Cape Town residents voice their views on the NHI

Cape Town residents, civil society organisations, political parties, traditional healers and healthcare workers made their views heard at the Cape Town leg of the National Health Insurance (NHI) public hearings that are currently taking place in the province. The public hearings kicked off in November last year in KwaZulu-Natal.

At the start of the hearings, Sibongiseni Dhlomo, the chairperson of the Committee on Health, explained the purpose of the hearing. “We are tasked by the speaker of the National Assembly to conduct these public hearings to get your input so that the document can later be processed in Parliament. NHI is based on the World Health Organisation’s policy of universal coverage,” Dhlomo said.

Dhlomo, who is a doctor by profession, told the crowd that packed the Khayelitsha Multi-purpose Centre that the NHI is the financing system that will ensure all South African citizens, permanent residents and prisoners are provided with essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund. He also said that asylum seekers would only be provided emergency medical attention from the fund.

Parties use the hearings for political point scoring

Ward councillors from both the Democratic Alliance (DA) and the African National Congress (ANC) were among the first people to voice their views. The DA councillors are against the NHI as they see it as just another opportunity for the leaders of the ruling party to steal from the public purse. Mayoral Committee Member for Energy and Climate Change, Phindile Maxiti, asked where the money will come from to fund the NHI and said that the bill is not clear on the role of medical aid schemes.

Former mayoral committee member and now a proportional representation (PR) councillor, Anda Ntsodo, said that he is totally opposed to the NHI bill as it will open opportunities for more corruption. “Annually 22-billion rands gets lost to corruption. The national government is failing the SOEs (state-owned enterprises),” Ntsodo said.

Another DA PR councillor, Ncumisa Mahangu, said that the country is in turmoil as a result of corruption. “The country is in turmoil – look at what is happening at Eskom. This NHI would be our way of giving money to the corrupt,” she said.

An ANC PR councillor, Banele Majingo, said that he supports the bill because it will benefit the most needy, especially the unemployed. “I’m prepared to contribute to the NHI fund so that our people can have access to healthcare,” he said.

ANC ward councillor in Khayelitsha, Patrick Mngxunyeni, said that he supports the bill because it is about caring for the poor. “The people who are dying the most and could have been saved if they had access to healthcare is the poor in both the urban and rural areas,” he said.

NGOs in the health sector provide nuanced arguments

Most of the representatives from different non-governmental organisations that operate in the health sector said that they support the bill but were concerned about the fact that it gives too much power to the minister of health and that there won’t be any civil society, labour and community stakeholders in the NHI structures.

Andile Madondile from the Treatment Action Campaign (TAC) said the organisation supports the bill but they want the centralisation of powers in the minister of health to be reconsidered. Madondile also questioned the results of the pilot phase. “What were the results of the pilot sites – have they been considered?” he asked. NHI pilot projects were rolled out in 11 health districts countrywide between 2012 and 2017.

Another representative from the TAC, Phumeza Rhuneyi, said they are concerned that most healthcare centres in Khayelitsha have failed the accreditation process. The Office of Health Standards Compliance audit report revealed that most healthcare facilities were not compliant with NHI accreditation standards. An audit of nearly 700 public facilities recorded 99% of them as non-compliant with NHI accreditation standards.

Tinashe Njanji from the People’s Health Movement said that even though the NHI would be about closing the gap between the private and the public sector, the fact that few public healthcare facilities were non-compliant with NHI accreditation means that most of the facilities that would be accredited are in the private sector. Njanji said that public healthcare facilities in rural areas would also be non-compliant.

“It means that a clinic in Lusikisiki in the Eastern Cape would be non-compliant whilst a clinic in Cape Town would be compliant. Also, it is important to have a functioning and corruption-free state for the NHI to be successful. We need to fix the current problems in the public healthcare sector,” he said.

Njanji said that as the PHM, they think that the NHI would be successful only when government departments work together. “The Department of Human Settlements, for example, has to make sure that people have decent houses, Water and Sanitation has to ensure that people have access to clean water and the police need to prevent crime,” Njanji said.

Mary-Jane Matsolo from the Healthy Living Alliance (HEALA) said that they support the bill and that HEALA calls on the government to tax the sugary drink industry to fund the NHI. According to Matsolo, in 2016 they called for a 20% levy on sugary drinks but they only got 11%. “The government has already collected 20-billion rands but we are not sure what that money is spent on. We want it to be put back into public healthcare. We are also putting the 20% back on the table and we expect that the minister of finance would make pronouncements on this in the budget speech,” she said.

Unions and traditional healers

Unions in the public healthcare sector said that they support the bill. Provincial Deputy Secretary of the National Education Health and Allied Workers Union (Nehawu), Emilia Maloi, said that the union’s concern is how the issue of staff shortages at public healthcare centres would be solved.

Lungisani Mani from the Democratic Nursing Organisation of South Africa (Denosa) said that they are ready to implement the NHI but added that skilled clinicians like nurses and doctors should be part of the 11 board members that the minister of health will appoint.

Ntombomzi Sikhakhane from the Traditional Healers Organisation said that they are disappointed that the bill does speak about them because most people consult traditional healers.