Defend Truth


Be clear South Africa, the window to contest the NHI Bill is closing fast


Kabelo Kgobisa-Ngcaba is a communications consultant based in Cape Town. She previously completed her articles at Lawyers for Human Rights and worked as a researcher in Parliament.

The goal of providing universal healthcare is laudable. In more ideal circumstances South Africa would be able to implement relevant, appropriate legislation, and perhaps more importantly, governance reforms, to achieve this goal. 

Policymakers cannot ignore our reality, and neither should Parliament. The ideal circumstances needed are unfortunately not our South African reality, and the National Health Insurance (NHI) Bill is not the appropriate vehicle to achieve universal care in any case.

Despite our context being painfully apparent, the NHI Bill has recently been pushed through Parliament’s National Council of Provinces (Ncop) without a single amendment. That the Bill was passed in this manner, even though it attracted fierce opposition and public critiques, unfortunately points to a legislative process which has been wholly deficient given the grave consequences that the legislation heralds for the country.

The NHI’s pilot projects, which ran between 2012 and 2017, were meant to lay the foundations for its implementation. They are widely regarded as having failed. A report released after the programme further highlights serious governance issues: clinics which couldn’t connect to the internet because of myriad challenges including a lack of IT staff; a lack of planning and funds to complete new infrastructure; the deterioration of infrastructure due to a lack of maintenance. 

Read more in Daily Maverick: NCOP passes NHI Bill in face of widespread condemnation by health professionals, business and opposition

These are just some of the issues highlighted in the districts which were purposefully receiving attention to improve outcomes. In a painful irony, the report could not conclusively say whether the pilot’s initiatives had improved overall health outcomes, because of data quality challenges. Yet, a government which was unable to measure the success or failure of its own costly NHI pilot has now pushed ahead with the policy’s implementation. 

In this context, far from achieving universal healthcare, it is widely believed the Bill’s enactment will plunge our country’s healthcare system into disarray. From setting prices for health services, determining patient medical choices and managing the purchase of medicines, to deciding which doctors can contract with the Fund, the NHI envisages the state playing the central role in the whole sector. In a country with rolling blackouts, water infrastructure collapse, and crumbling roads, rail and ports, it is clear that the NHI Bill’s implementation would signal a death knell to the health services — both public and private. 

Financial and social disaster

The foreseeable consequence of this debacle will be massive disinvestment in the sector at a point when there is no scope for government investment to make up the shortfall. So rather than ensuring access for those who have not been able to receive quality healthcare, the only universality this Bill will achieve is adding the remainder of South Africans to the ranks of those receiving inadequate care. 

This would also have a severe economic impact, including knock-on effects like the deterioration of the health of South Africa’s workforce. We can also expect an attendant skills exodus from the country as doctors, nurses, and other medical professionals emigrate in search of systems where they can help their patients. Ultimately, those who can will likely leave the country in droves in search of quality health care. This will decimate tax collection and leave South Africa contending with an even bigger skills deficit. 

As worrying as its impact on health outcomes is, the fact that the NHI may also be the tipping point for an already immensely financially stretched state should sound alarm bells across society — even without the NHI Bill, our country’s financial position is tenuous. Implementing it, with estimated costs being in the region of R400- to R700-billion per year (depending on who you ask), would finally break the back of our severely strained fiscus. 

Years of massive bailouts of failing State-Owned Enterprises, paired with high public sector wages, high unemployment and low economic growth which have shrunk government revenue, have already meant serious government budget cuts being tabled for the coming financial year. It is a secret to no one, except seemingly those who have voted to pass the Bill, that South Africa is in no position to fund the NHI.

With the strong, well-reasoned objections to the Bill, the manner in which this Bill made its way through our Parliament should concern every South African. It appears the Bill has been passed at all costs. In fact, recent media reports have cited calls by political leaders urging members of Parliament to pass the Bill through the Ncop without delay, encouraging those with issues to use litigation later to address its defects. This is tantamount to an admission that the work of the houses of Parliament in this case is not to refine legislation nor to ensure it is fit for implementation and constitutionally sound, but rather to simply act as a rubber stamp. 

Unfit for purpose

It is now vital that every part of society, from the private sector and civil society to individuals to recognise that the window of opportunity to raise objections at this final stage in the Bill’s legislative path, before its assent by the President, is very close to being shut. This is not the time to mince words or embark on various forms of ‘quiet diplomacy’.

That every person deserves access to healthcare is indisputable. But we won’t improve the outcomes of all South Africans by destroying those systems that do work to serve political ends. Rather, the emphasis should be on improving and expanding what is already working as opposed to collapsing existing healthcare services.  

We must not conflate opposition to the NHI Bill with a lack of support for better healthcare for all in our country. It does not mean a lack of care for those who have been left behind by the current system. But to break what works in an attempt to fix what is broken is illogical and cannot replace the serious systemic governance overhaul that is really needed in the public health sector. DM

Kabelo Kgobisa-Ngcaba is the Chief Operations Officer at Resolve Communications.


Comments - Please in order to comment.

  • jcdville stormers says:

    Good logic!!!Oppose vehemently

  • Nic Tsangarakis says:

    Don’t break parts of the system that work, and focus on improving the parts that are not. The NHI bill is a huge threat to SA and must be resisted vigorously.

  • Janet Sully says:

    It is frightening how government is pushing this NHI bill through as quickly as possible. There is no logic to this at all. To me it is all about the elections – a desperate attempt to get the masses on side to vote in order to keep the ANC right where it is, running the country into the ground.

    The government health system is in tatters due to mismanagement of hospitals, clinics and funds, corruption, theft, lack of maintenance for buildings and required medical machines. What is the real reason for this haste? There is no transparency here. Is government trying to capture the reserve funds of all the medical aids? Is that what this desperate race is all about? We know the ANC is bankrupt and desperate for funds. There is so much going on under the radar here. No sensible, intelligent member of parliament can possibly think this government can manage to fulfil efficiently, effectively and competently the very costly introduction of the NHI bill and be able to run the NHI sustainably. Is the very small percentage of tax payers going to pay for this? What source is going to be used for the massive amount of funds required for the NHI bill? This is truly worrying.

    Or will all this pressure and pushing for the NHI bill to be passed simply disappear into nothing, once elections are over???

    • Richard Bryant says:

      I think you are right. This is just an election stunt like zuma did with tertiary education. Post the election it will just fade away into the morass of everything else that is broken

      • Confused Citizen says:

        Unfortunately, free higher education WAS inplemented! It was not only electioneering! Universities are clogged with academically illequiped first years that struggle to pass. Others graduate with useless degrees. NSFAS is just another grant scheme to pay money to youths that support multiple people in their family.

  • Wendy Dewberry says:

    If there was ever a show-and-tell for corruption, looks like this is IT.

  • Vincent Britz says:

    The corrupt ANC government will push the NHI bill through no matter what we do or say! The NHI is just another cash cow for the corrupt ANC government that they can loot till it ends up like the rest of SOE in south Africa! The corrupt ANC government is now playing with our very life’s to make themselves rich.

  • John Smythe says:

    It doesn’t matter what we say. It won’t change their minds. One can’t negotiate with those who won’t listen.

  • Doreen Helena says:

    Totally not in the best interest of S.A. Why pushing this bill down our throats it’s totally unacceptable. No wonder all the medical professionals are leaving the country because of this. I strongly believe that it will not work, just like everything else the ANC has touched turns into a complete

  • Rob Rhodes-Houghton says:

    The ANC’s modus operandi to achieve equality for all is, and has always been, to drag everyone down to the lowest level rather than try to raise everybody to a higher standard.

  • jcdville stormers says:

    Communist ideology ,destroy everything and out of the ashes the new ùtopia ,everybody is equal(dirtpoor) except the leadership

  • Matome Azwifheli says:

    Guys, lets be honest. Our government failed all SOEs. Now they want to kill us. Please stop this nonsense.

  • Beyond Fedup says:

    Oppose, oppose to the bitter end! I urge Discovery and all other medical aids, Netcare, Mediclinic, all other private hospitals, business, NGOs, doctors etc. to draw a line in the sand and oppose legally. I would happily contribute to a fund that serves this purpose. As decent and thinking South Africans, we cannot allow this travesty and massive theft/fraud to be enacted. This vile and corrupt “government/party” breaks, destroys and steals everything they lay their parasitic and thieving hands on. Enough!!!


    While I don’t support the NHI I’ve long had a problem with the private health sector where doctors charge different rates depending on which medical aid you belong to and whether it is a PMB condition. There are now third party service providers that actually approach doctors with this service and promising them 30%+ turnover. I can’t help but think that in the end this keeps pushing medical aid prices upwards, which means more people are excluded from accessing private health care. Can’t believe that this is legal.


    NHI will be the end of SA as we know it. Middle class have been able to insulate themselves from failing public sector by paying for private education, healthcare, security and going off the grid. NHI will make it impossible or unaffordable to have access to decent healthcare. Expect a massive increase in emigration. South Africa will be like the rest of Africa. A few thousand politically connected elites that can afford to fly to Switzerland for healthcare and millions living hand to mouth with nothing in between.

    • Cachunk Cachunk says:

      Spot on Johann.

    • Andrew W says:

      this is the exact scenario that too few are talking about. Sure healthcare sector will tank, but the consequences are that those that can go, will go. this as the author sets out. its a doomsday weapon that will reshape SA into another failed state. wealthy political elites and voting fodder, with nothing in between. My sense is this is the actual desired outcome. entrench the cadres, gouge the rest. simple.

  • Pierre Nel says:

    The ANC is an absolute joke. Unfortunately with elections coming this is the only ticket they can wave. I do how ever find the pricing in the private sector a disgrace. 1500 for a cavity to be filled. Insane. Their needs to be some sort of control. I have no doubt that there is some conniving force dictating prices. If all the major banks of our country colluded to manipulate the currency, what else is going on.

  • David Hold says:

    There is a saying that if you can’t beat them join them. The private sector is fighting a losing war as it is simple politics There are about 10 million private sector insured against 40 million uninsured who vote The math is simple Politicians will implement UHC regardless as if it does not work out they will always find somebody to blame it on
    There are viable solutions it is called preventive care and we have developed it but it is disruptive technology with no pedigree that the private sector refuses to even evaluate

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