The Health Justice Initiative (HJI) says the National Health Insurance (NHI) Bill provides no clarity on how medicine selection, procurement, pricing and access will be managed to ensure broad medicine access.

HJI founder, Fatima Hassan says it’s unclear how the government will merge the current public and private health systems to ensure broad access to essential medicines. She says there is also no clarity on the selection and pricing of medicines not covered by the NHI.

“The part of the medicines system’s access pricing is unregulated, untouched for the foreseeable future and I think that is part of the problem. And they are part of the private sector who are still to be informed, who are not interested in international benchmarking and they have no interest in trying to make the system unified, fair, transparent and affordable,” says Hassan.

She was speaking on Tuesday during a webinar. Also on Tuesday, Nicholas Crisp, the Deputy Director General of Health briefed the National Council of Provinces (NCOP), on the NHI. This comes a week after the National Assembly passed the proposed bill. The NHI will roll out in phases from 2026.

Medicine access inequality looms under NHI

But Hassan says that the NHI bill is likely to fuel further fragmentation as the current version of the bill is far from equalising access in a radical way. 

“Is it possible to have a single pricing structure for whatever model is operating, so that you can actually regulate that space in a context where there are limited funds? The pricing structure for non-NHI medicines urgently needs attention, as it is said that the Medical Schemes will continue to operate for some time before NHI is fully implemented”, says Hassan. 

She warns that medicine access under the NHI-funded health system is too preoccupied with documentation at the risk of public health needs. She says it is very far off the social solidarity mark.

NHI is not revolutionary legislation

“Our issue is around how do we build forward with a transparent, single medicine access and pricing system in South Africa. We believe that the NHI is very far from the revolutionary mark and could actually worsen the idea of social solidarity,” says Hassan.

She also says it’s impossible the NHI will serve all South  Africans due to the politics and unanswered questions surrounding the bill. Hassan says the country needs a fair, unambiguous, equitable, single-medicine pricing system, but the bill’s current format does not provide this.

Unaddressed concerns remain

Last year HJI  raised 17 Questions on the NHI and Medicine Access. Among these were questions on price determinants and regulation of medicines not included in or covered by the NHI. Hassan says several of the questions they raised remain unanswered.

Andy Gray, a senior pharmacology lecturer at the University of KwaZulu-Natal agrees there is a lack of clarity on the processes and structures of the NHI Bill.

“The NHI Bill is not actually passed. We have got a version that is now moved from one house of parliament to another, we have a complex process. At the moment, medicines in this country can be put into two entirely mutually exclusive boxes, “ says Gray, referring to public and private access.

He says the NHI is new territory. “What we do know is that if a bill does not provide for sufficient public participation that alone can result in it being declared unconstitutional”. 

The National Health Insurance is a health financing system that is designed to pool funds to provide access to quality affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status. It will provide cover, preventive, promotive, curative and rehabilitative services and the emphasis will be on preventing disease and promoting health.-Health-e News.