Minister of Health Dr Aaron Motsoaledi (pictured) has published proposed regulations that provide for appointing members to the board of the National Health Insurance Fund.
The proposed regulations were published in Government Gazette No. 52224 on 6 March, as provided for in section 55(1) of the NHI Act.
The NHI Fund, the financial cornerstone of NHI, will purchase healthcare services from public and private sector providers.
President Cyril Ramaphosa signed the NHI Act into law in May 2024, but none of its provisions has yet to be brought into effect.
Business Day quoted the Department of Health’s deputy director-general for NHI, Dr Nicholas Crisp, as saying the draft regulations have been gazetted “so that when the relevant sections of the Act are promulgated, the regulations are ready”.
Four organisations have brought applications to declare the NHI Act unconstitutional. The case by the Board of Healthcare Funders (BHF) got under way last week. Papers have also been filed by the South African Private Practitioners Forum, trade union Solidarity, and the Hospital Association of South Africa.
Read: What the BHF and HASA are arguing in their legal challenges to the NHI Act
The BHF, which represents more than 40 medical schemes and administrators covering 4.5 million beneficiaries, said it was disappointed that the Department of Health “continues to forge ahead with the implementation of the unworkable, unaffordable, and unconstitutional NHI Act” instead of working with the private healthcare sector to find sustainable ways to address the country’s healthcare needs.
“Following his signing of the Bill into law, President Ramaphosa committed to engaging with stakeholders on their concerns regarding the legislation. However, it appears the president and minister Motsoaledi have continued to ignore all well-reasoned arguments that have been made by various groups, including the BHF, on why the NHI Act is unconstitutional,” the BHF said in a statement on Friday.
Solidarity said Motsoaledi “is persisting with a financially unsustainable project” while the Minister of Finance is “taking desperate measures to limit budget deficits, and tax increases seem to be inevitable”.
Spokesperson Theuns du Buisson said the successful implementation of the NHI is “unrealistic”, so “any appointments in this regard should be regarded as futile”.
The draft regulations provide for the appointment of the board of the NHI Fund (established by Chapter 4 of the Act), the fund’s chief executive (Chapter 5), and two advisory committees: the Benefits Advisory Committee and the Health Care Benefits Pricing Committee.
They also provide for the establishment of an ad hoc advisory committee that will conduct public interviews of candidates short-listed for the board.
The members of the committee are appointed by the Minister of Health for up to four years. The ad hoc committee comprises between four and eight members and is chaired by a retired judge (appointed by the minister).
The draft regulations say nominees for the ad hoc committee must be identified by the statutory health professions councils, actuarial associations, the South African Institute of Chartered Accountants, and the health science and commercial faculties of higher education institutions. The nominees must also “broadly reflect the diversity of the Republic”.
Appointments to the board
The Minister of Health will issue a call for nominations to the Fund’s board, which consists of up to 11 members. To be eligible to be nominated, a person must not be a member of a national or provincial legislature or a municipal council. Sections 13(5) and sections 16(1) and (2)(a) of the Act set other requirements for nominees.
A person must be nominated by at least five natural or juristic persons.
A nomination committee established by the Director-General of Health will draw up a shortlist of recommended candidates, which will be submitted to the ad hoc advisory committee.
The committee will recommend its chosen candidates to the Minister of Health, who will submit the names of the board members to the Cabinet for approval.
The minister, after consultation with Cabinet, will appoint the chairperson of the board from among its members.
The board must establish a nominations and governance committee that will recruit the Fund’s chief executive. The committee must submit a shortlist of candidates to the board, which will interview the candidates and decide who to recommend to the Minister of Health. If the minister accepts the recommended candidate, he will send the recommendation to the Cabinet for approval.
Two advisory committees
The Benefits Advisory Committee (established by section 25 of the NHI Act) will determine and review the healthcare benefits and types of services to be reimbursed at primary healthcare facilities and at district, regional, and tertiary hospitals.
The Health Care Benefits Pricing Committee (section 26) will advise on the prices that the NHI Fund will pay to providers for health service benefits.
Each committee has between 16 and 24 members and a chairperson appointed by the minister.
The minister will issue a call for the statutory health professions councils, actuarial associations, the South African Institute of Chartered Accountants, and the health science and commercial faculties of higher education institutions to identify people who can serve on the committees.
Nominations must be submitted to the chief executive, who, after conducting a due diligence of each nominee, must submit a list of nominees to the board. The board will interview the nominees and recommend candidates for appointment by the Minister of Health.
The public has three months from the date of publication of the regulations to comment. Click here to download the Notice, which includes information on how to submit comments.
