President Cyril Ramaphosa said some people opposed to the National Health Insurance (NHI) are opposed to transformation against the backdrop of massive inequality in the health sector.

"In South Africa, we are confronting severe inequality, where around R250-billion is spent on the 16% of the population who have access to private health care, while only R220-billion goes towards health care for the rest of the population," Ramaphosa said as he answered questions in the National Assembly on Thursday.

"There are those who say we must leave things as they are. We are called upon to retain an unjust system that deprives the majority of South Africans access to the doctors, specialists, allied health professionals that are supposed to serve only a few to the exclusion of the rest.

"To this we say: 'No'. This is unfair, inefficient and unsustainable."

"We have enough resources in this country to give every man, woman and child health care, but we refuse because we want to promote interests of a few to the detriment of the rest."

He said implementing the NHI while improving the health system will have several benefits.

"The NHI will increase the resources available to hire more health workers, thus reducing waiting times at clinics and hospitals. Contracting health professionals from the private sector into NHI will increase access to the services of doctors, specialists, dentists, physiotherapists, psychologists and others."

He said through a more efficient allocation of health resources, the NHI will improve access to medicines and equipment, reduce drug stock-outs and improve facilities' maintenance.

"The NHI Fund will separate the purchase of health services from the delivery of services, thereby increasing value for money. It will help to ensure that funds, staff, medicine and equipment are more fairly distributed.

"It will further enhance the quality of services delivered because all those who receive contracts must be able to provide services of a specified quality."

He said it will help improve efficiency, transparency and accountability.

"As we have done before with all major policy interventions since 1994, we will ensure effective consultation and engagement across society at all stages of this process," he said.

"The quest for universal health coverage is probably one of the most significant public-private partnerships that we will undertake, and it is essential that all social partners are involved in its design and implementation.

"It will be implemented incrementally and within available resources."

One of the concerns opponents of the NHI has raised is that it would open the door to even more looting of state resources as another state entity will have to be created.

Ramaphosa was asked about this and said that the NHI's funding will be watched "with a hawk's eye".

"We would want to run a clean shop in our NHI finances," he said.

He said government has learned valuable lessons regarding the management of state owned enterprises and this will be applied to the NHI fund.