Health Minister Zweli Mkhize says he does not understand fearmongering when it comes to the National Health Insurance (NHI) system because it will be managed in the same way as institutions such as the Road Accident Fund (RAF) and the National Student Financial Aid Scheme (Nsfas).
This week, Mkhize went on the defensive after City Press’ sister publication Rapport reported that opinion polls indicated that many doctors were threatening to leave the country if the NHI was implemented in its current form.
City Press also reported on these polls in the January 5 edition.
Both publications referred to an opinion poll conducted by mutual financial services company PPS, in which 72% of its professionals said they would emigrate, as well as to a poll conducted by the SA Medical Association, which found that 38% of doctors said they would leave.
In response, Mkhize said he had “noted” the reports and proceeded to encourage stakeholders who had “constructive commentary” about the NHI to participate in the parliamentary process.
He said the polls had shortcomings because the respondents had a “biased response”.
Mkhize urged “interest groups” not to “generalise the findings of such results in an unscientific manner”.
He then defended the NHI, saying it would be managed like other Schedule 3A entities – defined as “extensions of a public entity with the mandate to fulfil a specific economic or social responsibility of government”.
South Africa had more than 150 Schedule 3A national public entities, and hundreds more in the provincial sphere, which were managed effectively and with integrity, said Mkhize.
“There is a high index of confidence in 3A entities as they have set a precedent of good governance and accountability,” he said.
But Mkhize did not spell out exactly which entities he was referring to.
Although most Schedule 3A entities received clean audits according to the Auditor-General’s latest report, the entities that are managed well are mainly small ones, such as museums, theatres and small regulatory authorities.
Almost all of the entities with large budgets, or which are responsible for complex activities – as the NHI would be – have found themselves in some sort of trouble, including:
- Nsfas, which collapsed and had to be placed under administration;
- The SA National Roads Agency (Sanral), which has been crippled by poor implementation of, and resistance to, e-tolls on Gauteng’s roads. Rapport has reported that Sanral has now been forced to use money for the maintenance of untolled roads to keep its head above water.
- The Road Traffic Management Corporation, which has still not finalised the rollout of the Administrative Adjudication of Road Traffic Offences traffic fines system after almost a decade, also falls into this category;
- The SA Social Security Agency, which, in 2018, was found guilty by the Constitutional Court of wasteful and fruitless expenditure, to the tune of billions of rands, for the nonpayment of social grants that were meant to benefit the nation’s poor. This occurred under the watch of then social development minister Bathabile Dlamini, who was called “grossly negligent” by the court;
- The RAF, which is in such dire financial straits that it no longer owns its own office furniture because these items are regularly attached by the sheriff of the court. It has been reported that the RAF asked the court for 180 days to pay its debts because it was insolvent;
- The SA Revenue Service, which fell victim to state capture during the tenure of commissioner Tom Moyane, and suffered lasting damage through the exodus of its most skilled employees.
Schedule 3A entities that deal with health services have also been shown to perform poorly.
Under the NHI, the fund will become the sole buyer of all medical goods and services.
Some of these struggling entities are:
- The National Health Laboratory Service, which is well known for being mired in a backlog of blood sample analyses related to drunk driving matters. Last year, the entity suspended its chief executive officer and financial head over alleged “acquisition irregularities” amounting to R200 million.
- The Compensation Fund is buckling under complaints of poor service delivery to the public, and service providers such as doctors and hospitals;
- The Council for Medical Schemes, the regulator of medical aid funds, which is being investigated by the Special Investigating Unit over allegations of widespread corruption. Almost half of its executive committee was axed last year.
Mkhize’s office did not answer questions about which of these entities the health minister believed was effectively managed.
He had merely emphasised that the NHI fund’s best chance of protection against corruption was the fact that it was a Schedule 3A entity, adding: “There is no need to cast doubt on the governance of the proposed NHI. Casting aspersions on NHI governance and risk of corruption without substance is doing an injustice to the nation. It is fearmongering.”
Shortly before Rapport went to print, health department spokesperson Lwazi Manzi told the newspaper to ignore Mkhize’s initial response so he could react fully at a later date.
Earlier this week, the minister said that he understood people’s fear of the unknown and had reassured “doctors and other medical practitioners such as nurses and pharmacists”.