YUGEN PILLAY: The 2024 budget hints at a pragmatic approach to NHI

As the impending National Health Insurance (NHI) Bill looms large on SA’s political horizon, it’s critical that we take a pragmatic approach to its implementation.

President Cyril Ramaphosa’s remarks during his state of the  nation address, finance minister Enoch Godongwana’s 2024 budget and the palpable urgency within government structures to use the bill for its electioneering indicate a swift progression towards its enactment.

However, we must not overlook the daunting constraints that accompany such a monumental undertaking. The NHI represents more than just a healthcare reform bill; it’s a symbolic assertion by the governing party of its commitment to address the nation’s healthcare disparities. But amid the fervour surrounding it, we cannot afford to ignore the elephant in the room: the budgetary constraints that threaten to stifle its realisation.

At the heart of the matter lies a simple yet important question: can we afford the NHI? Despite its noble intentions, the stark reality is that our present fiscal landscape is ill-equipped to shoulder the financial burden it entails. With a burgeoning budget deficit, less-than-desirable growth and dwindling tax revenues, the prospect of financing the NHI through conventional means appears increasingly untenable.

In his 2024 budget speech, Godongwana set aside R1.4bn for the next financial year for the scheme. This reiterates the government’s intention to begin rolling out NHI, but to what extent? While some estimate NHI will cost R200bn in total, its true cost remains unknown. Then there’s the matter of the state of our healthcare services.

Consider that almost 800 qualified doctors are without jobs in the country due to budget constraints. So, even if we have the necessary facilities, we cannot even afford to place the doctors we have, let alone the many more we’ll require. That’s not to mention the exodus of skilled medical practitioners, which presents a further obstacle. How can we hope to implement a comprehensive healthcare scheme when we lack the necessary workforce to sustain it?

Healthcare is the heartbeat of the nation, and there’s no point in having a system that doesn’t work, leading to a population that’s continuously sick. That affects productivity and the economy, creating a vicious cycle. So to navigate these challenges, we must adopt a multifaceted strategy that prioritises economic growth and human capital development.

Rather than rushing headlong into NHI implementation, we should focus on laying the groundwork for its success. This entails devising a comprehensive budgetary plan, at least a three-year phased implementation strategy, and concerted efforts to retain our medical talent.

In his budget speech, Godongwana did identify several areas where the NHI still needed to be developed before its rollout. This should provide some comfort as it indicates a realisation by government that in its current form SA cannot afford to fully implement the scheme.  But what are some of the ways the country can better prepare itself for the inevitable rollout of NHI?

Crucially, we must engage with healthcare professionals to understand their concerns and address the systemic issues driving their departure. By fostering an environment conducive to their growth and development together with the Health Professions Council of SA (HPCSA), we can stem the brain drain and fortify our healthcare infrastructure from within.

Furthermore, we cannot afford to overlook the invaluable expertise of senior specialists. Their mentorship and guidance are indispensable in nurturing the next generation of healthcare professionals and optimising the utilisation of our existing resources.

Though the minister acknowledges that further developments are required before NHI can be rolled out at scale, the incoming seventh administration — even if it is a coalition government — may be more aggressive in implementing the scheme in a show to radically transform the health sector. That said, for now reason and logic prevails.

Ultimately, the success of the NHI hinges not only on its legislative passage but on the concerted efforts of all stakeholders to address the underlying constraints and seize the opportunity to redefine the future of healthcare in SA.

It is incumbent on us all to rise to the occasion and ensure that the promise of universal healthcare becomes a reality for all South Africans, without compromising the fiscal integrity of our nation.

• Pillay is public sector head at BDO SA.