Solidarity warns Ramaphosa on NHI implementation

Solidarity pointed out on Friday that government cannot, through "political rhetoric or administrative manoeuvres", continue implementing the National Health Insurance (NHI) system, which is currently stalled by a court order.

This was in response to President Cyril Ramaphosa's statement during Thursday's parliamentary question and answer session, in which the organisation said he gave the impression that the implementation of the NHI Act is continuing, even though, according to a recent court order, it cannot.

Last month Ramaphosa confirmed that he would not promulgate any provisions of the NHI Act prior to the Constitutional Court handing down judgment on the public participation challenges, and that he would not enforce any part of the Act until he was requested to do so by the Minister of Health.

The court cases related to the public participation process that led to the adoption of the NHI Bill by Parliament, arguing that it was inadequate on this score.

The President clarified that the court order would not stop preparatory work already underway, such as registering patients who would use the NHI, as well as the accreditation and contracting of health service providers.

"The President is living in a dream world if he thinks that the court order will not disrupt the NHI timeline," said Solidarity Research Institute economic researcher Theuns du Buisson.

Solidarity's legal team will study Ramaphosa's statements to determine whether the preparatory work mentioned could potentially be a violation of the court order.

Du Buisson believes that Ramaphosa is trying to create the impression that the NHI already has momentum and that implementation is inevitable.

"This is not the case. The position is clear: the NHI must not proceed at this time. The NHI is not going to materialise," he said.

The organisation pointed out that many of the examples that Ramaphosa presented as preparation for the NHI – such as the renovation of hospitals, the construction of new health facilities and the appointment of doctors – do not actually relate to the implementation of an NHI system.

Du Buisson said it was misleading to suddenly present such basic State functions as NHI-related.

"That kind of thing should be done in any case, without any mention of an NHI. It would, of course, be good if doctors were appointed, and hospitals were built and maintained. Unfortunately, this has not been done and has been neglected for many years," he said.

The only element that could be linked to an NHI scheme is the development of new financial systems and record-keeping, he added.

"Even in this regard, it is inconceivable that something like this has never been done for the existing public healthcare system to this day," Du Buisson said.

Following the court order, Solidarity also sent a formal notice to Ramaphosa, the Department of Health, the National Treasury and relevant Ministers, warning them against any possible disregard of the court order.

In the notice, the organisation expressly stated that no implementation, preparation or budget allocations regarding the NHI may now take place, and that any action in violation of the court order may lead to further litigation.

Du Buisson said that, with the necessary support, Solidarity's litigation would "avert the NHI disaster", as he reiterated the organisation's argument that the system was unaffordable and unworkable.