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The global trend in public health is to move towards providing universal health care. It is crucial that South Africa follows suit. With an accumulative budget of over R222 billion across all provincial departments and its entities, this is a possibility for our country, but the devil is in the detail.

South Africa’s two-tier healthcare system is unsustainable and has over the past two and half decades created an environment of insiders and outsiders. The insiders who have healthcare coverage form only 16% of the South African population and this number is on the decrease in light of the country’s poor economic outlook. Over 80% of the population rely on the crumbling public health system and they continue to be failed by it as it has been unravelling for decades.

Our health system has become the microcosm of our deep inequalities in this country.

President Cyril Ramaphosa and the newly appointed Minister of Health, Dr Zweli Mkhize, have confirmed that the National Health Insurance (NHI) Bill has now been approved by Cabinet and will be introduced to Parliament eminently.

When the Bill was first introduced in the 5th Parliament, it was riddled with problematic elements which would see the collapse of the health system as we know it and the economy at large.

Initially, the Bill came with the R259 billion price tag, which was later found to be a guestimate and not a reflection of what was needed.

While we have not seen the revised Bill that would be sent to Parliament to deliberate on, we know that the ANC government has committed to the following undertakings which will be disastrous for the health system and the people who rely on both private and public facilities.

Nationalization of healthcare - The Bill is likely to enable the establishment of a ‘state-owned-entity’ (SOE) which will ‘pool’ funds within the public and private health system. This means South Africa will once again have billions of rands in public money at the hands of a politically connected few. The record of mismanagement at SOEs in this country demonstrates why we cannot have healthcare follow the same route. Furthermore, South Africans will be denied agency to choose the kind of healthcare they want and the kind of healthcare they deserve. NHI will in essence deem medical aids useless as the government will buy health services and dictate where patients can receive healthcare – essentially doing away with medical aids. Minister Mhkize, himself, admitted that medical aids will most likely cease to exist under NHI. The DA opposes any form of nationalisation especially in a key portfolio such as health.

No sustainable funding model - When the Bill was first touted, it was modelled on the basis of a 2.7% economic growth. South Africa’s economy is growing at a dismal 0.6% with little to no chance of rapid growth. Even if the initial R259 billion needed was, in fact, realistic, this plan is unsustainable and unaffordable.

Provincial service delivery threatened - According to the National Health Act of 2003, the national department sets policy and governance structures while the provinces become the implementing arm of public healthcare. However, as per the draft NHI Bill,  powers delegated to provinces will be centralised at a national level in an unprecedented manner. There has been no constructive engagement with provinces at the National Health Council as the departments that will be rolling out NHI. Instead, there has been a reduction in the investment of primary healthcare across all provinces. This also points to a deeply flawed process that has been followed in bringing this legislation about.

Failed NHI pilot projects - Over the past three years, the Department of Health has allocated nearly R5 billion to pilot projects across the country. However, when this was done, there was no benchmark of what success will look like for each project or at least the system being adopted. A qualitative report into the performance of these pilots is yet to be released yet the Bill is being pushed through Parliament. It is our assertion that the report confirms the anecdotal evidence we have of these failed pilot projects and as such is being kept a secret or thoroughly redacted to not reflect the truth as we know it: NHI has failed.

It is for these reasons that the DA has developed its alternative model for rolling out universal healthcare.

Sizani Universal Healthcare Plan – DA alternative:

The plan, aptly named Sizani Universal Healthcare Plan (SUH) is a workable solution to provide universal healthcare for South Africa.

Sizani is a Zulu word meaning “care” or “assistance” and emphasises the DA’s commitment to place the patient at the centre of the health system.

We want to state it clearly and unequivocally: The DA supports quality, universal healthcare for all South Africans, but we don’t need to follow the NHI model - that will ultimately nationalize health care, lead to a brain drain and cripple the economy - to bring that about.

Sizani will see the establishment of a national strategic resource allocation scheme to operate within the first tier of government.

This scheme would allocate a universal subsidy in respect of every eligible person in South Africa, irrespective of whether or not they are covered by the public or private health systems. Every person will be able to choose whether to buy public or private sector cover with their subsidy – with rules against opportunistic movement between the two.

The value of the subsidy will be set in relation to an affordable and comprehensive package of services available within the public health system. Within medical schemes, benefits will be standardised for the main package, whilst medical schemes will be allowed to offer top-up cover.

Under Sizani, public services will be free at the point of service for both those who have medical aid membership and those who do not.

Ultimately, Sizani will not kill the private health sector like NHI. Instead, it will offer a sustainable private-public partnership that will offer comprehensive coverage for all South Africans and we would be able to do this within 5- 8 years. This is mainlybecause we would not be creating a large SOE in the form of pooled public and private funds and we would be able to roll this out within the current budget envelope.

Funding Model:

Sizani will strategically reform the system within its current resource envelope and strengthen our constitutionally ordained and provincially organised public health care delivery system. The total accumulative budget of over R222 billion across all departments and its entities will be reallocated to ensure universal healthcare. Once the value of the basic package has been established by a team of medical experts, the current budget envelope will be redistributed.

There are two mechanisms which would immediately free up funds to be allocated to the national strategic resource allocation scheme: Bringing medical tax credits into the main budget and reallocating two items from the national Health Department budget. This will respectively free up R27 billion and R3.3 billion.

As a welcome act of justice, R6 billion will be used from the medical tax credit to improve the public health system. This cross-subsidy will be divided as follows:

Provide an additional R1 billion per year towards the training of medical, nursing and health professional staff.

Provide an additional R2 billion per year for expanded maternal and child health programmes for which clinics and hospitals that qualify compete.

Provide an additional R1 billion for a single number national public-private emergency service governed by an independent board.

Provide for expanded clinic-building programmes especially for under-served areas nationwide by devoting an additional R2 billion per year to building and staffing clinics.

This investment alone will set us in good stead to be able to improve the health sector as we know it. The available public funds will then be utilised to effectively purchase a standard package of primary health facilities that will be afforded to all.

Parliamentary Process:

We are currently awaiting the introduction of the Bill to Parliament. As soon as this is done, we will request the Chairperson of the Portfolio Committee of Health, Dr Sibongiseni Dhlomo to begin the process of a line by line analysis of this Bill. Should the fundamental problematic elements we have highlighted still be in the Bill, we will work to oppose those sections and fight for amendments in line with the Sizani Universal Healthcare Plan.

The committee has a healthy split of 4 permanent opposition MPs (2 DA, 1 EFF AND 1 FF plus). We will work with opposition parties in the committee to bring about reforms. While we may not have the ANC majority, we will certainly ensure that Parliament is not just a rubber stamp station for fundamentally problematic pieces of legislation. We will be sharing our alternative plan with other opposition parties and working with them to root out problematic aspects of NHI or throw it back to the department altogether.

Conclusion:

What is clear is that the current health system is under severe pressure from decades of mismanagement, corruption, under-investment and superfluous spending. It is, therefore, the DA’s first priority to invest in the public health system to bring it to the same level of some of our private health facilities.

We would then roll out UHC across the board using the existing tax credits and reprioritisation of the budget. This would mean we would not pool public and private funds, but we would collaborate with the private sector. Ultimately, the user will have a choice on where they receive care, they will be covered comprehensively, and it will enhance competition within the private health industry to guard against the rising cost of healthcare, and the economy will not be left in tatters while pursuing a narrow ideological goal.

Issued by The DA