Why are they opposing National Health Insurance?

Currently the total expenditure on health care in South Africa (SA) is 8.5% of the Gross domestic product. It is important to note that only 16% South Africans have access to private health care and the remaining 84% use the public health care. It is highly worrying and unprecedented that of the 8.5% total health expenditure GPD, 4.4% serve only 16% of the total South African population, while the remaining 4.1% is shared by 84% of the population. If a loaf of bread was the total healthcare expenditure to be shared 100 South Africans, 16 rich South Africans will take half of that bread and the remaining half be shared by 84 South Africans.

This is the main reason we should support National Health Insurance (NHI), to redistribute the resources in accordance with the needs of our country. Now the fundamental question is, why is there a large number of South Africans against NHI? Maybe they are misled by the name NHI:  

NHI is defined by South African department of health (DOH) as financing system that will make sure that all citizens are provided with essential healthcare regardless of their employment status. While the term NHI is used in many other different countries in the world, it might not be the most suitable term in the South African context, below are the reasons for that:

1.       Insurance is a means of protection from financial loss. Is “Insurance” the most appropriate word to be used? Does it really define what we want to archive or it chase people away?

2.       Unfortunately the first thing that usually comes to mind when using the term NHI is “Money” and not quality healthcare. Looking into different NHI debates in SA :

a.       The definition by DOH itself is problematic, it define NHI as “Financing system”, most people therefore focus on the financing part of it and not on the intended purpose, which is quality health for all.

b.      Unlike many other countries, SA health system has lost lives of many people in the name of finance, in particular affordability:

i.                     One of the strongest HIV denialist’s argument was an issue of affordability, as a result, more than 350 000 lives of people were lost, more than 35 000 children were born HIV positive.

ii.                      The reasoning behind moving life Esidimeni patients to different NGOs was the issue of affordability.

There are many other similar examples, the main point is, should we sacrifice the quality of healthcare, in the name of affordability? Should the NHI debate be more about affordability or more about quality of healthcare?

c.       In 2016 the Democratic Alliance critique toward NHI was mostly about issue of affordability “NHI come at an enormous cost to South Africans, estimates put the costs at extra 100 billion a year”, while there is some truth to this statement, it is important to note that this doesn’t really portray the willingness to pay the highest price for quality health.

d.      Can we afford to pay for NHI? The similar question was asked 15 years ago, they asked “Can we afford to pay for ARVs” those who weren’t willing to save lives of people sad we couldn’t afford it. Those who were passionate about saving lives of people came and said, there is a way, it can be done, we will do whatever it take to save lives. Today ARVs prices went down by more than 100%, it is for this reason that we believe that the unreasonable healthcare prices should go down so that government can afford to cover everyone. So the answer is yes, we can afford NHI.    

e.      In a current political dynamic, with scary corruption dynamic, you can’t blame tax payers worried about NHI being another way of looting the money of taxpayers. Especially when we start talking about 100 billion+. It is therefore important for the department of health to come out with clear strategies on how corruption will be prevented in this very important project.

f.        It might be appropriate for government to honestly reflect on this issue, “Is the term NHI misleading”

We can’t once again postpone NHI, all lives matters. Students demanded free education, don’t be surprised when the next target is high quality healthcare for all. We must make it work, hence we must give a clear message, a message that doesn’t mislead South Africans, an Insurance message is misleading, we don’t want insurance, we want high quality healthcare.  


Sanele Sano Ngcobo

B.CMP, PGDPH, MPH, PHD Candidate

University of Pretoria

Twitter : @sanosanele

Facebook : Sanele Sano Ngcobo

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