South Africa: To Have or Not to Have an NHI


We must build an equitable, unified and sustainable health system that delivers good-quality healthcare to all according to need rather than means (an important distinction that lies at the heart of much of the debate).

While there seems to be widespread recognition that our current health service is inequitable and that access to care must be extended to all, commentary on the NHI Bill has generally been negative, even hostile.

A more constructive minority feel, with justification, that while the motivation behind the NHI is good, pushing ahead with it now will destroy an already critically ill health system. There are excellent examples in Daily Maverick pieces by Ferial Haffajee, Judith February and Mark Heywood; Anneliese Burgess' article in Vrye Weekblad; and critical comments by Professor Alex van den Heever.

Common themes that run through these contributions include contextual issues concerning corruption, poor governance and accountability at all levels of the state and a mercenary private health sector urgently in need of regulation; crises of quality and sustainability in both private and public healthcare delivery systems; and critical defects within the bill itself.

The controversy around the NHI Bill must be viewed against the background of South Africa's profound economic,...

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