ago. Now that the NHI is here, those who are beneficiaries of freedom, including the judges who enjoy the benefits of Parmed (a medical aid for MPs, MPLs and judges), see it fit to question something that took 30 years to be realised.
In a rare and courageous move, Botswana’s President Duma Boko has openly praised Captain Ibrahim Traoré, the young revolutionary leader of Burkina Faso, for his unwavering stand on African sovereignty and unity. South Africa stands at a crossroads of meeting the aspirations of the majority by doing what was promised in 1994 or face an unled, unpredictable revolution by the people. Voices like that of President Duma Boko and actions of leaders like Traoré are rewriting the future. At the end of this week, we will see whether President Cyril Ramaphosa’s visit to the USA to meet with President Donald Trump will assert his leadership or be turned into a joke via X even before he returns to South Africa. From where I stand, it is a visit not worth making.
The NHI is here, but its implementation and impact are still subject to ongoing debate in privileged spaces, in the biased media and going through scrutiny from decisions of unelected judges. Ascribed to the work of Juvenal, we must ask these judges “Quis custodiet ipsos custodes” – who judges the judges? Sinijongile…
The implementation of the NHI must move very fast to ensure that the following are delivered and enjoyed by all South Africans:
- Universal Access:
The Act aims to provide healthcare services to all South Africans, regardless of their income or social status. - National Health Insurance Fund:
The Act establishes a central fund that will be used to purchase healthcare services from both public and private providers. - Mandatory Contribution:
All South Africans will be required to contribute to the NHI Fund. - Phased Implementation:
The NHI Act will be implemented gradually, having started in 2024 and becoming fully operational by 2028. - Funding Sources:
The Act allows for various funding mechanisms, including payroll taxes and a surcharge on personal income tax. - Benefits Coverage:
The NHI Fund will cover a set of pre-determined healthcare services and treatments, ensuring that users do not have to pay at the point of care. - Role of Medical Schemes:
The Act specifies that once NHI is fully implemented, medical schemes will only be able to cover services not covered by the NHI. - Contracting Units:
Contracting Units will be responsible for monitoring the disbursement of funds to healthcare providers and facilitating the integration of public and private healthcare services.
The NHI Act has sparked concerns about the impact on the existing shortage of healthcare workers and the potential for a further exodus of qualified medical professionals. Those who want to leave can follow the 49 Afrikaners who went to get refugee status in America and elsewhere. When they find themselves, they will find us here in South Africa making the NHI work. Sithi hambani nizobuya!
There are also concerns about the financial viability of the NHI and the potential for increased taxes. This is just scare tactics by those who languish in privilege that the current systems deliver to them. The NHI is financially viable from the resources that are currently in circulation. The cost of healthcare in the private sector is insane, and when costs are regulated, we will all enjoy access to quality healthcare.
The NHI Act has also been criticised for its potential to create a two-tiered healthcare system, with the NHI Fund primarily serving lower-income individuals. The NHI will dismantle the current two-tier health system – one private and one public. We will have one health system that will ensure that healthcare is not seen as something to make money from investments in the stock markets, but a provision of quality services by dedicated health professionals and healthcare managers serving the people. Those who are opposed to the NHI – the doors of the Republic of South Africa are open for you to leave and go wherever you want, only to arrive there and find those countries implementing their own universal health coverage. When you wake up to this reality, you will then return home to be part of the solution we have to make succeed – which is the NHI.
Mabalane Mfundisi
Founder and Executive Director of Show Me Your Number
