National Health Insurance
SECTION27 has worked on the National Health Insurance(NHI) programme, a key component of health reform, since 2011; and 2019 saw significant movement in this area, with the National Health Insurance Bill being gazetted for public comment on 29 July 2019. We are a leading voice on NHI, and in particular on the need for specific changes to the Bill to put in place appropriate governance structures, and to ensure that NHI is capable of improving access to health care services for everyone in the country.
Following NHI workshops that we hosted in various provinces, SECTION27 took the lead in convening civil society meetings to cohere civil society’s voice on NHI. On 4 October 2019 we held a gathering of 59 people from 24 organisations, to discuss NHI and develop a common strategy. On 29 November 2019, together with the Treatment Action Campaign (TAC), we made our written submission to Parliament on the NHI Bill. The submission, which was endorsed by 12 civil society organisations, was well received. Our submission highlighted three key areas of concern.
- Governance: The Minister of Health appoints the NHI Fund Board members (after appointing the ad hoc panel that interviews and recommends them), the Board Chairperson, and the CEO of the NHI Fund. In simple terms, the decision-making is far too concentrated. Improving Access to Health Care
- Transparency: To increase public trust in the NHI and to reduce the risk of corruption under NHI, it is imperative that all NHI-related processes and decisions are as transparent as possible.
- Try before you buy: The NHI Bill introduces a range of new structures and administration processes that are untested. We are bringing the establishment of these new structures into law with no way to turn back if they fail, and without any transition provisions that could stagger implementation and allow for learnings.
We have used the COVID-19 period to draw attention to the need for health systems change, including through open letters to the private sector, the President and the Minister of Health. We wrote to the Minister with principles for the contracting of private health providers to ensure that such contracting would be in line with constitutional precepts (including transparency, equality and protection of the most vulnerable) and would set the stage for longer term contracting with the sector. Our work on this issue continues.