NHI: Further cadre deployment and misappropriation await us

By Natasha Venter

The recent news that Health Minister Zweli Mkhize appointed his niece as the Department of Health’s chief of staff once again sounds the alarm bells about the government’s planned National Health Insurance Fund (NHI). This is especially problematic as there are already serious allegations of corruption against Sibusisiwe Ngubane Zulu from when she served on the board of the Public Investment Corporation. This news broke shortly after President Ramaphosa’s announcement at the ANC’s lekgotla that the party would be more stringent in the selection process for “comrades” that are appointed in governmental positions. Clearly, Cyril’s fine promises won’t change the status quo in the ANC.

Government institutions and state-owned entities epitomise the extent of the damage that the appointment of inept cadres can cause. The fact that the Minister of Health appointed a family member (who is allegedly corrupt) in such a high post in his department, and moreover maintains that he has done nothing wrong, is worrying, especially when one considers the NHI Bill and the power that it would afford Mkhize.

The ANC’s proposed health insurance fund could potentially be the biggest state-owned entity in the country’s history with billions in taxpayers’ money that will have to be dumped into it annually. According to Chapter 4 of the Bill, the power to appoint the board of this fund will vest almost exclusively in the Minister of Health.

The board of the fund will comprise no more than 11 persons who are not employed by the fund and appointed by the Minister, and one member who represents the Minister. The Minister, however, also appoints the ad hoc advisory panel that must submit its recommendations for the compilation of the board to the Minister.

Section 10 of the Bill provides that the fund will, amongst others, have the following functions:

  • Pooling resources to purchase health care services, medicine etc.
  • Purchasing health care services on behalf of members of the fund (i.e. every single citizen of the country)
  • Entering into contracts with accredited health care service providers
  • Monitoring the registration, licence or accreditation status of health care service providers
  • Determining payment rates annually for, amongst others, health care service providers
  • Prioritising the timely reimbursement of health care services to achieve equity.

So, in effect the Minister and his board will have the power to purchase health care services at a price that they determine themselves from entities or persons with whom THEY have the power to enter into contracts and which they must accredit. This while the board will be able to decide which providers are a priority, and the Bill does not elaborate on the concept of “equality” …

Opposition to the NHI is simply dismissed by government as voiced by those who are against quality health care for all. The real reason why organisations and members of the public are opposed to the NHI is that the ANC and its cadres are too incompetent to provide quality health care to all. Furthermore, the citizenry should become less dependent on the state, not more so, and the NHI will in effect place people’s health and lives in the hands of the state.

The Auditor-General, in his 2018/2019 audit outcomes for the national and provincial governments, found that almost R67 billion was wasted by government in a single year, R4,16 billion of which was fruitless and wasteful expenditure. According to the ANC’s presentation on the NHI, the public, however, need not be concerned about corruption and misappropriation, because the NHI fund will:

  1. Report to parliament on an annual basis;
  2. Establish a risk engine to mitigate against fraudulent activities; and
  3. Be overseen by the Health Sector Anti-Corruption Forum.

These meagre “precautionary measures” are hardly reassuring. South African Airways (SAA), for example, must also submit reports to parliament annually and this has done nothing to prevent the widespread corruption in this state-owned entity.

It is therefore unthinkable that one person will in effect have all the power to decide over the health of an entire country’s people. What if, in the future, a health minister is once again appointed who claims that garlic and beetroot are better cures for Aids than antiretroviral drugs?

Natasha Venter is a campaign officer at AfriForum and the organisation’s spokesperson on the NHI.

Photo: Daily Maverick (2017)

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