What started as a marathon has turned into a sprint. After over a decade of policy documents, each iteration being further denuded of detail and meaning, and with little apparent attention to legitimate comments and concerns, the National Health Insurance Bill looks likely to be rushed through the legislative process following its hasty presentation to Cabinet tomorrow.
The draft NHI Bill was finally published for comment in June 2018 with interested parties (everyone in South Africa) being given only three months to make submissions. Requests for extension by TAC, SECTION27, RHAP, PHM and others to allow for proper consultation were ignored. Further requests by SECTION27 for transparency about the number and type of comments made have also been ignored.
Just two weeks after the final date for submissions (21 September 2018), a version of the Bill amended by presidential advisor Dr Olive Shisana without the knowledge of the Director General of Health and without consultation with the Minister of Finance was leaked, together with a letter from Treasury complaining about this change in direction. This version, prepared so soon after the submission deadline, cannot have taken into account the likely hundreds of submissions made by interested parties across the country. It was also, interestingly, prepared before the Presidential Health Summit of 19 and 20 October 2018, at which delegates made clear the need to focus on system improvement aimed at fixing the crisis in public health rather than on legislation.
Now we understand that the Bill will be presented to Cabinet tomorrow for approval – the final step before it is presented to the legislature. The legislative development process has been removed from the office of the Director General, who bravely spoke out last week about being side-lined by the presidency and her subordinates. We also understand that the Bill has not been discussed in the National Health Council – the body established by section 23 of the National Health Act 61 of 2003 to advise the Minister of Health on policy and on proposed health legislation (before it is introduced to the legislature).
Having ostensibly provided so many opportunities for comment, the comments made over the past decade do not appear to have been taken into account, either between the Green and White Papers and the Bill or after the draft Bill was published for public comment. This makes a mockery of public consultation as required by the Constitution and opens the Bill up to future attack and delay on these grounds.
Pro-poor civil society organisations and healthcare professionals have consistently argued that government needs to focus on fixing the crises in private and public health rather than on hastily passing legislation that, in its current state, takes the country in the wrong direction.
In other countries where national health insurance schemes have been implemented without proper reflection, including in Ghana and Colombia, the schemes and the health facilities providing services have been taken over by private interests and the quality of and access to services has diminished.
These examples do not mean that National Health Insurance cannot work. What they mean is that it is vital that protections are put in place to prevent the privatisation of the health system and to improve access and quality, primarily through strengthening the public health system. The NHI Bill as it stands fails to do this and risks damage to the functional elements of the health system – public and private.
We call on Cabinet to send the NHI Bill back to the Department of Health and to require a proper and thorough consultation process and consideration of options available for improvement of access to and quality of health care services in the country. The health of the nation is not a political game.
Treatment Action Campaign (TAC)
Rural Health Advocacy Project (RHAP)
People’s Health Movement – SA (PHM)
Lawyers for Human Rights (LHR)
For further information, please contact: Nomatter Ndebele – firstname.lastname@example.org 072 9192752