In a groundbreaking move for South Africa’s healthcare system, President Cyril Ramaphosasigned the National Health Insurance (NHI) Bill into law on Wednesday, 15 May, at the Union Buildings in Pretoria. Following this controversial milestone, the minister of health, Dr Joe Phaahla, addressed the media, responding to questions about the NHI’s implementation and its impact on the health sector.
Health For Mzansi has shortened and lightly edited the media’s questions and Dr Joe Phaahla’s answers:
With the term of office ending for the current government, what are the implementation transition plans in place?
Dr Joe Phaahla: While government and parties may come and go, the state remains. When you pass legislation, it becomes an act of the state. Even if there may be changes within parties, the state and government remain. The president has signed the law, so it must be implemented. Whoever comes to the political desk will find it and must implement it.
When the NHI is in full swing, where does that leave medical aids and those covered by medical aids?
We want to say to everybody that this is a process, and when it is ready, you will be informed. The medical schemes are still relevant, and even if there are changes of responsibility, the changes will be made accordingly.
Keep your medical scheme; everything will be transparent the day it reaches certain reduced coverage, and the ministry will announce when all basic services are covered.
For an ordinary person sitting at home, wondering if they’ll have a choice of which hospital they’ll be treated at. Can you clarify that?
As the programmes for actual implementation start rolling out, everything will be communicated. We are bound by our own institutions and laws to make sure there is public participation. We just want to tell people to be patient; the changes are starting, and in not very long distant time you’ll be able to see them.
How will you ensure the NHI funds will not be looted or stolen like the Covid-19 funds?
Already, even before this signing about three years ago, there was already a health centre anti-corruption forum that had been established. But with the control systems, we definitely are committed to making sure that through all the various accountability systems it will be reported to parliament on a regular basis, so it can be caught at any time if there is something suspicious and called to parliament to account.
Please clarify how long exactly it should take. Expand on the timelines.
So the bill speaks of two phases with timelines. The first phase is from 2023 to 2026, and this first is to deal with the establishment of the institution, accelerating the strengthening of the health platform and all other basic instruments, many of which have already started.
We are implementing various quality improvement programmes in all provinces, from the primary health level right up to specialised health services. Equipment, digital X-rays – in all provinces, those improvements are being rolled out.
Some elements of actual programmes should start even in the first phase. But when it comes to the second phase, it must be a more intensive conclusion of actual implementation programmes in terms of contracting services.
Even though we have free services at clinics and community health centres, there are still a lot of primary health services that are not part of our package, like not enough audiologists, dentists, orthopaedics, and even GPs, so we need to get such in order first.
Please explain the practicality of how it’s going to work for the public.
Essentially, in practical terms, what we are saying is that moving forward, we want to start building a system where all the citizens of this country will be able to be on a reliable system of registration through which they can be able to go to various facilities. We are also quite advanced in including a biometric system.
We will be able to modernise even the health information system so that, as long as you are registered in the system, you’ll be able to access services when you need them at an appropriate level.
So if you’ve got a headache, you’ll be able to approach your nearest clinic with your ID or your nearest GP if that GP is registered. With your permission, through your biometrics, they’ll be able to even see your medical history, and through that, you’ll be able to be assisted once the system is operational.
It seems there are at least 6–7 challenges that we can expect in court following the signing of the NHI Bill. Can you explain, in your opinion, what you believe is the resistance to the NHI?
This is a real radical departure; therefore, when you want to move from a comfort zone, there will be a lot of people who will be unhappy, as people are used to a certain way of doing things.
But there are also vested interests, so anything that challenges that comfort is going to be a challenge to these organisations, so we accept the fact that that is so. But as the president mentioned, we are in a democratic country, and the courts are part and parcel of our democracy.
We are dealing with serious vested interests, so we do acknowledge the fact that they believe they have a point. So we must be ready to go and present our case.
ALSO READ: Explainer: How the NHI will impact South Africans
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