Slashed health budget should send us back to the drawing board on how to fund National Health Insurance

February is always a busy political month for SA. The president delivers the state of the nation address, quickly followed by the tabling of the country’s annual budget in parliament by the minister of finance. Both have great governance significance for the country and indeed the global community with which we conduct our business.

Every year for the past decade these two major events in the country’s legislature have been punctuated with great anxiety about SA’s future. This year was no different. In fact, many commentators remarked that both President Cyril Ramaphosa’s address and finance minister Tito Mboweni’s budget speech were the most significant in democratic SA, as the country finds itself teetering on the precipice of a financial, social and political cliff.

The country has been engaged in a discussion about health reform and how we fund quality health care for people who have been denied this basic right for the past two and a half decades. It was therefore key to observe how both the president and the finance minister addressed the National Health Insurance (NHI) Bill, which is before parliament.

During his state of the nation address, President Ramaphosa touched on the NHI Bill and made sweeping statements about how citizens are yearning for the bill to be implemented.

This, I assume, is what his ANC colleagues who serve on the portfolio committee on health hastily relayed to him.

I would also assume that there is great pressure — politically — for the president to be seen to be resolute on this bill regardless of the many red flags.

This week, the president released his newsletter, which was dedicated to the NHI Bill and its historical significance. The main thrust of his argument is that the bill “will be among the most far-reaching acts of social transformation this country has experienced since 1994” and that all South Africans should support it.

The piece was laden with this kind of rhetoric — then signed off with a small disclaimer that the government will not be reckless in implementing NHI.

I would argue that the introduction and the handling of this legislation has been nothing short of reckless.

The minister of finance dealt the entire health sector a massive blow on Wednesday when he announced a reduction in the total health budget. This is despite the fact that the system is on its knees.

There are critical posts that are yet to be filled, massive infrastructure projects that need to be undertaken to ease service pressures and general investment in the public health system, which will likely stall.

SA now spends almost as much on health care and education as we do on servicing our national debt. This budget slash, albeit inevitable, is brutal.

It also raises a question about the feasibility of the implementation of the NHI Bill, which came with an initial R30bn price tag for the roll-out phase. The 2026 timeline, which was set by the minister of health, is becoming impossible.

The DA has always called for an urgent reconfiguring of healthcare funding in order to attain universal health care. We have held that the NHI Bill does not adequately diagnose the health-care problem and therefore will not address it.

The ANC has been married to this flawed piece of legislation at all costs and perhaps the fiscal limitations will be our only saving grace.

The World Health Organisation describes universal health care as the provision of quality health care for all citizens without individuals having to incur great financial expense. It is possible to achieve universal health care in SA if we are prepared to make the bold and necessary decisions. In a constrained financial environment, we must utilise what we have, improve on it, ensure that it is of quality for everyone.

While many South Africans will attest to being able to access a health facility, it is undoubtedly inadequate. This is due to ageing infrastructure, critical vacancies not being filled in health facilities, lack of investment in emergency medical care services, unsafe working conditions for staff and unmanageable service pressures.

Therefore, for universal health care to become a reality instead of a political pipe dream, we would have to rectify what is broken by investing in those critical areas and plugging the corruption hole that takes away valuable resources from the public.

It would also require a complete overhaul of how we fund health care in the country.

It is clear from the 2020/2021 budget allocation that if we are not creative about how we deliver health care in the country, we are likely to preside over a failing health system for decades to come.

The ANC government has to choose South Africans over narrow political wins.

This will require going back to the drawing board, expanding the decisionmaking table to include all industry players and, most importantly, the people we are meant to serve.

Gwarube is a DA MP serving on parliament’s health portfolio committee and is the DA’s spokesperson on health