It will require more than just good and honest intentions to make NHI work

On Tuesday 12, June 2023, the National Assembly passed the National Health Insurance (NHI) Bill. Should the National Council of Provinces also pass it into law, something close to a revolution will have taken place in the South African health landscape.

The revolution will have taken place quietly and forever changed the way healthcare operates in South Africa and the Bill of Rights proclamation on healthcare will have been realised. In short, the gap between the wealthy and the poor will have disappeared, as if by magic.

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NHI still needs to be implemented. By the same government that broke Eskom, Transnet, SAA, the water system and education – and the list goes on and on. South Africans have millions of reasons to be scared by the coming to fruition of the NHI system.

On paper, it is simple enough. A common, government-run medical scheme will pay all healthcare providers for whatever health service they provide for any South African citizen.

That would mean that someone living in a shack in Diepsloot would stand exactly the same chance of having access to a cardiologist or nephrologist as the chief executive of a JSE-listed company, because both of them would have access to the same amount of money provided by NHI to pay the specialist.

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Utopia! But this is South Africa. The country in which an accountant was murdered for exposing the fact that millions of rand were being looted from Tembisa Hospital while the leadership of the hospital looked away.

Babita Deokaran paid with her life for exposing that corruption. Should this stop the implementation of an ambitious grand scheme that would equalise healthcare in the country? No, nothing should stop that but the country deserves to know what the government will have put in place to prevent the almost R500-billion-a-year scheme from going to pay for skinny jeans, like Babita Deokaran discovered?

As noble as NHI sounds, until basic questions like: if the government is currently failing to administer funds before NHI is implemented, what is going to change to enable it to successfully administer a bigger scheme with even bigger funds?

Now is not the time for grandstanding and choosing to take righteous offence at imagined insinuations that the government can’t manage money.

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The evidence is that each time the government pools together large resources of money for the good of citizens, the ruling party’s tenderpreneurs rub their hands in glee waiting to outdo each other in a race to show who can get the biggest slice of the money for doing nothing.

NHI, if implemented well, could be the only beacon of glory that the ruling party can leave as its legacy. And just like everything that South Africa has ever attempted to pull off, the possibilities of its success are there.

But lurking with those possibilities are the very real dangers that saw the country looted blind during the “nine wasted years”.

NHI will work if the government treats it like it did the staging of the Fifa World Cup in 2010. Devoting its best people to the project, importing the best project managers the world has to offer to work on ensuring that the system works and works well.

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It will require more than just good and honest intentions to make NHI work. It will require the creation of space for a Babita Deokaran to work and expose corruption before it claims lives.