NHI: Bridging the Gap or Deepening Divisions in South African Society

Exploring the Implications of Healthcare Reform on Access, Equality, and Social Cohesion

Just under two weeks to voting, and it seems like the big three parties cannot agree on anything. Politics in South Africa at the moment feels divisive, with the similar understanding that citizens are tired of the inefficiencies of the ANC government. Yet, it's not clear both or agreement about how to curb this entity, if you believe they should be out.

However, just yesterday, they changed South Africa, so many argue for better or for worse. But they finally passed the NHI bill, which provides free healthcare to all South Africans, or so we hope it does. Let us unpack this confusing victory that many parties and citizens seem opposed to.

Fundamentally, NHI looks to provide healthcare to all citizens. This healthcare is subsidized by the government through money raised from tax. Uniquely, it allows South Africans of any kind to access the nearest hospital to them and access their services rather than having to be subjugated to a public hospital because of an inability to cover the fees for a private hospital. Moreover, in a perfect world, it would lead to the abolishment of medical aid because the state would cover your medical bills. What this also means is that all medical budgets will be centralized by the government, essentially making it an SOE. Now for many of us, this already raised flags, centralized funds make it significantly easier to embezzle funds and commit fraud on a large scale, but this will be addressed later. What this does mean is that private hospitals will be paid by the government for their service, and there will be no charge for the citizens. But the question still is why NHI.

The most simple answer is that the private sector has become too large and so big there is an inability to actively implement regulations to make healthcare reasonable and accessible again. Moreover, public hospitals were under immense pressure and were already dealing with slow and inefficient systems due to a lack of maintenance and provision of adequate supplies and resources to actually aid people. Whereas most private hospitals remain rather empty in comparison to private hospitals, there was a need to redistribute the stress that public hospitals had faced.

However, the poor public healthcare system has been a direct result of poor maintenance and governance. The lack of accountability to provide the community more clinics, more nurses and doctors and actually reinvesting back into the community that needs it most due to greed does put some of the onus on the ANC. But also addresses a large overarching issue that EFF has passionately spoken about throughout the media. NHI looks to benefit people in metropolitan areas and suburban areas as they tend to be the ones who are closest to the private hospital. People in townships are still subjugated to the same clinics. Though much of this sentiment holds true, I think it is important to ground it in real examples. For the majority of working South Africans who live in the city who do not have access to medical aid are forced to go to public hospital instances where they need aid or have an emergency rather than going to the nearest hospital to get assistance. In some ways, it provides a safety net for South Africans who are in the city and decreases the necessity to go to public hospitals allowing for more efficiency. Some hope that through a referral system people will be sent to the right doctor for their “necessary care” as mentioned in the NHI Bill. But once again, there is a question on whether or not private and public healthcare systems will actually work hand in hand. Showing willingness to help all South Africans.

Currently, the private sector is openly rejecting the bill as they believe this bill will place significantly more pressure on doctors in the private sectors as they will receive a surcharge of patients which would obviously lead to more stress, depression and in the worst case suicide. With our shortage of doctors in the public sector, doctors are already 2.5 times more likely to take their lives. I think it is important to remember that doctors are as heroic as they are people and still need to be treated as such. However, there is a more nuanced take which is that private doctors simply do not want to have full days of work because introducing patients means more work but not an overload of work. Some who may have had private practice for their family and friends are being forced to open their doors to the public and treat people, which for them goes against their social contract. To that, I think we need to separate the fear of being a more integrated country and actually providing equitable solutions to all South Africans.

Of course, there is always a want to protect an industry which generates billions of dollars a year. But if that industry is not fulfilling its pure purpose of providing aid and care to South Africans I think we should call it out. By no part do I believe NHI is the only solution; there have been various proposals from the EFF and BOSA. They try to either break down the private sector entirely, the EFF led by Julius Malema, or alternatively have a two-tier system, BOSA led by Mmusi Maimane. So important we engage with NHI and its core and understand the value that we want to protect as a country.

Already the anxiety grows as people grapple with the understanding that the ANC government has never had the ability to administer funds and keep the system running as we have seen with most SOEs and NSFAS which most resembles what NHI will be. It is important that we find a way to make the government accountable to implement a sufficient system because this policy looks to protect South Africa. So let’s take this opportunity to redirect South Africa and find a way to prioritize the health and well-being of all South Africans in the most efficient way possible. Already the DA has stated they will legally fight this battle and the EFF and BOSA have provided the alternatives. Depending on who we vote for we will change the direction of this country.

And yes, even though to many it does appear to be another looting scheme by the ANC being they have drained the funds of their entities. And for many others it seems like a political ploy just before elections. I think we can celebrate the little victory we do have, a world where South Africans will, hopefully one day, can access healthcare which is sufficient, fair and affordable/free.

With all the media and the private sector painting this as an end of days for most South Africans. 84% South African use the public system and 14% private sector. There is a clear disappearance in the voice we are hearing. Instead of simply giving in to the idea that it is bound to fail from the onset without ever engaging with it.

Though it is hard to be optimistic, it is important to remember that it is very unlikely we will have just an ANC government. With the possibility of coalition, the hope for a more accountable and efficient government without doubt is what we should continue to hope for. So NHI as policy is clear showing that the ANC is still seriously contending these elections but also could show they need something large to hopefully garner support. For those who are aggrieved make sure you take the polls and vote and get the change you want and need.

NHI for sure is controversial, but it prioritizes everyday South Africans. It looks to challenge the inequality that exists in South Africa. It forces people to face their privilege. It truly begs to ask how much do we care about humanity?