This week Parliament’s Portfolio Committee on Health is in the Western Cape for the second-last leg of the public hearings that began in 2019. After the Western Cape, Gauteng residents will have an opportunity to have their say on the National Health Insurance Bill.
On Tuesday the first stop was Piketberg in the West Coast District. Members of Parliament were shuttled in in air-conditioned white mini-buses in the scorching heat. They only entered the hall at the start of proceedings.
But first, residents had to queue at the Allan Boesak Hall in a predominantly coloured neighborhood of Piketberg with their identity documents to be captured and have their photos taken.
Later inside the hall, parliamentary health committee chairperson Dr Sibongiseni Dhlomo set the scene. What followed was a cringeworthy “Dhlomofication” of one of the most important legislative developments in the country’s public health sector.
For almost half an hour Dhlomo offered those present a dumbed-down version of a rather complicated and deeply contested piece of legislation. This he did on the assumption that the department “already did some groundwork” in explaining the bill to communities. The national Department of Health seemingly did not – at least according to residents that came from as far as Vanrhynsdorp and Klawer. So, it is safe to assume for many of those present, the first real breakdown of the bill was the one presented by the committee chair.
In written submissions and in comments at previous hearings the feasibility of certain aspects of the bill has been questioned. Also, within the ruling party, questions have been raised on how the NHI will be funded given a shrinking fiscus. Fears have been raised that the bill centralises too much power in the hands of the national Minister of Health and that the NHI Fund set to be established may end up as yet another portal for corruption – paving a way for State Capture 2.0 — and this time lives will literally be at stake.
‘ ’n Groot sak geld’
Dhlomo did touch on certain aspects of the fears raised in the public domain. The NHI Fund, one of the key issues in the bill that is fueling fear about possible looting, Dhlomo explained, will be like a “groot sak vir die geld” (a big bag for the money) where all will benefit irrespective where they come from.
“The plan is to have a big pot of money called the NHI Fund.” He says it will mean you can then go to a clinic and nobody will ask you “where is your money?”
“And,” Dhlomo assured those present, “it is envisaged that the fund will be administered by various structures and not by people who are thieves, but who will look after the money for the good of the country”. He, however, failed to explain how exactly this will be guaranteed.
He also took people through some of the committees to be established in terms of the bill and some of the services that will be covered. When he explained what he called the package of service committee, more curious analogies followed.
Dhlomo said some people would want their “fat pulled out” through what is called liposuction and would want to have “vacuum the fat” as a procedure to be added to the basket of services. So, some might think that is a good treatment and others may think it’s better to buy a pair of shoes and run to lose the fat. But if you argue strongly for liposuction, you are free to write to the minister and tell him you want your fat sucked; so, you request the minister to give permission to vacuum your fat, he explained.
Some in the audience chuckled.
Tempering expectations, Dhlomo also reminded people that the bill will be implemented incrementally.
“So, you won’t just wake up one day and see NHI everywhere. But you will see signs of NHI.” Many residents across the provinces have called for government to fix the current health system before NHI as many feel the public health system is failing them.
After Dhlomo’s crash course in the meaning of the bill, it was time for what appeared to be a version of musical chairs. Those wanting to give input were asked to position themselves on brown chairs that were tipped over in two rows in the hall.
Minutes dragged by as bodies and chairs moved around.
A total of 13 people stepped up to occupy the brown chairs. Only 12 got to speak.
When Director for Business Development in the Western Cape Department of Health Michael Manning stepped up to sit right in front and first in line to give his input, Dhlomo quickly stepped in and reminded him that “government” is there to listen as it is “your Bill”.
The Western Cape government, has been vocal in its opposition to the Bill and its stance as a proponent of universal health coverage but qualifying that the NHI Bill is not the ideal way to get there.
Rich versus Poor
Back in Allan Boesak Hall with Manning now back in his seat – a black plastic chair for those who did not wish to speak – resident Laurence Mahlaleni got his turn at the microphone.
Randal Swarts, a local ward councillor, started off by reminding all present that the Western Cape provides the “best healthcare service”. In some of the back rows people were mumbling “Yo” – an expression in Afrikaans evidently milder than outright booing. Members of the public such as Janay de Jongh bemoaned the quality of healthcare services for the rural poor, especially around the farming communities in Klawer. Outside the hall before the proceedings started she called the treatment of the public at some health facilities “undignified”.
Meanwhile, microphone in hand, Swarts expressed concern that the current system is not equipped to handle NHI.
“NHI won’t cure all our problems. We must first look at our current problems before we fail our people again. So, park the NHI for now and let’s fix the current system.” This has been a refrain echoed across provinces.
After Swarts aired his reservations, resident Xolani Mondiwa stressed that he “categorically supports” the bill and took a swipe at rich people.
“It is good for the poor. I know the rich will not support the bill because they do not want to queue with us for services,” he said.
In the next brown chair Thando Beja sat immaculately dressed from head to toe in the green, gold and black colours of the ANC. In her hands she was fiddling with a card with the number 34 written on it. If you are not on a brown chair and do not have a card and number, you don’t get to speak for the two minutes allotted to you.
Up on the stage, however, some MPs appeared far removed and disengaged with some staring at phone screens as people got up from their brown chairs – the irony of a predominantly one-way conversation in a public engagement setting lost on some.
It was when Desmond Philander from Moorreesburg started talking about residents calling the hospital in Piketberg “never come back” that Dhlomo’s interest was piqued. He told Philander to note and elaborate this to officials taking notes at the back. Philander told Spotlight afterwards that some people call the hospital “never come back” because service is so poor you don’t know if you will get to walk out of there again.
Democracy is served
Resident after resident stood up to relay personal accounts, giving a face to an often dysfunctional healthcare system. Some people had valuable suggestions and questions on some clauses in the bill, others only had hope that this will be the start of the great fix and for now, at least, they are being heard.
After all, they are there, seen with the microphone. But are they being heard? That is the question.
Officials sat at long tables behind laptops, taking notes so that complaints aired hopefully don’t just suffer a quiet death somewhere in a hall in Piketberg.
A woman got up to say a closing prayer and somewhere popped in a line asking God “to not let all this be empty promises”.
Afterwards, MPs left the stage for their white mini-buses.
The people went home.
They had had their say.
And officials packed away the attendance register – clear evidence that they were there.
A box can now be ticked.
Democracy was served.
Outside the hall, in her backyard, a resident was hanging clothes on her washing line as proceedings began. She said she was not attending because she still needs to cook before load shedding scheduled to kick in by 19:00.
And so, load shedding was also offered as an explanation for why the public hearing scheduled for four hours from 4.30pm until 8.30pm turned out to be a session that ended around 6.30pm.
I guess sometimes democracy needs to be hurried along.
So, on Tuesday, yet another sun set on public hearings and diminishing expectations of the quality of the democratic process.
*NOTE: This article has been corrected by Spotlight. An earlier version incorrectly stated that in the Free State officials like the head of the provincial health department got a chance to speak at the province’s NHI hearings. In an earlier article we quoted the Head of the Free State Health Department, but the comments we quoted were made directly to our journalist attending the hearing and not as part of the hearing. MC
This article was produced by Spotlight – health journalism in the public interest.