The National Health Insurance Bill: Passed at NCOP

By Danélia Botes

December 7, 2023

A Landmark Moment for South African Healthcare

On Wednesday, 6 December 2023, the National Council of Provinces (NCOP) held a crucial vote on the South African National Health Insurance Bill (NHI). All provinces, except for the Western Cape, voted for the Bill. This decision was expected as the provincial mandates were publicly disclosed in the NCOP health and social services committee on 21 November. This vote was not a mere routine procedure. It was a significant political event for the ruling African National Congress (ANC). This vote marked the realisation of a policy principle from the ANC’s 2007 Polokwane national conference and 2010 national general council. The NCOP session had an unusual three-hour debate. Mostly set on the ANC where they set the stage for the 2024 election campaign.

The National Council of Provinces’ adoption of the NHI Bill marks a significant milestone in South Africa’s healthcare evolution. Health Minister Dr Joe Phaahla celebrates this achievement. It brings us nearer to the goal of Universal Health Coverage for all South Africans. Once law, the NHI Bill will guarantee quality healthcare access for all citizens. This access does not depend on their socio-economic status. It aligns with the principles of value-based healthcare.


The Transformative Provisions of the NHI Bill

The NHI Bill proposes transformative changes for South Africa’s healthcare delivery, based on the principle of universal access. It aims to provide a comprehensive set of health services without financial barriers. However, this move towards value-based healthcare presents challenges. These include financial issues, health workforce capacity, and the integration of current healthcare systems. Despite these challenges, the government is determined to tackle them with strategic planning, collaboration with stakeholders, and continuous evaluation of the implementation processes. 


The Next Steps: From Bill to Act

The next phase involves forwarding the Bill to the President for consideration and promulgation. Once it receives Presidential assent, the Bill will become an Act of Parliament, creating a statutory mandate for the Minister and the National Department of Health. This will enable the establishment of key institutional and organisational structures, such as the NHI Fund. However, the actual implementation of the various provisions will be pending until specific sections of the Act are proclaimed as law.


The petition against the NHI Bill

The consortium of business groups, including Busa, B4SA, and the Health Funders Association, confronts the proposed legislation with a significant challenge. These groups, which make up a large part of South Africa’s healthcare and business sectors, believe the bill is deeply flawed. They don’t just worry about practical implementation and affordability, but also question the bill’s constitutional legality. They claim the bill breaches both substantive and procedural constitutional principles, which calls for its review and amendment. The fact they plan to contact President Ramaphosa directly highlights the seriousness of their concerns and their urgent need for a solution.

Establishing the South African National Health Insurance Bill

The initial point of action, Section 9 of the Bill, establishes the NHI Fund as an autonomous public entity. This provision requires the establishment of a Board and other governance structures, crucial for accountability. The Department will prepare detailed Regulations, covering all aspects of the process. Once regulations are finalised, the Minister and the Department will proceed with the establishment of the NHI Fund. It’s expected to take between 6 to 12 months post-proclamation of the Act.

In conclusion, South Africa’s adoption of the NHI Bill signifies a milestone in its healthcare system. This event shows the country’s dedication to achieving universal health coverage. This not faced without challenges and collaboration will be key in moving forward. 

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