The first leg of the public hearings on the proposed National Health Insurance (NHI) Bill started on Friday in Vhembe District. Attendees raised several burning issues, including how government is going to make universal healthcare work with poor infrastructures and the shortage of doctors in public health facilities around Vhembe.

This is the third province the hearings have been held in as the parliamentary committee goes across the country to collect the oral submissions of South Africans. Mpumalanga and Northern Cape were the first two provinces where the community engagements were held. Four locations have been selected in each province and hearings typically take place from Friday afternoons until Monday evenings.

Four or five-hour slots — typically 16:30 to 20:30 on Fridays and Mondays, and 10:00 to 15:00 on weekends — have been planned for every province. Members of the public present their oral submissions in front of the committee and the public hearings come to an end when the residents indicate that there are no more submissions to be made.

[WATCH] Confused about what the NHI really is and what it could mean for your health? We break it down for you in just under six minutes. 

Lawrence Khethani, from Tshilungoma Village just outside Thohoyandou, suffers from a mental illness and depends on a disability grant to support his children said that if the NHI is properly implemented it can improve the lives of rural people who are often subjected to poor health services. “I believe that the bill will go a long in ensuring that we receive quality health care for people like me who depend on the government grant for survival and cannot afford to pay for private medical services for my children,” he said.

He added: “My only worry is the high number of illegal foreign nationals who frequent our local clinics and hospitals for free medical services, because if something is not done to stop undocumented foreigners from coming to exhaust our health facilities I do not see the bill helping us in any way”. 

Khethani was one of a handful of residents who brought up the issue of foreign nationals straining the South African health system — a rhetoric that resembles former health minister Aaron Motsoaledi’s unverified “anecdotal” evidence that foreign nationals “overburden” the country’s health system — which many have deemed xenophobic. 

The NHI bill has also come under fire from concerned health experts who have called the language the policy uses a “slippery slope of xenophobia”.

According to Jo Vearey, the bill implies that individuals who are asylum seekers — even those who have work permits — won’t be eligible for the NHI. Vearey is an Associate Professor with the African Centre for Migration and Society at Wits University.

“Non-nationals are currently facing huge challenges accessing basic healthcare. Not only is it sending a dangerous political message, it potentially has consequences for broader public health concerns,” she told Health-e in April.

Concerns about corruption

Despite the hearings being conducted by the parliament portfolio committee on health, no officials from the provincial department of health attended the hearings at Makwarela Community Hall.

Vhutshilo Mandiwana said that he hopes that the committee has a plan in place to prevent corrupt individuals from misusing the public funds for their own benefits. “I hope that the bill will be implemented during our lifetime and that measures to protect the funds from corrupt people will be put in place. I have gone through the whole NHI document and most of the things it promises are clear and if they manage to implement it properly it can go a long way in improving our health systems,” he explained. 

Residents also questioned the parliamentary committee on how corruption will be prevened because the procurement of health services is done by incapable people. “Some of the problems we continue to face in our public health facilities are the result of tenders which are being given to incapable people by the department of health in the province,” Saddam Masutha said. 

According to a report, local anti-corruption non-profit organisation Corruption Watch has received close to 600 whistleblower reports related to corruption in the public health system since 2012. In 2018 alone, the organisation received 108 reports on corruption in the healthcare system — including complaints about employment and procurement irregularities, abuse of state resources and abuse of power by officials. The majority of the reports were from Gauteng (40%), Limpopo and Eastern Cape (both 11%) and KwaZulu-Natal (10%).

In October, President Cyril Ramaphosa launched the Health Sector Anti-Corruption Forum, a partnership between government, law enforcement agencies, civil society and health oversight bodies. The main objective of the forum is to uproot fraud and corruption and is as a way of cleaning up the healthcare system, Ramaphosa said. 

Although most people who attended the hearing in Vhembe believe implementing the NHI will improve health services within the country, many are concerned about the problems they currently face at the hands of the public health system. Residents fear that if this is not dealt with, the bill will not succeed in improving their lives. 

The committee will be moving to the other three districts which are Mopani, Sekhukhune and Capricorn. -Health-e News

An edited version of this story was published on Health24.