I am Dr. Mvuyisi Mzukwa, Chairperson of the South African Medical Association (SAMA), representing over 12,000 doctors, expressing grave concerns about the National Health Insurance (NHI) Bill.

SAMA has consistently voiced objections, emphasizing that the Bill's current form is problematic. Key concerns include the focus on a funding model without addressing human resource shortages and infrastructure issues in the public healthcare system. Corruption risks, lack of cost assessment, and limitations on medical aid schemes are additional worries. SAMA emphasizes the need for comprehensive reforms to achieve universal health coverage effectively.

We have submitted written and verbal representations to Parliament, outlining our concerns regarding the proposed NHI Bill and its potential implications. Regrettably, our views have been largely disregarded, leading to the adoption of the NHI Bill by the Parliamentary Portfolio Committee on Health in May 2023 and its subsequent adoption by the National Assembly on June 13, 2023.

The implementation of the NHI Bill is anticipated to have detrimental consequences for the South African public, despite its purported aim of realizing the constitutional right to healthcare access for all. Essentially, the NHI Bill establishes a statutory fund, the National Health Insurance Fund, which the government, specifically the Department of Health, will utilize to purchase and finance healthcare services on behalf of all South Africans. It is reminiscent of the originally intended function of the plundered Road Accident Fund, designed to assist victims of road accidents.

Funding for the NHI Fund will primarily be derived from taxes, potentially resulting in increased taxation rates, particularly for individuals in higher income tax brackets. Presently, the highest personal income tax bracket deducts 45% of one's earnings as tax.

Moreover, the Bill effectively prohibits Medical Aid Schemes from providing coverage for services covered by the NHI. It remains unclear therefore, what Medical Aid Schemes will be allowed to cover. The specific services to be provided by the NHI Fund have not been clearly defined, yet the Bill has been adopted in its current form. Furthermore, the NHI Bill dictates where individuals can receive medical care and the treatments they can access, contravening the very constitutional rights it purports to uphold, such as the right to access to healthcare and freedom of association.

Stakeholders, particularly healthcare professionals, are not opposed to the principle of universal health coverage that the Bill aims to achieve, considering the urgent need for an overhaul of the dilapidated and understaffed public healthcare system, and unaffordable private healthcare system. Rather, their opposition lies in the solution presented by the NHI Bill. As previously mentioned, the Bill primarily functions as a funding model, neglecting to address the fundamental issues plaguing the public healthcare sector, such as human resources shortages, poor management, and inadequate infrastructure. These factors serve as the true barriers to achieving universal health coverage.

Another significant concern is the pervasive corruption within the public sector, with the Department of Health administering the NHI Fund. The absence of assurance regarding proper fund management heightens the risk of deteriorating quality in both the public and private healthcare sectors, contrary to the intended upliftment of the public healthcare system. It is evident that such an outcome would be catastrophic. In a 2020 survey, 72% of South African professionals expressed their intention to emigrate if the NHI Bill was passed.

Furthermore, the National Assembly has adopted the NHI Bill without the National Treasury presenting a report outlining the estimated costs of implementing the Bill and whether its successful execution is feasible for the country as a whole.

We therefore call on the South African public to join us in pressuring the National Council of Provinces, and the President, before it’s too late:

1. not to approve or sign the Bill into an Act of Parliament in its current form;
2. to meaningfully re-engage with and listen to alternative stakeholder solutions, particularly those put forward by healthcare professionals and professional organisations, on how else universal health coverage may be achieved;
3. to instruct the Department of Health to look to achieve universal health coverage by fixing the public healthcare sector’s infrastructure, poor management and lack of human and other resources.

Update: Thanks to the pressure created by this petition when it was handed over to the NCOP, the Select Committee on Health and Social Services is now calling for another round of public submission on the Bill. If you want to ensure that this Bill is not pass please fill out this form and allow us to submit your comments to the NCOP before 15 September 2023.