The government itself fears that the South African NHI is corrupt


Health sector stakeholders have raised concerns about the future of health care in South Africa under the proposed National Health Insurance (NHI) scheme – including issues of governance, management and responsibility.

These concerns are highlighted in a new report published by Section 27 and the Concentric Alliance on Monday June 20, which considered the opinions of 33 major healthcare players.

13 respondents, including officials from the Ministry of Health, said that the governance, accountability and management systems of the public health sector are an area of ​​great concern and in need of urgent reform.

It is also of grave concern that the public health sector is plagued by political patronage and corruption, exemplified most recently by the investigation into the improper bidding of Digital Vibes services by the Special Investigations Unit (SIU), the subsequent resignation of Minister of Health Dr Zweli Mkhize and suspension of Director General Dr Sandile Buthelezi.

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“For many respondents, the history of corruption and state capture, and the fact that despite post-Zuma leaders’ expressed commitment to good governance, state corruption continues unabated at the Ministry of Healthcreates significant governance risks for a national health insurance model and health service delivery in the future.

All respondents also expressed concern about governance systems within the public sector, which they believe undermine both accountability and the effective delivery of services to the public.

“One academic went so far as to say that this was an intentional design flaw this creates space for patronage systems to flourish and would be an obstacle to reform within the public sector.

“Nine respondents, including government officials, said that one of the most serious consequences of poor accountability in the public sector is corruption and escalating costs leading to significant misallocation of resources outside the public sector. “.

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Covid shows that the health sector is not clean

One of the biggest clouds hanging over the proposed NHI is the recent Covid-19 pandemic and government response.

While the government was initially praised for its rapid response to the pandemic and its decision to release funds for the health sector, public opinion quickly turned when it emerged that billions of rand had been misappropriated by government officials or their relatives.

Four participants, all of whom worked at different levels of the public sector and government, identified weak supply systems as the cause of the PPE supply scandals that took place during Covid-19, where middlemen and close associates of politicians sold PPE to government at vastly inflated prices

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A government respondent also added that weak accountability and the existence of embedded patronage networks is a system that benefits regional offices of the ruling party.

Weak accounting and oversight structures, such as hospital boards, clinic committees, and non-transparent systems, are also present in hospitals and clinics, if any. Concerns have been raised about how existing governance systems will interact with the governance systems proposed in the NHI Bill.

Seven participants, representing civil society and regulators, argued that the current bill concentrates too much power in the hands of the Minister of Health without providing the necessary control over the NHI’s planned massive resources.

A participant from a regulatory body stated categorically that “the fund will be plundered‘.

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