Can talks save South Africa’s NHI from a courtroom war?

Health Minister Aaron Motsoaledi has met the South African Medical Association (Sama) — one of the organisations taking him to court about theNational Health Insurance (NHI) Act— to talk about “things we have in common”. Motsoaledi spoke to Bhekisisa for theMarch episodeof its TV show,Health Beat.Samais a membership organisation for doctors. The NHI will create a massive, state-controlled medical aid, to which all South Africans will belong.

Public and private health facilities and professionals will have to sell their services to the fund and private medical aids will cease to exist in their current form. Sama’s chairperson Mvuyisi Mzukwa, confirmed the meeting with Motsoaledi, which took place on February 26, but says “the discussion did not allow for in-depth engagement on specific issues”. He explains: “The minister requested that engagements continue on a monthly basis, with each session focusing on a single, clearly defined area of interest or key concern to enable more substantive discussion.” Motsoaledi told Bhekisisa that President Cyril Ramaphosa was also planning to meetBusiness Unity South Africa (Busa), the country’s largest umbrella body representing influential businesses, again, after aninitial meeting in 2024.

During the engagement they discussed alternatives to the NHI, based on mandatory private medical aid membership for everyone earning above a certain threshold, that would reduce the proportion of people which the state has to fund for basic health needs, Motsoaledi said. Busa isconcerned aboutthe NHI’s potential negative impact on the quality of healthcare, taxpayers, the economy and investor confidence. “There’s nothing wrong with talking,” Motsoaledi said.

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“The question is: What are you discussing and what is the ultimate aim? This country has always believed in talking.” Serious concerns about the ability of the health department — and NHI — to manage a trillion-rand NHI Fund were raised this month when Motsoaledi took action against three of his key officials for alleged corruption. The national health department director general, Sandile Buthelezi; the deputy director general for hospital services and human resources, Percy Mahlathi; and the department’s chief financial officer, Phaswa Mamogale, are onprecautionary leave. They allegedly misused donor money meant for Covid activities in 2023, to instead pay for the allegedly irregular appointment of a chair and investigator for a disciplinary hearing of an employee linked to uncovering corruption in the North West health department.

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