COSATU CEC statement on the envisaged structures for NHI implementation
30 August 2017
The Central Executive Committee of COSATU is shocked to learn that the National Department of Health is pushing ahead with establishment of various committees dominated by vested interests and are designed to undermine the Cabinet approved National Health Insurance Policy (NHI). Overall these committees will take the country’s health care system to the wrong direction.
Not only are these committees, in terms of composition, unwieldy but have let the door wide open for corporate capture of one of the most significant social policy reforms since1994.
The seven committees established in terms of section 91(1) of the National Health Act, 2003 (Act 61 of 2003) are dominated by the private sector namely: Private hospital groups, Private hospital management, Council for medical schemes, Medical aid schemes and actuaries. COSATU views this move as a classic case of: one step forward and ten steps backwards with the detractors of the NHI given the mantle by the Minister of Health.
The medical aid scheme industry has come out publicly to oppose the NHI as financially unsustainable and impractical; how then does the Minister of health see fit to give such institutions the custodianship role over the implementation of NHI. It makes no sense to draw from institutions or persons that have opposed a single payer NHI and have vested interests.
The terms of reference of most of these committees published in government gazette last week, are the opposite of the features and principles of NHI Policy as set out in the Green and White Papers.
The NHI White Paper makes it clear that NHI is about guaranteeing all South Africans quality and affordable health care, based on their health care needs, irrespective of their income status and will be free at the point of service. It will be implemented through creation of a single fund or single-payer system that is publicly financed and publicly administered as opposed to the current fragmented and wasteful multi-payer system.
Instead of going directly going to a single payer system as set out in NHI White Paper, the terms of reference seek to establish a more fragmented multi-payer system with different funding systems for different groups (civil servants, formal sector employees in big business and informal sector etc).
Against the principles of NHI, they seek to prop-up the profit-driven medical scheme industry through “mandatory membership and cover for all individuals in formal employment”.
We are raising a question - Is Minister Motsoaledi really in control of NHI Policy Implementation or are there other forces at play that are now in charge?
Clearly those driving this process want to bring back a private-sector driven agenda through the back door, undermining the very policies government has adopted. This is not the first time that the Department of health has made an attempt to sneak corporate capture through the back door. The Director General has held meetings with medical aid schemes to ensure the schemes bosses of their vital role in NHI moving forward ,while the white paper explicitly states the future of medical aid schemes as being only a complementary ; when NHI has been successfully implemented.
This new betrayal by the Ministry confirms our fears that Government has no interest in non-racial and non-biased Universal Health coverage. This is evident in the dragging of feet to establish the State pharmaceutical company and the corporate capture of the NHI implementation structures.
We reiterate our call that Minister Motsoaledi has to go because after more than eight years in charge of the department of health, he has spectacularly failed. He spends most of his time making speeches and delivering presentations ,while he mischievously maintains the status quo of unequal and uneven distribution of health care.
COSATU says government must stop the process of appointing these committees immediately and implement NHI programme according to steps clearly outlined in the NHI White Paper.
We call on the ANC government to show leadership and not confuse the public. In line with the NHI White Paper it should do the following:
- Immediately start the process of amending legislation to prepare NHI implementation;
- By November this year submit the Draft legislation for comment and ensure it is submitted to Parliament by end of February 2018
- Amend National Health Act to be in line with NHI requirements.
- Amend Medical Scheme Act to be in line with NHI implementation.
- Finalise the costing and immediately mobilise funds in stages.
- Accredit facilities and providers to ensure that only those who provide quality care are contracted to provided NHI services.
Issued by Sizwe Pamla, National Spokesperson, COSATU, 30 August 2017