Pretoria – President Cyril Ramaphosa on Wednesday signed the National Health Insurance (NHI) Bill into law, setting off an outcry and a barrage of criticism from detractors that included political parties and medical bodies.
The public signing of the NHI Bill, which was broadcast on TV live, occurred at the Union Buildings.
Speaking ahead of the signing President Ramaphosa said: “We are gathered here today to witness the signing into law of the National Health Insurance Bill, a pivotal moment in the transformation of our country”.
He added: “It is a milestone in South Africa’s ongoing quest for a more just society.
“This transformational healthcare initiative gives further effect to our constitutional commitment to progressively realise access to healthcare services for all its citizens.”
President Ramaphosa said in its essence, the NHI is a commitment to eradicate the stark inequalities that have long determined who receives adequate healthcare and who suffers from neglect.
“By putting in place a system that ensures equal access to health care regardless of a person’s social and economic circumstances, the NHI takes a bold stride towards a society where no individual must bear an untenable financial burden while seeking medical attention,” President Ramaphosa said.
“This vision is not just about social justice. It is also about efficiency and quality.
“The provision of health care in this country is currently fragmented, unsustainable, and unacceptable.”
President Ramaphosa said the public sector serves a large majority of the population but faces budget constraints.
He said the private sector serves a fraction of society at a far higher cost without a proportional improvement in health outcomes.
“Addressing this imbalance requires a radical reimagining of resource allocation and a steadfast commitment to universal healthcare, a commitment we made to the United Nations,” said President Ramaphosa.
“The real challenge in implementing the NHI lies not in the lack of funds, but in the misallocation of resources that currently favours the private health sector at the expense of public health needs.
“The NHI Bill presents an innovative approach to funding universal healthcare based on social solidarity.”
He said it proposes a comprehensive strategy that combines various financial resources, including both additional funding and reallocating funds already in the health system.
“This approach ensures contributions from a broader spectrum of society, emphasising the shared responsibility and mutual benefits envisioned by the NHI,” the President said.
“The financial hurdles facing the NHI can be navigated with careful planning, strategic resource allocation, and a steadfast commitment to achieving equity.
“The NHI carries the potential to transform the healthcare landscape, making the dream of quality, accessible care a reality for all its citizens.”
The NHI Fund will procure services from public and private service providers to ensure all South Africans have access to quality health care.
The NHI recognises the respective strengths and capabilities of the public and private healthcare systems.
“It aims to ensure that they complement and reinforce each other,” President Ramaphosa explained.
“Through more effective collaboration between the public and private sectors, we can ensure that the whole is greater than the sum of its parts.
“The effective implementation of the NHI depends on the collective will of the South African people.
“We all need to embrace a future where healthcare is a shared national treasure, reflective of the dignity and value we accord to every South African life.”
He said the preparations for the implementation of NHI necessarily require a focused drive to improve the quality of health care.
“We have already begun implementing a national quality improvement plan in public and private health care facilities, and are now seeing vast improvement,” said President Ramaphosa.
“In signing this Bill, we are signalling our determination to advance the constitutional right to access health care as articulated in Section 27 of the Constitution.
“The passage of the Bill sets the foundation for ending a parallel inequitable health system where those without means are relegated to poor health care.”
He said under the NHI, access to quality care will be determined by need not by ability to pay. This will produce better health outcomes and prevent avoidable deaths.
“The NHI is an important instrument to tackle poverty. The rising cost of health care makes families poorer,” the President said.
“By contrast, health care provided through the NHI frees up resources in poor families for other essential needs.
“The NHI will make health care in the country as a whole more affordable.”
The way health care services will be paid for is meant to contain comprehensive health care costs and to ensure the available resources are more efficiently used.
“Through the NHI, we plan to improve the effectiveness of health care provision by requiring all health facilities to achieve minimum quality health standards and be accredited,” said President Ramaphosa.
“Following the signing of this Bill, we will be establishing the systems and putting in place the necessary governance structures to implement the NHI based on the primary health care approach.”
He said the implementation of the NHI will be done in a phased approach, with key milestones in each phase, rather than an overnight event.
President Ramaphosa acknowledged that there has been much debate about this Bill.
“Some people have expressed concern. Many others have expressed support,” he said.
“What we need to remember is that South Africa is a constitutional democracy.”
President Ramaphosa said Parliament, which adopted the legislation was democratically-elected and its members carried an electoral mandate to establish a National Health Insurance.
He reassured that South Africa was governed by the rule of law in which no person may be unduly deprived of their rights.
“We are a country that has been built on dialogue and partnership, on working together to overcome differences in pursuit of a better life for all its people,” the President said.
He said the NHI is an opportunity to make a break with the inequality and inefficiency that have “long characterised our approach” to the health of the South African people.
“Let us work together, in a spirit of cooperation and solidarity, to make the NHI work.”
Earlier, Health Minister Dr. Joe Phaahla said in this 30th year of democracy the signing into law of the NHI represents a momentous occasion.
Dr. Phaahla said the signing of the NHI Bill into law “sets us on a course that is able to guarantee that every South African can access healthcare”.
The minister said the present system required a fundamental overhauling to ensure equity.
He said the NHI Bill, which was many years in the making, involved over 60 public hearings in all parts of the country.
“This is for the betterment of all South Africans… it is not electioneering.”
NHI is a health financing system that is designed to pool funds to ensure access to affordable health services for all South Africans.
“Don’t listen to the doomsayers… things can only get better,” the minister said.
However, the opposition Democratic Alliance and the Board of Health Funders, which represents most Medical Aid schemes, have vowed to take legal action to stop the implementation of the NHI Bill.
