NHI rollout: Balancing act between hope and skepticism

When former president Jacob Zuma signed a Bill that introduced free higher education on the eve of his exit as president, there was such a huge uproar.

And it was a justified uproar, there wasn’t even a single structure that government had set up to look at the feasibility of providing free education at tertiary level.

There were even suggestions that he had done that as a way of saddling the then incoming President Cyril Ramaphosa with a problem he could not solve.

Several years later, free higher education is a reality in South Africa. It does not mean that it is without problems, there are many problems, with corruption being central to the problems.

Last week, Ramaphosa signed the National Health Insurance (NHI) Bill into law. There is no denying that the ANC is not exiting the stage without putting up an almighty fight.

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They have already done away with e-tolls in Gauteng and have also given the country close to two months of uninterrupted electricity supply.

How the country can suddenly come down from stage 6 load shedding a few months ago to absolutely no load shedding on the eve of this election is still a mystery that will become clearer after 29 May.

And so will the government’s intentions with regards to NHI. Is it an election gambit or a genuine move towards solving this country’s health problems?

It does not help the situation that the government has taken a major step towards overhauling the health system in this country without bothering to educate citizens about it.

Chief among those who claim not to understand what the NHI is all about are health sector workers themselves.

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And these are professionals with tertiary Tuesday 10 21 May 2024 qualifications, yet they have no idea how the NHI will transform their industry and what their new roles are going to be in it.

What then of the masses of uneducated people who are meant to be the primary recipients of whatever good will come from the NHI?

One of the worst tags that South Africa has gained and hung onto is that of being the most unequal society in the world. It is a shameful tag that can only be addressed by deliberate and thoughtful action that targets those areas of inequality.

The contrast between Sandton and Alexandra is going to stay for as long as there is no deliberate action to transform the poorer neighbourhood. And the introduction of NHI should be seen as a step towards correcting that inequality in the health sector.

The biggest problem with the NHI is not funding. Yes, funding is going to be a headache that needs to be cured before any major step is taken towards implementing the NHI, but the biggest enemy towards addressing health system inequalities are those who are implementing it.

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Those who are asking why the government isn’t fixing the current public health system before attempting to merge private and public health care are asking a valid question. And it is a question based on knowing the track record of those who are in power. They have not covered themselves in glory.

It will take years to set up the kind of structures required to pull off the kind of changes NHI requires to be in place for successful implementation of what is required.

The only thing the country can do is hope those years intervene to help in setting up a successful structure that will ensure that NHI does not become the failure that everyone expects it to be.

Done right, it will reduce inequality.