OUTA: NHI Bill falls well short of universal healthcare goals

OUTA, the Organisation Undoing Tax Abuse, advocates for universal healthcare but criticizes South Africa’s National Health Insurance (NHI) Bill. Executive Director Stefanie Fick warns of the gap between NHI ideals and implementation realities, citing funding and management shortcomings. Concerns include strain on finances, corruption risks, and potential skill drain. With the Bill signed before elections, OUTA questions motives and urges collaboration with industry experts for a viable healthcare model. Vigilant against misuse of public funds, OUTA stands prepared for legal action if necessary.

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From the Organisation Undoing Tax Abuse (OUTA)

The Organisation Undoing Tax Abuse (OUTA) says that it fully supports the constitutional right of all South Africans to proper healthcare but warned that Government is creating false hope by signing the NHI Bill into law just two weeks before the National Elections.

“There is a big disconnect between the dream of the sort of universal healthcare envisioned in the NHI Bill, and the reality of implementing it. Our country is in crisis on so many levels. For a universal healthcare system to work, you need enough funding and proper management, something that is sorely lacking at this stage of the country’s history,” says Adv Stefanie Fick, Executive Director of OUTA’s Accountability Division.

“We have analysed the NHI bill, and while we acknowledge the good intention to create a better healthcare system for all the people of our country, we have several concerns, the biggest ones being funding and management,” she adds.

OUTA says that the law in its current form will put undue strain on the fiscus. “There simply isn’t enough money for what is envisioned by the NHI Bill. It should also be noted that there is a national healthcare system in place at the moment, but it has been badly managed and hollowed out by corruption. What will stop this from happening with the NHI? One just needs to look at Eskom, Prasa, Transnet or the SABC – to just name a few entities – to know that government does not have the capacity to efficiently run a national health system of this magnitude,” says Fick.

Adv Fick says South Africans, who are still reeling from the impact of the Covid-pandemic, should also not forget the corruption with money meant for equalising the health care system during the pandemic. “We haven’t forgotten the Digital Vibes scandal or PPE corruption. In Gauteng, we are also still waiting to see justice for Babita Deokaran, who was murdered after exposing massive corruption within the Gauteng health department and specifically at Tembisa Hospital. Can we trust Government when a much bigger healthcare budget comes into play?”

According to Fick, OUTA finds it concerning that the Bill is signed into law shortly before the national elections. “Is this just an electioneering ploy?” she asks. “Various role players in the healthcare system have voiced their concerns – from professional bodies representing medical professionals to medical aids, academics, civil society, and economists, but it is apparently just ignored. Why the rush with signing the Bill into law?”

Fick said OUTA is also concerned about the potential exodus of critical medical skills, further complicating the long-term success of the scheme. The South African Medical Association (SAMA), the Board of Healthcare Funders (BHF) and the Hospital Association of South Africa (HASA), have all expressed their commitment to universal health coverage, but previously pointed out that the current NHI legislation suffers from fundamental problems, including a lack of input or participation from the industry during the process. (See article here)

“These bodies represent thousands of medical doctors in both the public and private sector, and it is worth noting their concerns about the practical implementation of a functional health system. They are – after all – the ones who will be responsible for treating millions of South Africans. Who will do the work if the doctors and nursing staff choose to leave? And can we afford to lose more professional people who will shrink our tax base even further?”

OUTA urges the president to return to the drawing board and work with the various industry experts to design a workable universal health care model. “Government still hasn’t learnt that simply legislating new policy won’t magically make it work – just like with AARTO and e-tolls. You need the correct systems, enough finances and efficient governance for NHI to work, and unfortunately government’s history in this regard is not convincing. We also need many other things to get the country’s economy back on track – like proper infrastructure, job creation and electricity. And what good will the NHI do while thousands of people in the country have no access to clean drinking water?”

OUTA says it will continue to monitor developments in the NHI space. “We remain vigilant and committed to upholding accountability with public money. While litigation is always an option if needed, we are aware of collective efforts from various organisations who are ready to address all the issues around the NHI Law through legal action.”