In late May, President Jacob Zuma signed into law long-dormant sections of the National Health Act that would give the Director General of Health the power to deny doctors operating licenses depending on where in the country the medical professional wished to operate, or open or expand a practice.
Following Zuma’s promulgation, doctors would have had to apply to the Department of Health for a “certificate of need,” or permission to work in an area, by 1 April 2016.
Health Minister Dr Aaron Motsoaledi says that the introduction of Certificates of Need is meant to address health inequalities between rural and urban areas.
“(Netcare) Park Lane Clinic has more gynaes than Limpopo and Mpumalanga provinces put together,” Motsoaledi says in the South African Medical Journal, which is published by the South African Medical Association (SAMA). “It will be difficult to force them to move – but should we allow more gynaes to move into that small space called Park Lane? I don’t think so.”
SAMA, the South African Dental Association, and the specialist body, the South African Private Practitioners Forum have all vocally opposed Certificates of Need and were considering Constitutional Court litigation against the department over the matter.
Consultations prompt a re-think but not a redrafting of policy
Director General Precious Matsoso has been consulting with doctors and health professionals on the matter. According to Department of Health Spokesperson Joe Maila, feedback from the consultations informed the department’s decision to withdraw the proclamation.
“(The director general) consulted interested parties extensively over the past few weeks,” he said. “Interested parties requested that we allow adequate time for the drafting of regulations and subsequent engagement, first arguing that the 24-month time limit in the act would unfairly pressurise them.”
“The (director general) considered their submission, which led to the decision to request the withdrawal,” he added.
SAMA has welcomed what spokesperson Dr Mzukisi Grootboom called a “stay of execution”, which he attributes to advice from the state attorney.
“It became quite clear when we engaged with the department that they had been given some wrong advice, which I think is a pity,” he said. “The way those sections (of the National Health Act) have been written is problematic.”
“What needs to happen next is that they must go back to Parliament and someone has got to write them properly,” said Grootboom, who added that, while introducing regulations would help clarify some of the sections, they would not address fundamental flaws in the legislation.
However Maila says the department does not plan to re-write the sections.
“The intention is not to redraft the Act but to allow parties sufficient time to engage with regulations before the act takes effect,” he told Health-e News. “The next step is to draft regulations and allow interested parties to engage with them before the act takes effect. This is essentially a process issue.”
In a statement, Democratic Alliance Shadow Minister of Health Wilmot James has echoed SAMA’s call for the matter to return to Parliament for further discussion.
An edited version of this article first appeared in The Mercury newspaper