Minister of Finance Tito Mboweni. Picture: ESA ALEXANDER
Minister of Finance Tito Mboweni. Picture: ESA ALEXANDER

Finance minister Tito Mboweni’s maiden medium-term budget policy statement last week laid bare just how little progress the government is making on National Health Insurance (NHI).

The fact that the Treasury shaved more than half a billion rand off the R2.3bn NHI grant it allocated to the health department in the February budget signals how little faith it has in the department’s capacity to spend the money. With good reason. The health department has been going nowhere slowly for years: it is halfway through the ANC’s self-imposed deadline of implementing universal healthcare by 2025 and has precious little to show for it. We still don’t know what benefits NHI will provide, what it will cost or how it will be financed.

It is not the first time the Treasury has cast the spotlight on the health department’s slow pace in implementing NHI. In the 2014 budget it revealed that private sector general practitioners had de facto shunned the offer of contracting with the state, as at that point just 96 had agreed to see state patients, against a target of 600.

The Treasury has dug into the NHI indirect grant towards meeting President Cyril Ramaphosa’s commitment to fill 2,200 critical posts and buy extra beds and linen, because six months into the fiscal year the department had spent just 10.4% of the allocated funds. Worse still, not a cent had been spent on the priority health programmes such as those for mental and school health .

The department’s explanation for the slow spending in the first half of the fiscal year is that it was hobbled by striking staff. But it is clear that it does not have the capacity to drive such an ambitious policy. Seven years into the process, the deputy director-general responsible for NHI has a mere three people on the job, one of whom is a ministerial adviser.

As The Economist so rightly argued in a special report this year, the case for universal health care is compelling: a healthier nation is more stable, productive and prosperous. Universal health care — which the government has dubbed NHI — aims to provide quality health services  free at the point of care, to protect the sick from the risk of financial ruin. At the heart of NHI lie financing reforms that will compel everyone to contribute to a central fund (according to their means), which will purchase services from public and private sector providers. It is enshrined in the social solidarity principles in which the young and healthy subsidise the old and sick.

Given the truly catastrophic state of so many public health-care facilities, you have to ask why we are not seeing more rapid progress on NHI. Is it sheer ineptitude, malign intent or a lethal combination of the two? NHI is not the only initiative that emerged from a resolution taken at the ANC’s 2009 Polokwane policy conference that has yet to bear fruit — the promise of the state-owned pharmaceutical company Ketlaphela is another prime example of a long-promised initiative that remains stuck on the drawing board — but this has greater consequences.

The UN Committee on Economic, Social and Cultural Rights recently warned that SA’s deteriorating public health-care system threatens to wind back its recent health-care gains, which have seen life expectancy rise on the back of the country’s massive HIV treatment programme. To his credit, Ramaphosa has recognised the crisis. He has convened summits on NHI and health care and appointed former health director-general Olive Shisana as his special adviser.  But he now needs to act. He could do far worse than ditch the rhetoric on NHI and fix what SA already has: a massive public health system of dubious quality and a poorly regulated private health-care system. If both parts worked as they should, with proper government stewardship and oversight, SA would in fact be well on the way to universal healthcare.