The public hearings into government’s proposed National Health Insurance (NHI) Bill had a rocky start in Mpumalanga recently as civil society organisations and some opposition parties slammed the process. Some raised questions over poor planning and possible hidden agendas. Others raised concerns that the hearings may be a missed opportunity to meaningfully bring the public into the conversation about the bill that is meant to outline the funding of universal healthcare.

A local newspaper, The Bulletin, in the days before the scheduled meetings criticised the Parliamentary Portfolio Committee on Health for failing to communicate the hearing details properly to the public and to media.

Meeting well-attended

Despite a last minute venue change from Secunda to Ermelo (two towns about one and a half hours’ drive from each other) and without prior notice, apologies or explanations, the fourth of the Mpumalanga public hearings in Ermelo was well attended. The hearings were held in the municipal council chambers that were packed with people – reportedly between 800 and 900. The meeting was also live-streamed.

Sfiso Nkala of SECTION27, who’s also the civil society chairperson for the province’s AIDS Council, was one of the people who drove from Ermelo to Secunda on the Monday afternoon to find the shut doors at the Lillian Ngoyi Centre. He had to drive back to Ermelo knowing he would miss the first hour and a half of the meeting.

Nkala said: “It was like an ANC rally, not a public hearing. About 90% of the people were wearing ANC regalia; you can’t help thinking that these people came from the branches and from the ANC alliance partners.”

Asked to endorse NHI

Nkala told Spotlight that when he took up a spot in the line of people waiting their turn at the microphone, there was a person who moved down the line telling the people to have their say but also to state that they endorse the NHI.

“It was like they wanted to make sure that it looked like the NHI Bill had everyone’s approval, it was just a sham.

“My biggest worry is that people have not been given any information so that they can ask informed questions about this bill,” said Nkala.

A ‘managed democracy’

Thami Nkosi, Right2Know campaign manager, said the shambles of the Ermelo public hearings amount to a “watered down version of public participation that is an indictment on the ANC and on opposition parties who are not holding the ruling party to account”. He said the public hearings should not be reduced to political rallies, or manipulated processes of public consultation in decision making.

Nkosi added: “When politicians act with their own political interests rather than for the public and the most marginalised then we are left with a managed democracy, not a true democracy.”

Alleged ANC propaganda

DA MP Siviwe Gwarube, who serves on the Portfolio Committee on Health, also slammed the hearings as “deeply politicised”. Gwarube said in a statement the hearings sought to mislead the public about the legislation in order to sway their inputs.

“Parliament produced a leaflet that was not signed off by the Portfolio Committee, which sought to educate people about the bill but instead advocated for the passing of the bill. This is a complete betrayal to the people of South Africa and undermined the work that Parliament is meant to do.”

The Afrikaner and minorities rights group AfriForum was also critical. Its spokesperson on National Health Insurance, Natasha Venter, said:

“How did they get so many people to the meeting when the general public didn’t know about the changed venue till the day? The pamphlets were also only in isiZulu and it was essentially a script of ANC propaganda about NHI funding. They didn’t tell people about how unsustainable NHI will be; only that people will be able to get referred for private healthcare – of course everyone wants to hear that. It seemed from the start that these hearings are about reaching an outcome that push through the NHI, without really being truthful to the public.”

AfriForum also complained about the venue being changed without prior notification; the fact that on the night there were only pamphlets in isiZulu; a lack of translation services offered for a public meeting that was conducted in isiZulu; and that the hearings were cut short by an hour and half despite the hearings being set down for four hours.

‘Quite a good level of understanding’

The chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo, said the change of venue from Secunda to Ermelo came from the municipalities and was not in Parliament’s control. He said he knew eight days before about the venue change.

Dhlomo explained that isiZulu is the dominant language in Ermelo, which is why the meeting was conducted in isiZulu. According to him translations were “offered simultaneously” for those who requested it. Dhlomo said pamphlets that were distributed on the night were only one part of public engagements undertaken by the provincial department of health. He didn’t have a direct answer as to why the meeting ended an hour and a half early, despite people being in the queue to speak.

“We found that the people at the hearings had quite a good level of understanding of the bill,” said Dhlomo, who was previously the MEC for Health in KwaZulu-Natal.

Despite the hearings already under way, he said it is too early to comment on the criteria he and his team are using to measure the success of the processes by which the public hearings are being run.

“We are parliamentarians; all we are doing is listening to what people are saying so that we can collate that feedback and take it back to the Speaker of Parliament.”

Skipping steps?

The Gert Sibande district in Mpumalanga was one of 10 districts in the country where the NHI was piloted in 2011/ 2012. In 2016 the organisation Section27 undertook an evaluation of the programme.  At the time the overriding conclusion was:

“The piloting process in Gert Sibande has shown very limited success and provides important lessons for NHI as a whole although the infrastructural, human resources and governance weaknesses in the district are far from resolved. More fundamentally though, NHI requires more than a few ‘tweaks’ to the funding system for health.”

Now, three years later, these concerns remain.

“It is as if steps have just been skipped,” said Nkala. “There hasn’t been logical progression to get to the point of an NHI Bill being under discussion.”

He said key issues surrounding corruption and misappropriation of funds for the public health sector have not been addressed, likewise the training and retention of nurses and doctors. According to Nkala, people have also not been advised about their rights to a better health service.

“Most people don’t know they can fill out an official complaint about a clinic or a hospital and those who do know are unlikely to find a complaint form in any of our hospitals.”

Nkala proposed that the hearings that are scheduled for four-hour sessions should include a short but sound explanation of the bill, to help people better understand its contents.

It also emerged this week in Parliament that subsequent meetings in the Northern Cape were poorly attended, with only 10 people attending in De Aar  and 60 in Upington. MC

This article was first published in Spotlight.

Note: A SECTION27 employee is quoted in this article. Spotlight is published by SECTION27 and the Treatment Action Campaign but is editorially independent – editorial independence that the editors guard jealously. Spotlight is a member of the Press Council.