Elders support SA’s plans for universal health coverage

On Thursday, former Norwegian prime minister Gro Harlem Brundtland urged SA MPs not to let their concerns about corruption or the weak economy stand in the way of the that is National Health Insurance (NHI).

Parliament is currently considering the NHI Bill, which sets out the government’s proposed legislative framework for the biggest health reforms in post-apartheid SA.

The bill proposes establishing a central NHI fund that will purchase services on behalf of the entire population, from accredited public- and private-sector providers. Critics have questioned whether the fund’s governance structure, which gives the health minister the power to hire and fire key appointments, contains adequate checks and balances to protect it from corruption, and whether the tight fiscal environment will permit increased government spending or raising taxes to fund the initiative.

Brundtland is in SA with a delegation of the “Elders”, a group of former world leaders established by former president Nelson Mandela in 2007 to work for peace and human rights.

Responding to questions from MPs concerned that NHI will  flounder on corruption, Brundtland conceded SA had a “bigger problem than many other countries” but said these could not be an excuse not to pursue universal health coverage.

“This cannot be a reason not to make NHI. It is part of a bigger issue that you need to take seriously,” she told a joint sitting of the National Assembly’s portfolio committee on health, and the National Council of Province’s select committee on health and social services.

She said many countries, including Norway, had successfully implemented universal health coverage despite their poor economic conditions at the time. Investing in healthcare would boost the economy, she said, citing work by the former secretary of the US treasury Larry Summers that showed health investments could yield benefits that were 10 times greater than their costs.

Her fellow elder, former Chilean president Ricardo Lagos attributed what he said was the successful implementation of universal health coverage in Chile to its staged approach, and urged SA to do likewise. “It is a process of step-by-step, otherwise it will be very difficult to implement a change like the one you are trying to do.” 

Sceptical opposition party MPs expressed support for the principles of universal health coverage, but said they were concerned about the scope for corruption. The EFF’s Naledi Chirwa said corruption is robbing South Africans of decent healthcare. “We have public servants who steal, and there is no mechanism that can be exploited efficiently to hold people accountable. If you steal [and get caught], you get moved to another department.” 

The DA’s health spokesperson Siviwe Gwarube said no-one is opposed to rolling out universal health coverage, but her party wants to ensure the legislation for NHI contains the right checks and balances to protect public funds. “Our opposition to aspects of the legislation is not opposition to universal health coverage,. 

kahnt@businesslive.co.za