By Phenyo Selinda
Health Minister, Dr Aaron Motsoaledi, has reaffirmed the department’s dedication to implementing the National Health Insurance (NHI) in a phased manner during his Budget Vote Speech in Parliament on Thursday.
“We will have to start implementing NHI in phases, as we are already in phase 2. The rest of the building blocks of health will easily fall into place,” Motsoaledi stated.
Budget Allocation and Priorities
Presenting the Budget Vote for the 2024/25 financial year, the Minister announced a budget of R62 218 899 for the Department of Health, marking a 3.5% increase from the previous year’s R60.1 billion. He outlined his priorities for the next five years, based on six building blocks identified by the World Health Organisation (WHO): leadership, governance, access to essential medicines, the health workforce, health systems financing, information systems, and service delivery.
“Five of the six building blocks seem acceptable to everybody and debates around them are straightforward and clear. But one of them has generated a lot of heat and sometimes fury in some quarters. This is the health systems financing. In our country we have decided to call this NHI,” he said.
Debates and Challenges
The Minister acknowledged the differing opinions on NHI, with some critics arguing that South Africa is not ready for such a system, and others deeming it too expensive given the country’s financial constraints. “NHI is a health financing system, called Universal Health Coverage (UHC) by the WHO. It is a health financing system, which is meant to be an equaliser between the rich and the poor.”
Motsoaledi highlighted the stark inequalities within the South African healthcare system, describing it as the most unequal society globally. “If you want to see what inequality means, come to the health sector in South Africa. Within the borders of the same country, some are getting world-class healthcare, while others get such poor healthcare you may believe we live in different countries.”
Addressing Inequality
The Minister stressed that South Africa can no longer sustain such “gross inequality” and has been searching for a solution for nearly a century. According to the WHO, a country should allocate at least 5% of its Gross Domestic Product (GDP) to health to ensure a robust healthcare system for all. South Africa currently allocates 8.5%, surpassing the recommended percentage, yet the system remains unequal.
“This means South Africa’s health system was supposed to be as advanced as countries in Europe,” Motsoaledi explained. “As is evident that is not the case. The question is why? But the fact remains that 51% of it goes to serve only 14% of the population and the nearly meagre 49% goes to serve a whopping 86% of the population.”
Call for Support
The Minister called for support to end this disparity. “This needs to stop now,” he declared, acknowledging that while there is support for the NHI, there are also detractors who do not support it in its current form. “Fair enough, but we cannot throw the baby away with the bathwater. Let us discuss which areas need to be ironed out but let us not be obstacles to what poor people have been waiting for close to a century.”
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