SA health system favours the rich, says Motsoaledi on NHI

Health Minister Aaron Motsoaledi says the government can no longer “sustain” the gross inequality in the health sector, which he says favours the rich.

Motsoaledi presented his department’s budget in parliament on Thursday.

The health department budget for the 2024/25 financial year is R62.2 billion − a 3.5% increase from R60.1 billion of the last financial year.

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About R694 million of the budget is spent on the compensation of employees, while R56 billion goes to the provinces.

Motsoaledi said the country, however, still had a long way to address inequalities in the health sector, where some get world-class health care, while others get poor health care.

NHI ‘addresses inequality’

President Cyril Ramaphosa signed the NHI Bill into law just before the elections in May, earning both praise and criticism.

Several organisations have vowed to challenge the NHI in court.

“Some believe it is a system which South Africa is not ready for. Others believe it is a vintage very expensive health system for which there is no money in the country,” said Motsoaledi.

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“Let us clarify once more, NHI is health financing system, called Universal Health Coverage (UHC) by the WHO [World Health Organisation]. It is a health financing system, which is meant to be an equaliser between the rich and the poor.

“There is no debate at all, that South Africa is the most unequal society in the whole world. If you want to see what inequality means, come to the health sector in South Africa. Within the borders of the same country, some are getting a world class health care, while others get such poor health care you would believe we live in different countries.”

Motsoaledi said it was time the country bridged the gap between the two, and those who were against NHI were “the selected few”.

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“We are beneficiaries of a wrong system and we dare not meddle with our own comfort,” said Motsoaledi of the rich.

‘Don’t be an obstacle’

According to the WHO, for a country to have a good health care system for everyone regardless of their financial status, a country needs to spend at least 5% of its GDP on health.

South Africa spends 8.5%, and on average European countries are at 9%.

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But this is not reflected in the state of the country’s health sector, due its allocation, said Motsoaledi.

“Fifty one percent of it goes to serve only 14% of the population. The nearly meagre 49% goes to serve a whopping 86% of the population,” he said.

“Everybody agrees that we are the most unequal society in the whole world. If you want to see that gross inequality, come to the health care system and you will understand what inequality is all about. This ought to stop. It must end and end now.”

To those who argue they cannot support the UHC in the form of the NHI, “fair enough”, says Motsoaledi.

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“But we cannot throw the baby out with the bathwater. Let us discuss which areas need to be ironed out. Let us not be obstacles to what poor people have been waiting for close to a century.”