The decision by the National Assembly Portfolio Committee on Health to adopt the National Health Insurance Bill (NHI) in its current form has concerned civil society organisations.

The bill was first introduced in parliament in August 2019 and will now be debated in the National Assembly.

The NHI is a health financing system designed to pool funds to provide access to quality, affordable personal health services for all South Africans based on their health needs. It seeks to realise universal health coverage for all. This means that ‘every South African will have a right to access comprehensive healthcare services free of charge at the point of care at accredited health facilities, such as clinics, hospitals and private health practitioners.’

The bill aims to ‘create mechanisms for the equitable, effective and efficient utilisation of the fund’s resources to meet the health needs of users. It also seeks to create mechanisms to preclude or limit undesirable, unethical and unlawful practices in relation to the fund.’ 

What are the concerns?

The concerns centre around the lack of feasibility studies, unqualified public health facilities, lack of capacity, funding resources, and corruption within government departments, including the health ministry. 

Several organisations shared their views with Health-e News

People’s Health Movement South Africa

People’s Health Movement Coordinator, Tinashe Njanji told Health-e News that some parts of the bill are problematic. He says that the draft of the proposed NHI bill is written almost without context, as if South Africa is a functioning state that is free of corruption and is capable of introducing and managing the far-ranging changes to the health system that will be required.

Njanji says that it is concerning as some of the raised questions about the NHI bill still hang in the balance. “There’s a lack of detail about upgrading of the public health sector,the possibility of exacerbating inequality, failure to distinguish between primary health care and primary care and the lack of adequate mechanisms for civil society engagement”, he says.

“Fixing the public sector first is essential, as without a well functioning public health care system the NHI cannot succeed. It is therefore imperative to fix and upgrade the broken public sector to the level required for NHI accreditation. After more than two decades of public sector austerity, many public and rural health care facilities are understaffed and under-equipped and unlikely to qualify for NHI accreditation.”

According to Njanji, it also remains concerning that the most recent report of the Office of Health Standards Compliance (OHSC) found that only a small fraction of public health facilities surveyed met to meet the norms and standards required for certification.

He says that private facilities are not only more likely to get accreditation but are also overwhelmingly urban-based. “This increases both urban-rural and private inequality. There is a possibility that people living in some areas will not have access to NHI funded health care at all.

Facilities that already lack staff, medicines and equipment will not find it easy to register users as smoothly as those facilities already functioning at a much higher level of efficiency. At the moment many public sector facilities lack easy internet access,” says Njanji.

Treatment Action Campaign(TAC).

TAC General Secretary, Anele Yawa, says that they support the NHI but they have concerns which remain unanswered regarding the bill and how it has been structured in the drafted copy. According to Yawa it is concerning that there are a lot of allegations of corruption within the national health department.

“There is mismanagement of funds by some health ministry officials. Within the NHI bill there should be an inclusion of an anti-corruption unit which will be complemented by the Special Investigating Unit (SIU), so that, if they are any suspicions or allegations of corruption they both will be able to pick it up and deal with those who will be involved.”

Yawa says that it is also worrying that the country is currently battling a critical shortage of healthcare workers as most public facilities remain under-staffed, which negatively affects the rendering of healthcare services.

South African Medical Association

According to SAMA spokesperson, Dr Mvuyisi Mzukwa, the NHI bill has been developed with disregard to the legitimate concerns and recommendation of experts, particularly on critical issues such as the introduction of contracting units for primary Healthcare (CUPS), benefits packages, and reimbursement models.

He says that the NHI bill in its current form sets up the healthcare system for failure at the expense of further deterioration of the health and wellbeing of all who live in the country. “We believe that a robust approach to health systems strengthening is indispensable, as it would rectify the current deficiencies and overcome the challenges posed by the NHI,” says Mzukwa.

“The implementation of the NHI fund alone is insufficient to embody the principle of universal health coverage (UHC), as enshrined in the South African Constitution and thus while they support the principle of UHC they do not support the NHI bill in its current form.”

The proposed NHI bill is set to be officially fully implemented in 2026.-Health-e News.


  • Ndivhuwo Mukwevho

    Ndivhuwo Mukwevho is citizen journalist who is based in the Vhembe District of Limpopo province. He joined OurHealth in 2015 and his interests lie in investigative journalism and reporting the untold stories of disadvantaged rural communities. Ndivhuwo holds a Bachelor of Arts degree in Media Studies from the University of Venda and he is currently a registered student with UNISA.