I appreciate the space that has opened up in recent months to debate our national health care. It is good to be able to start and look constructively at the feasibility or non-feasibility of the proposed NHI instead of the whole idea shrouded in mystery and hidden from public scrutiny. For a very long time health care in SA has been implemented in a top-down dictatorial approach and if the very top structures made wrong assumptions the health care of the entire country suffered because the government leaders in health care did not want to listen to advice. Nobody is perfect, and we all have incorrect ideas from time to time but a broad consultative process helps to protect the country from a single individual's theories,and improves their theories through the advice from others. It is my earnest wish that the consultation process is not mere window dressing, but a genuine desire to hear all views, even if it comes from the opposite corner. I am in favour of universal access to good quality care for all South Africans and I know that if we all put our minds together we will achieve it. I have lived and worked in a rural area for the last four years, and after two years in a rural public hospital I could not take it anymore that patients continue to die unnecessarily every single day, and there was nothing I could do to change that, no matter how much energy and effort I put in to try and get life saving medication, or life saving transfers, or equipment repaired etc. Finally I decided that I could no longer continue fulltime in a health care setup where I am consistently devalued, and unable to perform my primary function of saving lives. I stayed on as a part time sessionist but joined an HIV home based care organisation to start a ARV program for farm workers, which after two years, were seeing better average mortality and defaulting statsitics than national ARV sites. And even though we had much less money than state ARV clinics we were able to ensure higher quality care because we as the health care workers were directly involved with the funding allocation and implementation process; unlike what happens in the public hospitals where all decisions are still made in a top-down process, without listening to health care workers at the coal face. Even though I had a smaller income from the NGO, I was finally experiencing job satisfaction because I was able to make a real difference in many patients' lives. My big concern with the new committee is that there is only one practicing doctor on it, all the others are administrators, even if they used to be treating doctors. This continues a top down approach, without real involvement from health care workers currently on the ground, who experience the heart breaking inefficiencies every day. The draft proposal truly depresses me and I can only hope that those involved do not cling to their brain child out of pride, but allow actively treating health care workers the opportunity to shape it into a truly universal high quality system for all. The biggest cause of my depression is the fact that it is a clear continuation of a heavy handed top down approach that has absolutely crippled our public health over the last ten years. The learned Dr Shisana contends that our health system is not as bad as many make it out to be. I am sorry but I cannot agree with that statement, and my experience is based on current and personal involvement. Yes, the health care system is not so bad in most of the Western Cape,and in big hospitals in Gauteng and KZN. But apart from university hospitals the rest of the country's public hospitals are falling apart - both physically and emotionally. I stand under correction but many of the studies by Prof Di Mcintyre that showed the public's favourable response to public health care were conducted in the Western Cape, a province that has always been leagues ahead of the rest in many areas. The draft only seems to mention dozens of different overseeing committees and quality assurance committees and accrediting some health care providers and not others (on the basis of their ability to afford extra staff and extra facilities). This entire approach is merely continuing the trend of spending millions of rands in overadministrating health care, resulting in much poorer care than in private/NGO facilities where health care workers are directly involved in the administration. The problem in the public health's inability to provide health care to citizens unable to afford private medical aid lies not in a lack of money, but in this heavy handed top down approach. Even in the poorest NGO there is better care because the financial and administrative sections conduct themselves as supporters of the treating clinicians, not as the dictators of them like in government hospitals. Where the treating health care worker is unable to change the care his patient can receive because of administrative dead ends that patient loses his best chance on better care. The entire country loses its chance on better care. The current draft NHI will not result in better care for anyone, in spite of millions of medical aid money channelled to the NHI. All this extra money will go to the myriads of administrators and health care workers will continue to find themselves devalued, underpayed, disenfranchised and frustrated because patients will continue to die unnecessarily due to maladministration. Even when the managers have a health care background they do not have the same understanding of the need of the patient as the health care worker standing next to the patient's bed. Please chairperson, allow us the hope of a health care system where all treating health care workers are regarded as the most valuable employee in the public health system and the administration is only there to support their needs so that they are able to deliver better care to our country's neediest citizens. The current draft in its top down approach might look good to administrators from their high towers, but to us trying to save people here on the ground all we can see is barrier upon barrier between the patient and access to quality health care.