National Health Insurance (NHI) Bill: public hearings day 20

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01 December 2021
Chairperson: Dr K Jacobs (ANC)
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Meeting Summary


NHI: Tracking the bill through Parliament

In this virtual meeting, the Committee held public hearings on the National Health Insurance Bill. Three organisations presented oral submissions. All the organisations welcomed initiatives to improve access to quality healthcare services to all South Africans and proposed a number of amendments to improve the Bill.

The Treatment Action Campaign and Section27 gave a joint presentation. The presentation focused on governance issues, corruption, principles in practice and financing of the Fund. It was noted that the joint submission included inputs from 1280 people gathered through community dialogues across seven provinces. The online survey dealt with issues including decentralisation from the Minister, transparent decision making under National Health Insurance and the need to test the new structures before implementation. The need for the independence of the Board was emphasised and it was suggested that specific mention be made to this effect in clause 12 of the Bill. The need for transparency in the appointment of board members and the qualities of these individuals were outlined. It was suggested that measures be put in place to anticipate the existing and persistent problem of corruption. Stronger mechanisms were needed in procurement systems and the management of suppliers. The financing of National Health Insurance needed to be transparent and more clarity was needed on this. The need for the reform of the private sector in line with the recommendations of the Health Market Inquiry were emphasised.

Clarity was requested about the respondents to the survey only being from seven of the nine provinces and if the other two provinces would have changed the picture. A Member asked if the organisations were involved in qualitative research on the findings, to understand the reasons behind the responses given. A number of Members highlighted concerns around the provisions in the Bill for undocumented migrants and asylum seekers, particularly in light of international mandates. A Member suggested that the organisations were advocating for the ‘perpetual existence of undocumented migrants within South Africa.’ Challenges of high medico-legal claims were highlighted, particularly as this affected the supply of healthcare resources in the public sector. Clarity was requested about the organisations’ support of universal health coverage and lack of support for elements of the Bill. The Chairperson highlighted that both organisations were involved in the Health Sector Anti-Corruption Forum, it was asked what measures could be put in place to prevent corruption.

The Women’s Legal Centre emphasised that the NHI was needed to ensure that the inequality gap is reduced, however building NHI on an existing fraught system would cause more issues within the system. WLC wanted the Committee to adopt a feminist gendered lens when dealing with the NHI, so that those that were the most vulnerable were not falling through the cracks. The presentation further highlighted that the Bill needed to make express the provision for the procurement of adequate and comprehensive sexual and reproductive healthcare and services for women, particularly the most vulnerable and under-resourced. The quality of these services were severely stunted, with only five out of 649 public health facilities across South Africa complying with the norms and standards set by the Department of Health.

A Member noted that the Centre had suggested that the issues in the healthcare system needed to be addressed prior to the implementation of the National Health Insurance. The Member cited the British system where NHI was implemented before addressing all the issues facing their healthcare system. Clarity was requested about the suggestion that the Bill ‘discriminated’ against women. Evidence was sought for the claim that NHI was formulated within a week and by implication there was no cooperation with provincial departments, Ministry, statutory bodies nor Parliament.

Meeting report

Opening Remarks
The Chairperson said the Committee would be continuing with the public hearings on the National Health Insurance (NHI) Bill and would be hearing from three organisations. A combined presentation would be given by Section27 and the Treatment Action Campaign (TAC); the Women’s Legal Centre (WLC) would make a separate presentation. The Committee would consider and adopt previous minutes.

He hoped that Mr A Shaik Emam (NFP) was having a good recovery. The Committee wished him a speedy recovery. That evening at 18:30pm there would be a briefing by the Ministry and Department on the Omicron variant.

The Committee Secretary noted those in attendance and the apologies of Ms N Chirwa (EFF), Ms M Sukers (ACDP) and Mr Shaik Emam.

Consideration and Adoption of Meeting Agenda
The Chairperson asked that the agenda for the meeting be considered.

Ms A Gela (ANC) moved to adopt the meeting agenda

Ms S Gwarube (DA) seconded the adoption of the meeting agenda.

The meeting agenda was adopted.

Joint Oral Submission by Section27 and the Treatment Action Campaign
Mr Anele Yawa, General Secretary, TAC, introduced the joint presentation on the NHI Bill.

Ms Sasha Stevenson, Leader of the Health Rights Programme at Section27 made the presentation to the Committee.

The presentation focused on governance issues, corruption, principles in practice, financing the Fund, and Competition Law and NHI. It was noted that the joint submission included inputs from 1280 people gathered through community dialogues across seven provinces. The online survey dealt with issues including the decentralisation from the Minister, transparent decision making under NHI and the need to test the new structures before implementation.

Central Concerns
The NHI Bill envisaged the establishment of a complex and large fund that would be complicated to manage and tempting to loot from. Contracts would be created that would require skilled Human Resource (HR) capacity to manage. New structures would be created with overlapping functions and unclear relations to each other. How excess capacity would be leveraged from the private sector remained opaque. It remained unclear how the underlying political and governance challenges that were the ‘sand in the gears’ of our public service would be addressed.

The need for an independent board was emphasised; it was suggested that this be stipulated in clause 12 of the Bill. It was proposed that the appointment of the board members needed to be transparent, the composition of the advisory panel outlined, principles of appointment established and qualities such as knowledge, skills, experience, honesty, integrity and expertise needed to be prioritised in appointments. The need for diversity in the composition of the Board was emphasised. Issues around the removal of members of the Board and dissolution of the Board were highlighted, particularly that more accountability was required. Issues of appointment, membership and specification of roles were proposed for the advisory committees to the Fund.

It was suggested that measures needed to be put in place to anticipate the existing and persistent problem of corruption. Stronger mechanisms were needed in the procurement systems and management of suppliers.

Issues around the exclusion of asylum seekers and undocumented migrants was a regression in access to services, particularly within the global context.

The need for affordable and sustainable healthcare was emphasised. It was proposed that investment needed to be balanced with management of existing resources. Transparency and clarity were needed about the funding of NHI. It was suggested that medical scheme tax credits were an inefficient funding model would likely fail.

Implementation of the Health Market Inquiry Recommendations
Reform of the private sector was desperately needed, this could contribute to universal health coverage through standardisation and quality monitoring. The Health Market Inquiry recommended that standardised base packages be offered by medical schemes, a supply-side regulator be developed and quality measurement piloting take place in the private sector.

(See Joint Oral Submission by Section27 and TAC for further information)

Dr S Thembekwayo (EFF) noted that at the beginning of the presentation it was stated that the respondents, on which the findings were based, were drawn from seven provinces. What about the other two provinces? Would those two provinces responses not have changed the information presented? 

Ms Gela requested clarity about the organisations stating that they supported universal health coverage, when many of the statements made in the presentation were against the NHI. The organisations had said that they aimed to help Parliament ensure that health system reforms were implementable and sustainable. Clause 3 of the Bill… [Ms Gela lost Connection 1:10:02] to ensure the sustainability of NHI through various measures. Was that not adequate? The organisations suggested that a complex fund should be established. That would be difficult to manage, did the current fragmented system currently not ensure inequity in access to healthcare for all?

Clause 39(a) of the Bill made provision for the Minister to consider representation from the Board before making the decision to dissolve it or not. Did TAC and Section27 not believe that this provision would cover their concerns? She got the impression that TAC and Section27 were advocating for the perpetual existence of undocumented migrants within the South African borders. Why was that? Why was the presenter providing solutions or proposals on how the undocumented immigrants should be dealt with in a way that granted them the status of permanency? This was not aligned with what the Bill was trying to achieve for South African citizens. What was the view of Section27 and the TAC on the future role of the medical schemes under NHI?

Ms E Wilson (DA) appreciated the submissions. NHI included the right to access quality healthcare for all people in the country at no cost. Principally the country already had NHI, as nobody in the country was unable to go to a hospital or clinic and access services. Obviously, the question was around quality healthcare, which did not exist currently. Did this not mean that NHI was in place and what the Country needed was to refine the quality of healthcare? She asked if TAC and Section27 were in agreement with this. She agreed that governance was an issue and there could not be a situation where a minister was responsible for everything. She appreciated the organisations’ proposals on that.

One of the issues was the funding of the NHI, there was absolutely no idea or indication of how this would be funded. One of the biggest challenges South Africa was facing at the moment, particularly with health resources and staffing were the astronomical medico-legal claims and legal costs that the Department faced. These were in the region of billions of Rands. This was a huge concern. When the country was paying out billions of Rands in claims, poor health services, short staffing, lack of medical resources and lack of medical equipment resulted. There had even been a situation in Johannesburg where one of the hospitals had been unable to continue its operations due to a lack of clean linen. This was concerning. These issues were not going to go away anytime soon. Medico-legal claims and legal bills could not be budgeted for either. She was curious to know how the country would get around to quality health services when the its health services were diminishing fast due to this.

She was glad that the matter of asylum seekers and undocumented migrants had been raised. The law and the international agreement were very clear. People, be them documented or undocumented, were entitled to proper healthcare. She was concerned that this went against the international law and international standards of health. The comments made on competition law were very important, she appreciated the in-depth presentation on that. There was no doubt that the Country would see collusion by companies, people were concerned that this was already happening with the vaccination programme.

Mr M Sokatsha (ANC) noted the question about how additional capacity would be accessed. During the ‘era of COVID-19,’ the public and private sectors worked together to serve facilities, human resources, funding and vaccinate the population. Was that not a model that could be used under NHI. Would the organisations not agree that the country had come a long way to improve collaboration between the public and private sectors. He noted the concern about the single payer NHI Fund. He understood that a single payer system had more incentive to direct healthcare spending toward public health measures than separate medical schemes. For example, under universal health coverage, a full range of essential health services, including health promotion, prevention, treatment, rehabilitation and palliative care were provided to all based on need. Was such a system not desirable?

He asked if the survey respondents were engaged in qualitative research, with the aim of establishing the reasons behind the responses provided in the survey. When it was said that there needed to be decentralisation from the Minister of Health, who did TAC and Section27 suggest should be held accountable for the implementation of the NHI policies?

Dr X Havard (ANC) noted that the TAC and Section27 called for a separate process for reaching a consensus on NHI. They were publicly elected parliamentarians through a democratic process, how was it possible to have another democratic process that did not undermine the will of the people? TAC and Section27 had raised concerns about the members of the Board having to resign once they were no longer members of the body that appointed him or her. Were the organisations proposing that the appointment of the members of the advisory committees should not be supported by institutions in the first place?

Mr T Munyai (ANC) requested clarity about the views of TAC and Section27 on who should be appointed to the Stakeholder Advisory Committee, given that the presenter suggested that members of that committee would offer advice to the Fund on issues of affordability. A term, that was not easily quantified. He asked that this be addressed.

The Chairperson noted the governance issues raised by TAC and Section27. There were concerns that the establishment of the system leant itself to corruption. Corruption was unacceptable and a corrupt person would ‘find ways to steal.’ Both TAC and Section27 were part of the Health Sector Anti-Corruption Forum; he asked that it be shared what measures were put in place to tackle corruption. Should the specific mechanisms that addressed corruption not be included in the implementation plan, because they would vary with the nature of corruption?

It was suggested that the Board should include knowledge, skills, honesty, integrity and expertise in the appointment of board members. He noted that these were covered in clauses 13(5)(b) and (e) as well as clause 13(8)(b). Would this not address the organisations’ concerns?

It was stated in the presentation that the board members needed to be independent. This was mentioned in clause 13(5)(d), where it stated that members of the board could not be government employees – which meant that there should not be a conflict of interest. The bulk of the organisations’ inputs were on governance issues. Did TAC and Section27 accept that legislation addressed governance concerns, such as in the Consumer Protection Act, the Health Act as well as the Constitution. He suggested that many of the organisations’ concerns would be addressed when stakeholders were involved in the development of regulations that would enable the implementation of the Bill. A lot of this information did not need to be included in the Bill.

He asked about TAC and Section27’s opinions on the future role of medical schemes and the organisations’ health reform perspective proposals – how was that different from the work that had been performed through the Presidential Health Compact?

Mr Munyai asked a question about the exclusion of asylum seekers and undocumented migrants. It was argued that the Bill excluded asylum seekers and undocumented migrants. Clause 4(2)(a) provided that asylum seekers or illegal foreigners were entitled to emergency medical services as well as services to treat diseases of public health concern, such as pandemics. What would be the impact of the budget of the NHI on the issue of the Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) services. TAC and Section27 maintained that in the Bill, there was no testing and treatment of HIV. The Bill indicated that services would be comprehensive, the financial implications stated that comprehensive HIV/Aids and TB were accounted for. Was that not an indication that testing and treatment of this disease would be included? He requested clarity on this.

Mr Yawa stated that when the breakdown was given of people consulted, he had mentioned that it was done by TAC and Ritshidze, there were accountability issues in some provinces, including the Western Cape, KwaZulu-Natal, Mpumalanga, Gauteng, Eastern Cape, Limpopo and North West province. TAC was operating in eight provinces with the exception of the Northern Cape. When the consultations took place. TAC had not engaged with the Northern Cape.

Ms Stevenson addressed the questions about supporting universal health coverage and not the NHI Bill. Both TAC and Section27 were health activist organisations that supported universal health coverage and had been working for the past 20 years to improve access to healthcare services in the country. Both organisations supported the move toward universal health coverage. This did not mean that the TAC and Section27 needed to agree with everything contained in the Bill. There were some elements of the Bill that went against universal health coverage. For that reason, TAC and Section27 had made recommendations on how provisions of the Bill could be amended to render them constitutionally compliant and ensure that the Bill was able to do what it sought to do – which was to improve access to quality healthcare services. The organisations did not want the situation to remain as it was, both TAC and Section27 were working toward health system reform to ensure equitable access to quality healthcare services for all. The Fund required some changes to ensure that it could do that. In the organisations’ submissions, it had been outlined what additional measures were required to protect a board from dissolution as this was such a dramatic step. Consultation with the Board before dissolution was not sufficient to protect the Fund and Board from potential interference through dissolution.

She noted that there were a number of questions about migrants’ access to healthcare services. This was not surprising – it was a matter of concern that the health system only had so much money. TAC and Section27 were not advocating for the perpetual existence of undocumented migrants in South Africa. The health system could not be used as an alternative to home affairs or a border management system. South Africa could not make its health system punitive and try and use it to squeeze out the undocumented migrants. The health system needed to meet the rights of everyone provided for in the Constitution. Everyone had the right to access healthcare services. Everyone had the right not to be refused emergency medical treatment. That was the case currently and it was a proud tradition in South Africa. That was what TAC and Section27 proposed should remain. It was not enough to state that there were not enough funds. The country could not propose to not treat people who were not from South Africa without showing how many migrants there were and how migrants having access to healthcare would impact South Africans. There were only anecdotes currently on that. There was no evidence, the country could not propose regressive rights to access healthcare services. There was no evidence of health service based migration in South Africa. The provision of emergency medical services, and services for notifiable conditions of public health concern, to undocumented people was insufficient - particularly because of how poorly that was formulated. HIV testing of undocumented migrants was not provided for in the Bill. That was important for the reasons outlined in the presentation. 

Clause 33 of the Bill sought to do away with medical schemes at some unspecified point in the future. This was concerning for its lack of clarity. Everyone recognised that it would be a process to transition to NHI and the intention at the end of the day was to have a single purchaser of almost all healthcare services, with medical aids providing complementary cover. That was fine but to word a provision in such unclear terms was problematic and unnecessarily adversarial. The purpose of NHI was to pool the funding so that more people could access quality healthcare services and could benefit from the resources that existed in the public and private sector. That element needed to be focused on first - how money would be pooled, how it would be governed and how services would be contracted.

She responded to Ms Wilson’s question. The country did not currently have NHI. There was a public healthcare system that provided healthcare services to those who needed it. The inequity across the system was so dramatic, and everyone knew the numbers, it did not need to be repeated. There was a lot of money and a lot of excess capacity within the private health sector. It made sense to use some of that excess capacity to serve people who used the public health sector.

She noted a question asked by Mr Sokatsha about an example of how there had been collaboration between the public and private healthcare sectors under COVID-19. That collaboration was welcomed and was something that many had been worried about at the beginning of the pandemic, given the lack of trust. It did needs to be built on. It needed to be noted, while there were contracts negotiated for use of private hospital beds by public sector patients during COVID-19, the only contract as far as she was aware, was finalised in the Western Cape and very few patients were transferred across. There was good collaboration but it needed to be extended to see how it could work across the health system in a time of no crisis. There was a need for real health system change rather than just a refinement of the public health system.

She had hoped that she had made it clear in the joint-submission that universal health coverage, and the health system reforms that were needed, could take place and funding of health services could be more equitable. TAC and Section27 agreed with universal health coverage. The question was how to get there and how to ensure that the financing system being put in place enabled universal health coverage to be implemented.

She responded to Dr Havard’s question about Parliament being the democratic body that made decisions on the way health system reform happened and why the organisations wanted further consensus seeking processes to resolve the matters. She had tried to address this at the beginning of her presentation, talking about the global research on how health systems changed. It was not just through legislation, it required input, feedback and the buy-in of people within the system. It was not to say that it should stop and things should wait and the sector should talk for another decade – it was to say that there were some issues that needed to be addressed and some projects that needed to be implemented presently. There were other areas that required more consensus building which should happen. Anyone who participated in the Presidential Health Compact would recognise that while there were some good elements in that process it really did not amount to a consensus building process. It did not bring parties closer together. TAC and Section27 had made some recommendations in the report around bringing parties closer together.

She responded to Dr Havard ‘s question about board members being supported by their institutions. The point being made was that board members were not appointed as representatives of their institutions. While those members might come from institutions, they were not intended to be representatives. That was the reason why it was thought that they should not be removed if the members left the institution.

She addressed the question asked by Mr Munyai on the Stakeholder Advisory Committee. There was a list of individuals/representation that should be appointed to the Stakeholder Advisory Committee, which was fine. It was important that civil society and health service users were incorporated in both the Stakeholder Advisory Committee and the other advisory committees of the Fund. There could not only be health service users in one structure and not be able to give input and feedback to the Benefits Advisory Committee and the Pricing Committee.

She noted the Chairperson’s question about the Special Investigating Unit’s (SIU) Health Anti-Corruption Forum that TAC and Section27 were members of. It was a really important structure. It was a structure that showed the benefit of different parties coming together. The structure had people form law enforcement, civil society as well as the private and public health sectors. It was a way of transparently dealing with some of the big corruption problems in health. It was important for that reason and needed to be continued. Dealing with corruption after the fact was obviously insufficient, structures needed to be put in place to make it more difficult for corruption to happen. That was the reason the Forum focused so heavily on governance structures and setting up systems so that corruption, maladministration and wastage of funds was made more difficult. There was a need for other corruption measures in the Bill, which TAC and Section27 had dealt with in their written submission. There needed to be measures in place to prevent corruption before the fact. Developing a resilient governance mechanism was a way of doing that.

There was provision for board members to act with integrity and honesty – TAC and Section27 were talking about the ad-hoc committee that appointed the board members and the importance of specific qualities in those people. Board members could not be government employees; the board needed to be independent.

She noted the point that some of the concerns might be addressed in regulations. It was important when passing legislation that matters were dealt with in legislation and that the processes and structure were setup in a way that was protective of the Fund and the decisions of the health system in general. Fixing things through regulations did not make sense. One needed to start with a system that would improve access to healthcare services; this could be tested and improved through regulation. Tweaking things through regulations was not the best law-making process. The Country needed to get the basics right now.

Ms Wilson stated that she had raised concerns over the current situation, particularly about the tremendous amount of money being used for medico-legal claims - current and future - as well as legal fees. How would that be circumvented? That would result in shortages of staff, medical equipment and medical resources. This was a situation that would prevail for quite a long time. She asked if there were any suggestions on that.

Ms Stevenson agreed with Ms Wilson that medico-legal claims were eating up a huge part of the budget and were a real risk for ongoing provision of quality healthcare services and improvement in access to quality healthcare services. There were some recommendations on the table at the moment from the South African Law Reform Commission. Different provinces were testing out different ways of managing medico-legal claims. It obviously came from different places; part of the problem was under-staffing in many facilities. Many healthcare workers were often ‘run off their feet,’ – it was really difficult for them to provide the kind of service needed. Another part of the problem was medical record keeping. Often the required information was not on file to defend claims. There were also predatory lawyers who only made matters worse. The end result was that there were huge medico-legal claims, which put the whole health system at risk. She did not think that medico-legal claims meant that the country should not be implementing health systems reform – she did not think that was what Ms Wilson was suggesting – but it was something that needed to be dealt with at the same time. Similarly, wastage and poor service in the public health sector needed to be dealt with and the issues in the private sector needed to be addressed. These were all urgent matters that needed to be responded to if the health system was to be improved for the interests of everyone in the Country – which was a priority for TAC, Section27 and the Committee.

Women’s Legal Centre Submission on the NHI Bill
Ms Seehaam Samaai, Director, WLC and Ms Mandi Mudarikwa, Attorney at the WLC, represented the WLC in the meeting.


Ms Samaai outlined the role of WLC as well as the Legal Resource Centre (LRC). Both WLC and the LRC were part of the Sexual Reproductive Coalition (SRJC) which provided an inter-sectional lens on reproductive justice. The SRJC aimed to provide a platform through which individuals and organisations produced and used evidence to foster and inform public debate and consensus. The presentation focused on the current issues that existed in the healthcare system, with particular focus on access to services for women. It was emphasised that these issues needed to be addressed before implementing the NHI.

Current Situation
The current health care system did not support women, especially in the provision of sexual and reproductive health care and services. WLC recognised that the provision of these services, within a sexual and reproductive justice framework, were necessary for the attainment and enjoyment of substantive equality for women in South Africa, especially for poor, black women living in under-resourced parts of the country. The Act and its provisions, irrespective of the formulation, could not work in the current health care system, which failed women. If the Bill was to continue along the parliamentary process, then WLC submitted that it needed to make express the provision for the procurement of adequate and comprehensive sexual and reproductive health care and services for women, and particularly the most vulnerable and under-resourced.

Race and gender divide
Within this inequality in access to resources along poverty lines was a racial and gender divide, leaving poor, black women in South Africa in the worst position when accessing healthcare services. The quality of these services were severely stunted, with only five out of 649 public health facilities across South Africa complying with the norms and standards set by the Department of Health. It follows that the experience of access to sexual and reproductive health and services necessarily tracks the same disproportionate pattern of unequal distribution in general health care services and resources. The public healthcare system was in such a skewed state, unable to provide majority of the population with adequate access to quality healthcare services, which healthcare services necessarily include access to sexual and reproductive healthcare. These services are used by the majority of the population – women. It is imperative for the legislature to ensure that women are no longer neglected when formulating laws and policy.

NHI within an ineffective and unequal system will fail
As a result, it was necessary to improve the public healthcare system prior to enacting the NHI Bill and seeking to implement it. The challenges of inequality are exacerbated by the existing, weak healthcare system, and the NHI Bill could not function in an unsustainable system that was incapable of adequately caring for the majority of the population. Furthermore, those sections that speak to the objective of strengthening the healthcare system and putting measures in place are inadequate in ensuring follow through. This left a great deal of responsibility at the discretion of the Minister of Health to pass effective regulations to ensure such systems were in place to strengthen the current healthcare system.

Abortion service provision in the public health sector riddled with obstacles to access
Stigma and discrimination. This is often expressed through health facilities and providers refusing services on the grounds of religious beliefs and conscience, turning women away when they sought an abortion. Often without referring them to a health care provider who was willing to provide them with the service. Restricted access to doctors authorised to provide terminations was an issue. A limited number of health care facilities at which women could access abortion services. Of the 505 facilities designed to offer abortion services in South Africa, only 264 were providing access to first and second trimester abortion services. Poorly-trained, or untrained, staff employed at these limited health care facilities were unable to provide women access to abortion services in a manner that was respectful and sensitive to their medical needs. It was estimated that 50 percent of abortions were procured in the informal sector as women turned to unsafe and illegal abortion services for assistance where the public health system has failed them.

(See Women’s Legal Centre Presentation for further information)

Ms Gela noted the WLC submission stated that the NHI Bill should not proceed unless the health system improved. It was common knowledge that the British implemented their national health system at the worst time, when the system was failing. It was reported that there was a patchwork of different services that all had varying levels of quality and access. Today the British National Health Services (NHS) was a model system for comprehensive quality healthcare for all. Should South Africa not follow this proven model of healthcare? She did not recall anything in the Bill that discriminated against access to women – she asked that the WLC indicate the clause in the Bill that suggested that.

Dr Havard noted the submission had said that NHI was formulated within a week and by implication there was no cooperation with provincial departments, Ministry, statutory bodies nor Parliament. She asked that WLC provide evidence of the lack of cooperation in the public healthcare system.

Mr Munyai noted the submission had indicated that NHI was formulated within a week, an unequal system and by implication there was no cooperation with provincial departments, ministry, statutory bodies nor Parliament. He asked that evidence of this lack of cooperation in the public healthcare system be provided. He did not recall that access of women was discriminated against in the Bill. He asked that WLC identify the clause in the Bill that covered this. He asked that WLC suggest the wording that would address their concern. Issues should not be raised that were not contained in the Bill.

The Chairperson raised various questions, including those of Mr Sokatsha, who had unstable internet connection. WLC had expressed that the Bill should contain provisions in the procurement of adequate and comprehensive sexual and reproductive healthcare as well as services for women. In Section 27(1)(a) of the Constitution, everyone had the right to have access to healthcare services, including reproductive health. Did that definition not include the healthcare services that WLC talked about, such as reproductive healthcare and emergency medical treatment?

Clause 39(8)(a) stated that if an accredited provider failed to provide comprehensive health services to people entitled to receive the services, the NHI Fund may withdraw or refuse to renew accreditation. What was WLC’s view on that? In the presentation it was suggested that before the NHI was implemented, the government needed to ensure balance of quality between the public and private sector. How was that expected to occur with the current funding arrangement - was NHI not a means to close the gap between the public and private sector by providing quality universal health coverage to all, based on need and not income?

Ms Samaai referred to WLC’s written submission, as the presentation had included highlights of that. She assumed that Members had read the written submission. There was a misunderstanding about ‘women being discriminated’ – WLC had stated that the Bill existed in a broad framework which was discriminatory. It was submitted that if the Bill went forward, certain amendments should be made to ensure that women’s access to comprehensive and quality sexual and reproductive health services, was a priority within the structure of the NHI. It was necessary to embed this in the ‘ethos and language’ of the Bill, ensuring a committed legislated dedication to improve women’s access.

WLC submitted that clause 1 required a more robust definition to ensure that the public was aware of those services, to which they would be entitled and for which the Fund would strive to attain, when procuring services on behalf of the public. The definitions should include a range of services around information, access to a wide range of contraceptives etc. The definition of ‘healthcare services’ included ‘reproductive healthcare,’ the meaning of this needed to correspond with the expanded definition. It would be necessary to insert a reference to the definition. This ensured that where either term was used throughout the Act, it included an express mention of the healthcare services and benefits listed in the definition.

The lack of cooperation arose from how some of the provinces had established Sexual and Reproductive Health and Rights (SRHR) and some had barely any services. In cases there were limited attempts to ensure that those in neglected and poor service areas were being assisted, she highlighted the example of abortion and access to information about such services. She highlighted the limited number of abortion services that were compliant with norms and standards.

She highlighted the issue of forced sterilisations amongst HIV positive women. WLC was in the court system around most of those provisions because of the broad failure of the State on the sexual health and reproductive rights of women. WLC noted that NHI was needed to ensure that the inequality gap was reduced, however building NHI on an existing fraught system would cause more issues within the system. WLC wanted the Committee to adopt a feminist gendered lens when dealing with the NHI, so that those that were the most vulnerable were not falling through the cracks. She highlighted the need for services in the private sector to be accessed by all.

Consideration and Adoption of Minutes

Minutes of 19 November 2021
In the meeting held on the 19 November 2021, the Committee received a briefing by the Ministry and Department of Health on their annual report.

The Chairperson took the Committee through the Minutes.

Mr P van Staden (FF Plus) moved to adopt the Minutes.

Dr Havard seconded the adoption of the Minutes.

The Minutes of 19 November 2021 were adopted.

24 November 2021
In the meeting held on the 24 November 2021, the Committee considered and adopted the Committee’s Budgetary Review and Recommendations Report (BRRR), considered and adopted minutes and had NHI public hearing discussions.

The Chairperson took the Committee through the Minutes, noting the resolutions of the meeting.

Ms Gela moved to adopt the Minutes

Ms Wilson seconded the adoption of the Minutes.

The Minutes of 24 November 2021 were adopted.

Closing Remarks
The Chairperson highlighted that an email was sent out which spoke to outstanding matters. It would not be discussed in the meeting, but he encouraged Members to consider if anything had been left of the list of matters. There would be a briefing that evening by the Ministry and Department. The Minister was on a provincial visit and the Deputy Minister and the Department would present the latest on the Omicron variant.

The meeting was adjourned.

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