The proposed National Health Insurance (NHI) solution to South Africa’s healthcare challenges continues to encounter substantial impediments.
This week, the North Gauteng High Court granted a costs order against the Department of Health in Solidarity’s case against the Certificate of Need (CoN), a cornerstone of the proposed NHI. This comes after the department applied to set aside this court’s judgment, with a costs award made earlier this year declaring sections 36 to 40 of the National Health Act unconstitutional.
Following sharp criticism of the department, the court ruled that the case be postponed pending a decision on Solidarity’s application to the Constitutional Court to ratify the earlier ruling by the North Gauteng High Court.
According to Solidarity, the High Court’s initial judgment was a milestone victory protecting the constitutional rights of health practitioners across the country. Sections 36 to 40 of the Act determined that health practitioners must be in receipt of a CoN issued by the department before they may establish a practice in a specific area.
“The state’s aim with it … is to ensure that everything is managed centrally. This objective has been clear all along, especially in relation to the NHI – the state wants to increase its power over the health sector and practitioners working in the sector,” said Anton van der Bijl, Solidarity’s deputy chief executive for legal matters.
“Sections 36 to 40 of the Act would empower the government to set requirements, in essence empowering the government to almost completely capture medical practices and to run them at its discretion – rather than that of doctors. We cannot simply sit back hoping that the government would always exercise its wide discretions responsibly. The government should not have such powers at all.
“The department launched this application today because they had no other choice; the certificate of need was an integral part of the proposed NHI. Without it, they cannot tell doctors where and how they should practice. The medical sector in South Africa does not need yet more bureaucracy. We actually should empower and encourage our healthcare practitioners. This type of legislation leads to ineffective care, a sicker country, and an outrage among medical staff, whose rights are being trampled on as a result of this, but the department chooses to ignore this and continue the fight,” Van der Bijl said.
DA threatens legal action if NHI Bill is passed
The Democratic Alliance (DA) said on Tuesday it will pursue legal action if the government passes the “disastrous” NHI Bill.
DA shadow minister of health Michele Clarke said the NHI Bill is completely out of touch with reality, as South Africa cannot afford to implement NHI. Opposition parties are yet to see an up-to-date costing model or feasibility study that takes into account the damaging effects Covid-19 had on the country’s economy or the possible effects of the looming recession.
The DA said that if the ANC uses its majority to bulldoze the NHI Bill through the Portfolio Committee on Health and both Houses of Parliament, the DA will challenge the legality of the bill in court. This decision was taken after deliberations in the health committee ended and the ANC did not accept any material changes to the bill, despite overwhelming opposition from the majority of opposition parties.
The DA said although it has championed universal healthcare, the NHI Bill, in its current form, will fall dismally short of achieving this objective.
“Instead, what we will see is the public healthcare infrastructure being even more underfunded and patients dying en masse from the lack of services available to them.”
The DA is of the view that the Act will result in large-scale corruption, as the Act will establish a fund that will pool the Health Department’s funding for the entire country under one entity without any guarantees that proper oversight and internal controls will be implemented.
“A fund of this size, without sufficient controls against looting and corruption, will see a state capture that is even greater than the one under Jacob Zuma’s reign,” said Clarke.
Last month, Health Ombud Professor Malegapuru Makgoba told the Portfolio Committee on Health that, having visited all nine provinces in the past year, he found deteriorating health services in all but the Western Cape. Something like 89% of hospitals in the country do not conform to the requirements set in the NHI proposals.
According to an EWN report, National Treasury’s acting director-general, Ismail Momoniat, said state capture corruption is so entrenched in the government that budgets are often looted before they are spent on service delivery.
Momoniat referred to what happened at Tembisa Hospital, where a number of financial irregularities were under investigation.
“I think the important thing is that we also respond too slowly, so even if there is consequence management, our investigative processes take too long. In this instance, you saw all the payments in Tembisa Hospital. I believe the system can act much faster,” said Momoniat.
This call comes too late for corruption whistleblower Babita Deokaran, who was gunned down after exposing some of the rot. This shows the ends to which those facing exposure will go not only to escape prosecution, but also to continue looting.
No doubt the President was “shocked” when he heard about this, as he had indicated that there would be checks and balances in place to prevent looting of the centralised funds.
The root cause of the problem was possibly identified by Spotlight editor Marcus Low, who noted that several provincial health departments “have stumbled from crisis to crisis over the last decade, with no sign of sustained or meaningful improvement”. One reason for this, he argues, is political interference and the cadre deployment and cronyism that usually accompany it. If this is correct, is it realistic to think we can address the dysfunction in our health departments without addressing the politics behind it?
With vital elections looming, do not hold your breath.
