Opposition to gains of NHI baffling
The drive towards achieving quality universal health care through National Health Insurance (NHI), which guarantees all South Africans access to affordable and high-quality health care irrespective of their socioeconomic status, is the most innovative and transformative policy achievement for 30 years.
The public health-care system currently serves more than 84% of the population, while private health care only serves 16% lucky enough to access it. Even those with medical aid cannot afford the high-quality treatment provided in the private sector as many medical aid members exhaust their daily benefits halfway through the year.
Only a system that ensures everyone in South Africa can access reasonably priced, high-quality health care can solve this problem. NHI is about realising the right to decent health care for all, stated in section 27 of the constitution: “Everyone has a right to have access to health care-services.”
There are shocking inequalities and problems in our health system. While our country spends much on health care compared with many others, only a few have access to good health care. The ANC and the broader democratic movement have a long history of supporting universal and primary health care, as outlined in the World Health Organisation’s 1978 Alma Ata declaration.
The “African Claims in South Africa” document and the Freedom Charter demonstrate this commitment well. The health charter in the former called for “a drastic overhauling and reorganisation of the health services of the country”. It emphasises preventive medicine, with all that implies in the modern public health sense. It also strongly urged the establishment of free medical and health services “for all sections of the population”, while the Freedom Charter stated: “The state shall run a preventive health scheme. Free medical care and hospitalisation shall be provided for all, with special care for mothers and young children.”
The NHI is only one part of the health system’s transformation; it is a fund meant to bring together resources and distribute them fairly when buying medications and covering medical expenses. The public health system faces numerous difficulties, including inadequate facilities, long waiting periods, a lack of physicians, et cetera.
Therefore, to achieve the larger goal of changing the health-care system, Gauteng is tackling some of the problems with our medical depots and health facilities, including inadequate budgeting and planning, noncompliance with standard operating procedures (SOPs) when handling medications, unacceptable substandard storage methods, and corruption. These interventions have eased Gauteng’s legal liabilities because of the delivery of better quality care.
The Gauteng government has demonstrated its commitment to NHI by working to overhaul its health-care system, including system operations. We have already shown our resilience to pandemics and epidemics, and while public trust in our health-care system is still being restored, several facilities are beginning to offer health-care services with noticeable improvements.
We are expanding the capacity of our health system in the province before implementation of NHI by partnering with the private sector to acquire 18 existing facilities. We are working quickly to implement a health information system that will support a single file for each patient. The Mamelodi Regional Hospital has been using it since November, and will be a model for other hospitals.
We are wrapping up the legal procedures to transform our Gauteng medical supply depot into a stand-alone schedule 3C public corporation. This entity will enable us to purchase bulk medication to establish a state-owned pharmaceutical company directly. This would significantly improve our supply chain and distribution procedures
Long-standing surgical backlogs were made worse by the pandemic, which resulted in the cancellation of electives and significantly affected society and health care. In keeping with our pledge to improve the lives of those living in poverty, we started our campaign to reduce surgical backlogs on Mandela Day in July 2023. The decreased HIV/Aids prevalence from 12.3% in 2014 to 3% in 2023 is evidence that the Gauteng government’s efforts to increase screening for priority noncommunicable diseases are paying off.
The centralised chronic medicine dispensing and distribution (CCMDD) programme has significantly reduced queues and waiting times at our health facilities. It has particularly benefited those with chronic conditions who face health or financial challenges. Reducing the need for these patients to visit hospitals for their medication has significantly eased the burden on our outpatient departments. As of the end of financial 2023 about 1.2-million clients were enrolled in the CCMDD programme. This represents a substantial increase from about 1.1-million the previous year.
Working with great South Africans such as Daphne Nkosi, Gauteng prides itself that in this term, we opened the Zakithi Nkosi paediatric haematology & oncology clinic at Chris Hani Baragwanath Academic Hospital. The only public centre in the country, this is a haven for children with cancer and life-threatening blood disorders across South Africa. The clinic sees more than 700 children with various cancers, including leukaemia, kidney cancer and cancer of the bone and soft tissue from various provinces.
We are also proud to have completed the nuclear medicine research institute at Steve Biko Academic Hospital, collaborating with the University of Pretoria, with R500m in funding from the department of science & innovation. This is the first of its kind on the continent, pioneering a revolutionary one-stop-shop medical nuclear imaging and theragnostic facility.
Creating NHI is only one aspect of transforming our health-care system; other changes include reorienting resources and making primary health care the cornerstone of the system. For most patients who wouldn’t need a referral to the hospital system, this would be the beginning and the end of their care.
To this end, R14.2bn was allocated in financial 2025 and R43.4bn was budgeted in the mediumterm expenditure framework (MTEF) for several initiatives, such as expanding access to highquality public health care, re-engineering primary health care, expanding community health centre 24-hour services, and reducing radiation oncology backlogs. To support the implementation of health and wellness initiatives, especially in townships, informal settlements and hostels, we have allocated the Gauteng department of health R64.8bn in 2024/2025 and R202.7bn during the MTEF.
Yet since 1994, while the ANC maintained its commitment to this progressive and transformative vision, some critics outside the government have sought to undermine this historic commitment. There have been sustained efforts to undercut NHI since the Polokwane conference, which explicitly called for its establishment. Since the publication of the green paper in 2011, this contestation has used our democratic institutions to usurp policy determination on NHI to engineer a shift away from the ANC mandate. Unfortunately, there is still a minority that remains opposed to the creation of a publicly funded and publicly administered NHI Fund, despite the NHI Bill having been passed with an overwhelming majority in the National Assembly.
The current situation cannot continue; therefore, President Cyril Ramaphosa must honour the people’s will by signing the NHI Bill into law. It is baffling that the loud detractors who incessantly claim that NHI is unaffordable do not address the high disease burden in this country or the fact that millions of people die from preventable and manageable diseases. This is not only a health issue but also an economic one since a nation’s human capital is built on its citizens’ health, and an inefficient or perilous health-care system is economically unsustainable.
Creating the NHI is only one aspect of transforming our health-care system; other changes include reorienting resources and making primary health care the cornerstone of the system