NHI is closer to being law, there are many concerns not addressed

South Africa is marching closer to implementing universal health coverage in the form of the National Health Insurance (NHI) Scheme. This is after the National Council of Provinces (NCOP) voted this week in favour of the implementation of the bill. 

The Western Cape is the only province that voted against the implementation of  NHI, while eight provinces voted in favour of the proposed health system reforms.

The NHI bill was first introduced to the National Assembly in 2019. The aim of the NHI is to ensure that all South Africans can access a set package of health services from any healthcare provider without having to pay out of pocket. 


Health minister, Dr Joe Phaahla has described the NCOP decision as important progress towards the actual implementation of the NHI, which is set to be rolled-out in phases. The bill is now before the office of the president Cyril Ramaphosa to be given a green light.

“This is a landmark moment for our country, and specifically for our health system as we move towards realising universal health coverage through the phased approach implementation of the NHI as a mechanism to ensure equitable access to quality healthcare for all citizens,” said Phaahla during a media briefing on Wednesday.

Phaahla says that the NHI represents a significant milestone in South Africa’s commitment to achieving universal health coverage. He says that the health ministry is confident that with the support of all stakeholders, they will create a healthcare system that is fair, efficient, and accessible to all. 

“The provisions outlined in the NHI bill represent a comprehensive and transformative approach to healthcare delivery in South Africa as it is founded on the principle that every South African, regardless of their socio-economic status should have access to a compressive set of health services without facing any financial barriers,” says Phaahla.


Though the NHI is now much closer to being signed into a law and being implemented, various concerns have been raised by politicians, and civil society organisations. The many criticisms levelled at the NHI  remain unaddressed as the NCOP voted in favour of the Bill without making any notable changes.

Dr Katlego Mothudi, managing director at the Board of Healthcare Funders (BHF) a non-profit company, says that they are not happy with various sections of the NHI bill.

“Despite submissions to the government, the recommendations of BHF and other stakeholders have largely been ignored and the bill is being passed virtually unchanged from its originally drafted,” says Mothudi.

“We have consistently given input into this proposed law and are disappointed that our concerns and those of other stakeholders appear not to have been considered or even tested. The bill in its current form will have a negative impact on healthcare access for everyone,” says Mothudi.

In August BHF wrote to the NCOP, opposing section 33 of the NHI bill.  Section 33 of the NHI bill states that medical schemes will only be restricted to a “complementary” role once the NHI is fully implemented. 

Mothudi says this is of major concern and has the potential for a wider negative economic impact. 

“Not only will the schemes industry shrink, but all the other private entities it does business with, including hospitals, pharmaceutical companies and health practitioners,” says Mothudi.

“There is still uncertainty around how the NHI will be funded, but it will very likely be through additional taxation, something that will unavoidably have a detrimental effect on the economy at large, companies, individual employees and the general public, in the form of job losses,” he adds. 


Phaahla says that the government remains committed to addressing some of the raised challenges through strategic planning, collaboration with stakeholders and ongoing evaluation of the implementation processes.

“The journey on the process of the NHI bill has not been without challenges, which include amongst others, financial considerations, health workforce capacity, and the integration of existing, in some instances parallel healthcare systems have posed complex issues that we must continue to collectively work together to find the most practical solutions to effectively meet the health needs of our people,” says Phaahla. – 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.

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