National Health Insurance - 44 technical posts to be filled by January 2023

Forty-four technical positions for South Africa’s National Health Insurance (NHI) scheme have been approved by the minister of public service and administration and the treasury has given permission for R30-million of this financial year’s NHI budget to be used for salaries for the new posts, according to Nicholas Crisp, the deputy director general in the health department responsible for the implementation of the NHI. 

All the positions, which will be filled by people with technical skills — such as economists, public health medicines specialists, actuaries and lawyers — will be based at the health department’s head office in Tshwane, says Crisp, who spoke to Bhekisisa on Health Beat, the centre’s newly launched television programme. 

More positions will become available in the 2023/2024 financial year that will take the NHI’s technical and administrative staff up to a total of 132 staff members, Crisp says. 

The NHI, for which membership will be compulsory, aims to provide all South Africans, permanent residents, refugees, inmates and certain categories of foreigners with the same health insurance, regardless of their income. The scheme will do this by creating a single fund that the government will use to buy healthcare services at set fees from accredited public and private health providers.

Funds will be collected through a combination of taxes, reallocating medical scheme tax credits paid to private medical schemes, as well as provincial health budgets, to the NHI fund. Payroll tax by employers and employees (collected by employers in a similar manner to unemployment fund insurance contributions), will also likely be implemented. 

If the current version of the NHI Bill, which was published in July 2019, is passed by parliament, private medical aids will eventually cease to exist in their present form, as they won’t be allowed to provide cover for the services that the NHI covers.    

The 44 NHI positions will be spread among five directorates — user and service provider management; healthcare benefits and provider payment design; health product procurement; health systems digital information; and fraud management — each led by a chief director. 

Crisp says the health department will advertise the positions in the coming weeks — possibly in mid-August — but it could take months to sift through candidates. 

“Some of these positions are very senior and shortlisted applicants would have to go through various screening programmes and writing of tests, so I’m not expecting that we will be making appointments before December. But we will hopefully have at least some of the posts filled by the start of the 2023 calendar year and the rest by February and March,” Crisp says.  

Because the NHI Bill has not yet been passed by Parliament, only positions with functions needed in the Health Department, regardless of whether the NHI is implemented, will be permanent. The other positions will be five-year contract posts.

“If the Bill doesn’t become law, and staff who were, for instance, appointed to design the package of benefits that the NHI will offer, those employees will be qualified to do other things for the remainder of their contract period,” says Crisp.

“One might argue why was I appointed as deputy director general to implement the NHI before the Bill was passed? The answer is: because somebody’s got to lead the definition and design of the process. You need an administrative process to be able to sustain whatever comes out of the parliamentary decision-making process.”  

The NHI Bill has been widely criticised for