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2023-12-07 10:24 AM

South Africa’s NHI Bill Sparks Concerns and Outcry

  • Passage of the National Health Insurance (NHI) Bill: The National Council of Provinces (NCOP) approved the NHI Bill, with eight out of nine provinces voting in favor, triggering concerns and outrage among various sectors in South Africa.
  • Stakeholder Concerns and Opposition: Medical professionals, businesses, and trade unions express unified disapproval of the NHI Bill despite supporting the concept of universal healthcare. They cite rushed legislative processes, potential threats to healthcare quality and access, governance issues, and the dismissal of their concerns during the bill's passage.
  • Impending Challenges and Legal Actions: Stakeholders, including medical professionals, businesses, and trade unions, gear up for potential legal battles and vigorous opposition against the bill's implementation. They foresee dire consequences for the healthcare system and are prepared to challenge the NHI Bill, questioning its constitutionality and potential negative impact on the nation's healthcare landscape.
By Miriam Matoma


The recent passage of the National Health Insurance (NHI) Bill by the National Council of Provinces (NCOP) has triggered waves of concern and outrage among diverse sectors in South Africa. This decision, endorsed by eight of the country’s nine provinces, including the rejection by the DA-led Western Cape, has left medical professionals, business entities, and trade union Solidarity deeply apprehensive about its implications for the nation’s healthcare landscape.

On Wednesday (6 December), the NCOP witnessed a significant vote in favor of the bill, delayed for a week due to petitions by business groups BUSA and B4SA, urging a reconsideration of its content and potential ramifications.

Primarily backed by ANC-led provinces, the bill’s proponents have touted universal healthcare as an ‘unstoppable train’, dismissing dissenting voices as racially motivated. In contrast, the DA-led Western Cape has firmly opposed the bill, citing concerns about its financial viability, feasibility, and labeling it as an electoral strategy ahead of the 2024 elections.

The passing of the bill despite objections and unaddressed concerns has elicited strong reactions from various stakeholders within the healthcare sector, voicing unanimous disapproval while highlighting the overlooked flaws of the bill as it stands.

Medical professionals, hospitals, private businesses, and workers’ unions, while unified in supporting the concept of universal healthcare, have expressed reservations about the NHI Bill as the chosen route to achieve this goal. Despite their continuous efforts to raise pertinent concerns, the bill proceeded without alterations, leaving them feeling disregarded.

Key among these stakeholders are medical professionals represented by the South African Health Professionals Collaboration (SAHPC). The group, comprising nine associations and over 25,000 healthcare practitioners, fears devastating consequences for the nation’s healthcare if the bill is enacted in its current form. Their concerns range from a rushed legislative process to potential threats to healthcare quality, limited access, governance issues, corruption risks, and challenges in retaining skilled professionals.

Similarly, the Hospital Association of South Africa emphasized the necessity for clarity regarding the role of medical schemes and advocated for a multi-payer approach, contrasting with the proposed single-payer system.

Business groups, including BUSA and B4SA, critical players in the delayed vote, have reiterated their dissatisfaction, labeling the bill as unworkable, unaffordable, and unconstitutional. Their concerns were summarily dismissed during the legislative process, raising serious doubts about the bill’s constitutionality and its potential to foster successful healthcare outcomes.

Trade union Solidarity has been vocal in its opposition to the NHI Bill from the outset, warning of legal action and launching a vigorous campaign against its adoption. The union staunchly opposes placing the entire healthcare system in the hands of politicians, likening it to the mismanagement witnessed in state-owned entities and predicting dire economic and human costs.

As the bill advances to President Cyril Ramaphosa for potential approval, these dissenting voices prepare to petition and challenge its implementation, indicating a looming battle over the future of healthcare in South Africa. The contentious nature of the NHI Bill continues to provoke widespread apprehension, setting the stage for further debates and potential legal confrontations.

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Miriam Matoma

Miriam is a freelance writer, she covers economics and government news for Rateweb. You can contact her on: Email: miriam@rateweb.co.za Twitter: @MatomaMiriam

Tags: NHI Bill