Ayanda Sishi-Wigzell: Is the NHI signing an election tactic?

Published May 15, 2024


By Ayanda Sishi-Wigzell

Today, on the Union Building lawns, the President of our country finally located his lost pen and signed the National Health Insurance Bill (NHI) into law.

President Ramaphosa is the first ANC and South African president to face such extreme electoral peril. No other president has had to deal with the possibility of the ANC flirting with the loss of power. Even if the ANC manages to cobble together a post-elections coalition, the fractious internal dynamics of the ANC would see Ramaphosa fighting an uphill battle to fend off challengers.

With so much riding on the outcome of these upcoming elections, Ramaphosa is not only campaigning for his party and his legacy. He is campaigning for his immediate political future.

With the campaign trail looking lacklustre for the ANC with former presidents campaigning for other parties and former presidents being fatigued from campaigning in KZN, I can understand why the PR stunts like braiding people’s hair and cleaning houses for votes are not working. People are simply tired of empty promises. We can only hope that the NHI is not just another empty promise that is being signed into law. Let’s examine why this bill is necessary, but, at the same time, the reasons why the ANC may be cynically using NHI as an election tool to garner votes.

What is NHI and why is it necessary?

The cost of healthcare in this country has drastically increased together with the cost of living. This means that more people will need public health hospitals and clinics to access healthcare, or do what some unfortunate souls in South Africa are forced to do: fall into debt because public health facilities are facing backlogs. People who need cancer treatment are being told that they need to wait, and, as we all know, cancer waits for no one.

The need for people to have adequate access to mental health services is dire with the rise in the number of people who have died by suicide. We have a history in this country of adequate proper healthcare being reserved for the richest people, and, with the history of Apartheid, for white people. With the advent of democracy, there was an opportunity to change the old system of healthcare that was never fully grasped, as evidenced by our current dysfunctional system.

The Law

Under Section 27 of our Constitution, the right to access adequate healthcare is protected, and, following Section 27, the government is obligated to provide healthcare that is easy to access for all those who need it.

We must understand that South Africa is a signatory to international bodies such as the African Charter on Human and People’s Rights, which states that everybody living on this continent must have access to adequate healthcare, and the United Nations Covenant on Economic, Social & Cultural Rights, which also states that everybody has to have a right to physical and mental healthcare.

This means that the country must do everything in its power, according to domestic and international law, to ensure that people have access to healthcare, but the government has its priorities elsewhere.

Objections to the NHI

The rollout of NHI will come with a host of other issues. We live in a country where an accountant, Babita Deokaran, was shot in her driveway for investigating corruption in the public hospital of Tembisa. We have long standing water issues that stem from the lack of maintenance and expansion needed to build capacity to bring water to the people of South Africa.

We have children in the Eastern Cape who are still dying in pit latrine toilets. How are we to trust that this government that fails so loudly when it comes to the basic services of this country will be able to roll out NHI?

Corruption runs rampant in South Africa and it mostly goes unaccounted for. The Department of Health is one of the vortexes of this corruption storm. There has been little systematic change that has happened in the public healthcare system that would warrant the trust that would be needed to continue with NHI.

I am not against Universal healthcare. I am against giving corrupt people even more access to the fiscus to continue the project of corruption. The governing party has not given me any indication that they are truly willing to root out corruption. The tender companies pointed out in the Tembisa Hospital scandal as fraudulent are still getting tender opportunities from the Department of Health.

We are unequal as a nation

The need for universal healthcare in South Africa could not be more dire. However, the state needs to stop being corrupt and realise that it can build a healthcare system that will be able to accommodate all people who live in this country. This issue that I take with NHI is the notion that private hospitals are the ones that are going to equalise the healthcare system.

That is not the case and we are being misled. Due to the structure of our society, the current capacity will remain the same and the issues will still be there: people who live in poor and rural areas will still have the same lack of capacity.

NHI will not change the infrastructure and transportation issues with the stroke of President Ramaphosa’s magical pen. What will solve this issue is to build state capacity, and all of this can’t be done on a shoestring budget.

However, the state must spend less on pro-party bureaucrats and hire more doctors, nurses and administrative staff. Austerity measures will be the death of us all.

The need for universal basic healthcare remains but just like the social grants and the universal basic income grant, the signing of this bill is being used as a last-ditch attempt from a political party that hardly has any credibility left.

*Ayanda Sishi-Wigzell is a social and political commentator, and a radio host.

** The views expressed herein are not necessarily those of IOL or Independent Media.