Precious Matsoso, director-general of health. Picture: FINANCIAL MAIL
Precious Matsoso, director-general of health. Picture: FINANCIAL MAIL

Health director-general Precious Matsoso says she has been completely sidelined by presidential adviser Olive Shisana and health minister Aaron Motsoaledi in revising the controversial draft National Health Insurance (NHI) Bill.

The draft bill proposes far-reaching reforms to SA’s health system in order to achieve the government’s ambition of providing universal health coverage. The draft bill was released on June 21, with a three-month comment period that closed on September 21.

It was then substantially changed by a team overseen by Shisana without consulting the Treasury officials, according to a leaked Treasury letter seen by Business Day last week.

It is now clear that Matsoso, who is the department’s accounting officer, has been left in the dark too.

In a hard-hitting interview with Business Day on Wednesday night, she said the last time she had seen a copy of the draft bill was when it was released for public comment in June.

"I have not been involved at all in Olive’s bill. The process has been driven through structures I am not involved in," she said
by telephone from Switzerland, where she was attending a WHO meeting.

Matsoso said policy development should be conducted in an open and transparent manner, but this had not been the case since Shisana’s involvement.

"I don’t know who has been consulted on the bill. I’ve never seen policy developed in this way. It is an unhappy state of affairs," she said.

Shisana said the Presidency had liaised with Motsoaledi, who had delegated two officials to work on the NHI Bill based on their technical skills — deputy director-general for NHI Anban Pillay and Motsoaledi’s adviser, Aquina Thulare.

"The role of the presidency is to facilitate where there are
difficulties," Shisana said.

In an unusual turn of events, Yogan Pillay, who was acting director-general while Matsoso was out the country, signed off on the revised NHI Bill on Thursday morning.

It is understood the minister has previously instructed Matsoso to return to the country to sign off important documents, such as the department’s annual report. But in this case, he did not do so. Pillay said the minister was expected to sign the bill on Thursday, and it would be submitted to the cabinet secretary later in the day in order to be put on the agenda for next week’s cabinet sub-committee meeting.

Wits University professor Alex van den Heever said it was "highly improper" for an acting director-general to sign off on draft legislation.

"They haven’t properly reviewed the submissions [or] taken into account serious flaws. It is too substantive to be rushed in an irregular way. "To bypass the director-general is suggestive of a deliberate strategy to subvert normal process. You don’t do it for good reason."

The Treasury’s letter raised a series of red flags with Shisana, including the fact that the revised bill reversed a number of issues previously agreed to by the ministers of finance and health, such as allowing medical schemes to continue to operate during a transition phase.

A joint statement issued by health, the Treasury and the Presidency last Friday said many of the Treasury’s concerns had been addressed, but provided no detail.

Pillay declined to comment on the bill’s contents. "If I had any reservations I would not have signed it," he said.