Health Minister Dr Aaron Motsoaledi. The Department of Health has called for vigilance after the number of confirmed mpox cases climbed to 24. (Photo: Leila Dougan) 
The ANC and the DA remain divided on the implementation of the contentious National Health Insurance (NHI) Bill, but it seems the DA has toned down its criticism of the Bill and won’t be heading to court anytime soon.
The NHI Bill, which seeks to introduce universal public healthcare in South Africa, dominated Health Minister Aaron Motsoaledi’s budget vote speech and many of the responses from MPs on Thursday. The ANC and DA failed to come together on the issue of the NHI — with the DA seemingly still pushing back on the current legislation.
“The NHI, in its current form, is unaffordable and needs to be urgently reviewed,” said DA MP Michéle Clarke.
In May the DA said it would pursue legal avenues to challenge the NHI, describing the Bill as a “death certificate for South Africa’s failing health system”. DA leader John Steenhuisen said at the time that the party would take the legislation to court as soon as it had been signed, with the DA’s legal team having been briefed “months ago”.
But it appears the party is no longer in a rush to head to court over the matter, choosing rather to first deal with the issue within the Government of National Unity (GNU).
“The DA will determine what mechanisms are available within the GNU for addressing the issue of the NHI, but we will keep our legal options open,” DA spokesperson Richard Newton told Daily Maverick on Thursday evening.
Read more in Daily Maverick: Relations & Relationships — GNU’s success may depend on Cabinet’s internal dynamics
Motsoaledi said the department had a budget of R62.2-billion for the 2024/25 financial year — a 3.5% increase from R60.1-billion in the last financial year.
The implementation of the NHI will receive R1.3-billion over the medium term.
“Some believe it [the NHI] is a system of health which South Africa is not ready for. Others believe it is a vintage, very expensive health system for which there is no money in the country,” said Motsoaledi.
“Let us clarify once more: NHI is a health financing system which is meant to be an equaliser between the rich and the poor.”
The NHI is unlikely to be a quick process and may take years to implement. However, Motsoaledi said the government would implement the NHI in phases and was already in Phase 2.
President Cyril Ramaphosa signed the NHI Bill into law two weeks before the general elections, on 15 May. The Bill completely overhauls health and will require all South Africans to sign up to the NHI to allow a pooling of private and public spending on health. Daily Maverick’s Rebecca Davis explains the complex piece of legislation here.
Multiple organisations, including the trade union Solidarity, AfriForum, the Health Funders Association and the South African Medical Association, indicated they would legally challenge the NHI Bill, even before it was signed into law.
Read in Daily Maverick: Understanding the National Health Insurance Bill – Six articles to read
In the House on Thursday, Motsoaledi said he knew arguments from MPs on the Bill would be forthcoming. “Even today, we are going to argue that we are not yet ready to implement [the NHI]; we are going to argue that the spear must continue to be sharpened and that we need another commission to tell us what is wrong with our system,” he said.
Clarke described the introduction of the NHI as a “monumental shift”.
“The DA has warned against potential devastation the NHI could cause and urges the committee to thoroughly scrutinise preparatory work funded through the NHI indirect grants; the health system component to strengthen health systems and improve service delivery,” she said.
“The NHI Bill is clear that every health facility must ensure that electronic patient record-keeping must be implemented. But let’s be clear, the implementation of the NHI will not mask the immediate need for transparency, accountability and efficient use of resources in our current healthcare system.”
Ailing health system
Motsoaledi, who was health minister between 2014 and 2019 in former president Jacob Zuma’s Cabinet, returns to a department on its knees. It was clear from the minister’s speech that he sees the NHI as the big fix for South Africa’s ailing healthcare system.
Not all MPs in the House on Thursday were in agreement with Motsoaledi. The opposition EFF argued the legislation was insufficient and would fail to improve public healthcare.
“The National Health Insurance Act, signed into law just before the election, is an insufficient, legislative measure and would only enrich private hospitals and not improve the quality of services in public institutions,” said EFF MP Dr Sophie Thembekwayo.
not support the Bill in its current form and had previously called it a “catastrophic development in the midst of the ongoing collapse of the public health sector”.
Read more in Daily Maverick: ‘NHI is his hammer’ – Mixed feelings as Aaron Motsoaledi returns to the health ministry
Speaking about the litany of problems in the sector, DA MP Karl le Roux said, “Although pockets of excellence remain in the public sector … the news from the ground is dire. Government is failing in its duty in terms of section 27 of the Constitution, to steadily and progressively improve healthcare services for all South Africans.”
He referred to tertiary hospitals in the Eastern Cape which ran out of essential items like syringe needles this week, leaving managers scrambling to find alternatives.
“Too many of our health policies are out of touch with the realities on the ground and are not implementable. And when policies are not implementable, they are not good policies,” said Le Roux.
“The NHI Bill is a classic example of this. The DA fully supports the principles of universal healthcare that underpin the NHI, but we believe that South Africa has neither the capacity or the finances to implement the NHI Bill as it currently stands.”
He urged the department to “focus simply on getting the basics right — that all South Africans attending government hospitals and clinics are seen quickly, treated with compassion and care by qualified, competent health professionals and that facilities are adequately staffed and stocked with essential medicines and other consumables.”
The EFF rejected the health budget vote, while ActionSA MP Dr Tebogo Letlape said the party supported the budget, but “not unconditionally.”
Rise Mzansi MP Makashule Gana said the party wanted the budget to ensure that doctors and nurses were employed; that critical posts in hospitals were filled and healthcare facilities refurbished; that “ethical professionals” were appointed to the department; and that “a concerted effort” was made for the provision of mental health services in primary healthcare facilities and clinics. DM
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