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Did NHI receive enough to keep going?


On Wednesday, 21 February, Finance Minister Malusi Gigaba (now former minister) announced a 49% increase over three years for a conditional grant to fund the National Health Insurance (NHI). In aggregate, government will be spending R792-bn on basic education, R668-bn on health and R528-bn on social grants, over the medium term. Over the next three years an additional R4.2-bn will be funded by gradually decreasing medical aid tax credits.

R191.6-bn had been set aside for health in 2017/2018 and R205-bn in 2018/2019. This is set to grow to R240-bn by 2020/2021. About R126-bn is earmarked for tertiary hospital services and R66.4-bn will support HIV/AIDS prevention and treatment.

Gigaba announced the launch of a “joint health action plan,” spearheaded by the DoH, to focus on areas such as the quality of care, human resources and infrastructure. Together with provincial counterparts, the department will also be looking to tackle the poor provincial financial management that has seen health departments such as Gauteng and Limpopo drowning in unpaid debt.

Sugar Tax: The tax on sugary drinks, referred to as the Health Promotion Levy, will be introduced on 1 April. Government expects that this tax – approximately 11% on a can of Coca-Cola – will net it around R1.93-bn.

Extra R1bn for AIDS and TB: An extra R1-bn has been granted for HIV/AIDS and TB, anticipating that the number of patients on treatment will rise from 3.9-m to 6-m by 2020-21.

Consolidated health expenditure, which accounts for 13.9% of the government’s total spending, is set to grow at an average of 7.9% over the medium term; R191.6-bn in 2017-18 to R205.4-bn in 2018-19.

*In his State of the Nation (SONA) address, President Cyril Ramaphosa announced that the time has arrived to
“finally implement universal health coverage through NHI” and that the NHI Bill would be “processed through government” and “be submitted to Parliament in the next few weeks”.


*Russell Rensburg of the Rural Health Advocacy Project said that while indications that an NHI Bill is imminent are positive, Gigaba’s additional funding for the NHI still falls far short of the R20-bn. Those who stand to be first in line for NHI benefits may be increasingly limited and mostly confined to school children and at-risk pregnant women under new, tighter budget, he said.

*Private health sector representatives have also warned that they believe the country is much further from an NHI than timeframes provided by the President and Finance Minister imply.

*Neil Kirby, director and head of healthcare and life sciences at Werksmans Attorneys said that apart from legal and fundamentally constitutional challenges and criteria that the scheme must meet, funding remains one of the greatest challenges to the successful implementation of NHI.