Elri Voigt and Alicestine October for Spotlight
On 5 February 2020, residents of the Cape Town metro descended on Khayelitsha, filling the CBD Hall near the Khayelitsha Mall with patches of blue for DA supporters; red for SACP and some unions; green, yellow and black for ANC supporters; and white for those representing the health workers’ community. The result – a colourful hall that looked like a Smarties box with representatives from Non-Profit Organisations (NGOs), ward councillors, traditional healers and medical personnel scattered in between.
Also in attendance was Dr Beth Engelbrecht, the Head of the Department of Health in the Western Cape and the man who will take over from her on 1 April, Dr Keith Cloete.
Dr Sibongiseni Dhlomo, chair of Parliament’s Portfolio Committee on Health started by introducing the bill, as he had been doing at previous hearings. Dhlomo’s explanation of the bill was littered with analogies that at times had some audience members in stitches. Engelbrecht too, at times looked dumbstruck and shook her head in disbelief while Dhlomo was explaining the bill.
It was when the chairperson referred to the people who will administer the proposed NHI Fund as those who should be “corruption-free, respectable people”, that some people in DA colours made heckling noises. Others saw it fit to take a power nap during this time.
After Dhlomo’s introduction, more than 80 people got up to present their comments to the committee. The proceedings at times got so rowdy, the chairperson had to intervene. Speakers could convey their submissions in their mother tongue, but presumably in an attempt to save time, there weren’t translations of every input made. Also in what appeared as an attempt to keep the order, Dhlomo said people can leave after they had given input, which meant halfway through the proceedings, the crowd had significantly thinned out.
Many of the speakers got drowned out by the noise from the floor and pockets of people standing in the gallery on top of the hall. Some were cheered on, others were heckled, depending on who was agreeing with whom. This interaction was often split along party lines with those in blue cheering those mostly opposed, or questioning aspects of the bill. Some in ANC T-shirts cheered those who stood up in support of the bill.
During the almost three hours of proceedings, residents pitted rich and poor, those with medical aid and those without, against each other as accusations were exchanged. One resident was visibly upset and pointed to Engelbrecht and other senior provincial health department officials in the gallery and accused the DA government of spreading “misinformation”.
“Shame on you! Shame on you for misleading us on this bill … it is just disgusting,” she said waving around a piece of paper while pointing at the officials in the gallery. Engelbrecht leaned forward, listening to the visibly angry woman being cheered on by the crowd. The woman submitted papers to the committee, which she claimed showed clear evidence of this disinformation.
A representative of the South African Youth Council said he is concerned about how NHI will be fully implemented in the Western Cape when there is such “distortions”.
One resident who introduced himself as a member of Black First Land First (BLF), accused those who opposed the bill of being “gatekeepers of white monopoly capital”. Another resident from Site C and the Khayelitsha Health Forum accused those opposing the bill as being “against equality” and he called the “brainwashing” unpatriotic. Another woman said: “We have been separated by colour, now by money. This must come to an end.”
A woman who introduced herself as a member of the National Education, Health and Allied Workers’ Union (Nehawu), reminded everyone that healthcare is a right. “You can’t sell healthcare. It’s not bread.” Other residents cloaked in red capes representing the traditional healers, among others things, wanted to know how their facilities will be accredited and how their traditional medicine, and treatments will be handled in terms of the bill.
Representing the nurses’ union – Democratic Nurses Organisation of South Africa – Lungisani Mani expressed support for the bill and said healthcare workers are ready to receive patients under NHI. Some community health workers dressed in white, however, expressed concerns that NHI will not “automatically improve healthcare”. “All this government cares about, is filling their own pockets,” said Laeticia Slabb, a community healthcare worker.
Treatment Action Campaign (TAC) member Andile Madondile expressed his concern over the powers the bill will give to the national minister of health and asked for it to be reconsidered. Some residents wanted to know how people living with HIV will be catered for in the bill.
Other residents had clear proposals on where the government should get money to fund NHI. The question on where the money will come from to fund NHI has been one of the concerns raised by many. Mary Jane Matsolo, advocacy and campaigns coordinator at the Healthy Living Alliance (Heala) proposed two sources of revenue for NHI.
“We support the NHI fully, but we also come with advice on how to collect even more revenue to ease the burden on us taxpayers. First the Health Promotion Levy. And the second way to collect even more revenue is by taxing the unhealthy food and drink industry,” she said.
Tinashe Njanji from the People’s Health Movement, said they support the bill “in principle”, but identified issues of concern. Among these concerns were the minister’s powers provided for in the bill, the need to include communities as stakeholders and to fix the present healthcare system.
Nearing the end of the evening after a litany of accusations, suggestions, and political and class posturing, it looked like those in favour of the bill had the greater numbers. MC
* This article was produced by Spotlight – health journalism in the public interest.