National Health Insurance (NHI) Bill: clauses 57 to 59 deliberations

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09 November 2022
Chairperson: Dr K Jacobs (ANC)
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Meeting Summary


NHI: Tracking the Bill through Parliament

In this virtual meeting, the Committee continued its clause-by-clause deliberations on the National Health Insurance (NHI) Bill on Clauses 57 to 59, all of which the majority party, the ANC, agreed to along with a proposal to make a minor change to clause 57(4)(f) because the range of services to be included for prioritization must include mental healthcare services.

Members of the opposition including the DA, EFF, and FF+ rejected the Bill for these reasons:
Lack of Financial Feasibility Study Members were still awaiting an up-to-date financial feasibility study that provided answers to questions about how the NHI Fund would be financed, from where the money to finance the NHI would be coming and if it was going to be possible to finance the NHI whereas there was not a big enough tax base to do so.

Incapacitated and Corrupt Healthcare System: Members expressed concern about the implementation of the Bill relying on current resources whereas the country’s healthcare system was in a fragmented state and required the very resources being channelled towards the Fund. The Health Ombudsman’s report stated that it is only the Western Cape healthcare services that are functioning optimally whilst the other provinces are performing poorly. That report said it will be very difficult to implement NHI with the current state of the country’s public healthcare system.

Opposition members did not understand how government was expecting the very same officials responsible for the current chaos in the public healthcare sector to manage the NHI. They put forward a suggestion to establish some form of alliance and cooperation between the public and private healthcare sectors so that experts and infrastructure can be shared between the two sectors. Sound management practices must be implemented.

Meeting report

Clause 57: Transitional Arrangements
The Chairperson took the Committee through clause 57 of the Bill.

Ms E Wilson (DA) explained that the timelines stipulated in the clause throw the entire Bill out of the window. Phase 1 was supposed to be implemented from 2017 to 2022 but we have reached the end of 2022. The implementation of Phase 2 was scheduled for 2022 to 2026. There is not one deliverable in the entire clause that has been realised within the given timeframe. The entire clause must be amended. Also, the clause mentions the establishment of a Fund but provides no details on how it will be funded, from where the money is coming and what it is going to cost. We cannot consider the Bill until more information is provided.

The clause talks about the process for the accreditation of healthcare service providers which involves the inspection and certification of health establishments by the Office of Health Standards Compliance (OHSC). Health professionals are licensed by their respective statutory bodies and must comply with the criteria for accreditation. The Committee’s visit to the Eastern Cape on the weekend demonstrated that not one of those facilities would come close to accreditation and they should be shut down because they are in a very bad state. The Health Ombud also relayed that healthcare providers will not meet the criteria for accreditation because of the state of health facilities making the NHI Bill improbable.

In clause 57(4)(g)(i), how would hospital services and other clinical services be financed using the Fund when there was no fund and no money? They were too busy trying to pay medico-legal claims to find the time and resources to establish the Fund in question. It would not be fair to redirect taxpayer contributions to establish a Fund that will pay medico-legal claims for dilapidated facilities. The condition of the facilities was not the fault of taxpayers to begin with and it follows that it should not be their problem.

Clause 57(4)(h) will require amendments. This is problematic because this includes subjecting amendments to public scrutiny and stakeholder inputs. The Bill cannot be considered until the amendments are made and the timeframes are adjusted.

Mr P Van Staden (FF+) also had concerns about the timeframes stipulated in the Bill. The implementation of the Bill cannot rely on timeframes because government will never be successful in implementing the NHI Bill in accordance with those timeframes based on the number of times they have had to defer implementation and adjust the schedule. The amendments that will be necessary to accommodate the realisation of the Bill require a host of procedures that cannot be ignored. This includes public participation and stakeholder comments.

If the South African government was genuinely concerned about the medical wellbeing of its citizens, it would have first ensured that existing state hospitals and clinics are fully upgraded before introducing a new system like the NHI. He pointed out that the Committee would have seen for themselves during their visit to the Eastern Cape on the weekend the conditions on the ground which were enough to confirm his assertion that state intervention by way of upgrading healthcare facilities was necessary. The Bill would certainly give government very wide powers infringing on the patient’s ability to choose their own course of treatment, who can provide them with treatment, and where they can go to get treated. These are grounds to do away with the Bill immediately.

Presently, South Africa has a public healthcare sector that is characterised by inadequate infrastructure, shortage of medicine and supplies and a lack of medical expertise. Contrastingly, the private healthcare sector in the country maintains world class standards. The biggest challenge that perpetuates the inadequacies in the public healthcare sector is mismanagement and corruption along with government’s obsession with transformation which has forced many experts out of the country. Many more experts were threatening to leave if the NHI Bill was realised.

He suggested establishing some form of alliance and cooperation between the public and private healthcare sectors so that experts and infrastructure can be shared between the two sectors. The main objective should not be transformation but rather accessible and quality healthcare for all citizens. Sound management practices must be implemented at all hospitals and clinics. Only people with managerial experience must be appointed as chief executives at hospitals.

The Freedom Front Pus condemns the overregulation of the medical aid industry where funds are taxed excessively and the net tax burden on individuals is increased. The medical aid industry and private medical service industry are crucial partners in offering good quality healthcare services in South Africa. We should rather endeavour to establish a national partnership between private and public medical services that is flexible enough to allow both sectors to function without any unnecessary red tape in the interest of a healthy population.

He appealed to government to indicate how it plans to resolve the challenges in the Department of Health and how it will save it from sinking even deeper into corruption and poor service delivery. Further, it must indicate how it plans to improve the terrible conditions in state hospitals and clinics and how it will hold negligent medical staff accountable for poor treatment of patients. Investigations must be conducted looking into the numerous deaths in state hospitals and the strange circumstances under which these deaths occur.

He did not understand how government was expecting the very same officials who are responsible for the current chaos in the public healthcare sector to manage the grandiose NHI which is doomed to fail. In July 2019 only 60% of South Africans had access to healthcare services even though state healthcare services can be found in the furthest corners of the country. This suggests that the problem lies with service delivery and not accessibility. Seeing how the current healthcare system is mismanaged any dream of implementing NHI is bound to turn into a nightmare. NHI will not improve healthcare in South Africa and should be done away with.

Mr T Munyai (ANC) said that the ANC supported clause 57(2)(a) along with the proposed amendments because it ensures that Phase 1 is implemented for a duration of five years from 2017 until 2023. It is important that 57(1) to (4) be retained because they emphasise the core areas of focus that must be undertaken by the Department in preparing and finalising applicable legislation, as well as in establishing structures that will create a functional Fund. He put forward a proposal for a new subclause which will establish administrative capacity for the Fund. In preparation for the establishment of the Fund as a Schedule 3A entity, the Minister must in consultation with the Minister of Public Service and Administration establish appropriate administrative capacity to develop the functions of the Fund.

The ANC supported clause 57(4)(g) because although the cornerstone of universal health coverage is a strong primary healthcare approach, the higher levels of care are also critical aspects of a comprehensive healthcare service covered under the NHI. This provision ensures that the Fund puts in place mechanisms that allow users to access a continuum of care that incorporates services offered at the highest level of care from public hospitals and diagnostic platforms such as the National Health Laboratory Service (NHLS).

The ANC supported clause 57(5) because the Fund will be established as a Schedule 3A non-business entity as per the Public Finance Management Act (PFMA). The state must ensure that steps are taken to create functional structures based on the principle that the Fund is a primarily tax-funded entity through a system that is mandatory / non-contributory. No user should ever be denied access to care because they are not able to make a payment or contribute to the Fund.

Ms A Gela (ANC) supported Mr Munyai on clause 57. The ANC supported clause 57(1)(b) because the phases of the implementation process based on the available financial resources was consistent with the constitutional obligation placed on the state to meet the healthcare needs of the population within the parameters of available resources as per the Bill of Rights.

The ANC supported clause 57(3)(a) because the establishment of the National Tertiary Health Services Committee will be pivotal in ensuring that provinces are engaged in the process of transitioning central hospitals into national facilities as well as ensuring that tertiary services are provided and governed in a consistent manner across the country.

The ANC supported clause 57(4)(a) because it is in line with clause 7(2)(f) of the Bill to ensure that the Fund is available to central hospitals nationally as opposed to being strictly confined to provincial hospitals. The clause ensures that there is equitable access to training platforms as well as innovative and excellent research centres for healthcare professionals. The clause is in line with section 41 of the National Health Act which empowers the Minister to determine a range of healthcare services that may be provided in central hospitals. The ANC supported clause 57(4)(c) because the phased approach in establishing the NHI Fund and its supporting governance structures is a key step to the realisation of the purposes of the Act. The clause ensures that the Fund is adequately capacitated with functional governance structures to ensure accountability of the Fund.

Ms M Clarke (DA) said that state hospitals in the country would never be able to comply with the rules and regulations specified by the NHI to attain a certificate of compliance with health standards because they were not in good condition. To improve healthcare in the country she suggested that government facilitate a partnership between the private and public sector to ensure that outcomes are reached. From the Committee visit to the health facilities in the Eastern Cape on the weekend, it was evident that wards that had received support from private entities like the Clinton Foundation were vastly different to those that had not received support. Based on this she insisted that government health systems needed some form of collaboration or partnership with the private sector.

The implementation phases of the NHI Fund should not be defined based on fixed dates but should be clarified through objective milestones such as expansions of priority service towards a package of comprehensive health services, population coverage and reduction in out-of-pocket expenditure. Clause 57(1)(b) talks about financial resource availability, yet no financial feasibility studies have been conducted to prove that there will be sufficient resources to fund the entire Bill. She requested that the Minister conduct a study before the Bill can be considered. The Bill had to be amended considering the new timelines.

In addition, the Bill was drafted before the pandemic. The economic state of the country before the pandemic and now is incomparable. So if there were doubts about being able to afford NHI in 2017/18, it is certainly evident that in this current economy, South Africa cannot afford the NHI. We should rather take the funds and upgrade our healthcare facilities rather than implementing NHI and potentially compromising the quality of healthcare. The implementation of NHI can be deemed to be reckless and irrational considering the country’s tax base is insufficient to adequately fund the Bill and Treasury cannot afford to fund the NHI. The source of funds to finance the Bill needs to be specifically included along with the list of other sources of income in clause 49.

The Democratic Alliance opposes the NHI but if it were to pass, legislative reform should only be considered once the NHI Fund is practically established. Precautions must be taken in terms of the liabilities that may ensue onto taxpayers during transition. In clause 57(4)(e), how does the Minister plan to register and certify healthcare providers when almost none of the public healthcare providers are able to meet the necessary standards for registration? In clause 57(4)(h), if those ten Acts are going to be changed due process must be followed and stakeholders must be allowed to submit their input as public participation is vital.

Also, it is very important that the timelines in clause 57(2) are removed because they were set in 2018. Medical aids need to give their input on the appropriate timelines as well. She requested that the state law advisors advise the Committee in writing about the legal implications in terms of material timelines and additional comments from medical aids since the timelines have been adjusted so much.

Mr E Siwela (ANC) supported the contributions made by Mr Munyai and Ms Gela. The ANC supported clause 57(2)(b)(i) to (iii) along with its proposed amendment because clause 57(2)(b) must be amended as follows: Phase 2 must be from 2023 to 2027. Subclause (i) to (iii) must be retained as they stipulate the need for continuity in the work to be undertaken as the phase rollout expands to include the accreditation and contracting of targeted healthcare service providers. The additional resources to be mobilized will include funds in the conditional grants currently managed by the Department.

The ANC supported clause 57(3)(c) because it empowers the Minister with the latitude and discretion to establish an interim advisory committee on healthcare benefits to strengthen the process of establishing NHI.

The ANC supported clause 57(4)(d) because a functional Health Patient Registration System (HPRS) will bring into fruition the objective of achieving universal healthcare coverage for all users by facilitating population coverage, especially in the form of access to quality and affordable healthcare. The information that will be made accessible via the HPRS is critical for supporting the Fund's planning, decision making and resource allocation processes. The development of HPRS is fundamental to ensuring that the Fund has access to the necessary clinical and non-clinical information that will enable it to execute its strategic purchasing functions. The HPRS is also essential for the functioning of various technical and ministerial advisory committees of the Fund. Without access to quality, timely, and accurate information, these committees will not be able to effectively support the functions and the activities of the Fund.

Dr X Harvard (ANC) said that the ANC supported clause 57(3) because the clause empowers the Minister with the latitude and discretion to establish an interim advisory committee on healthcare benefits to strengthen the process of establishing the NHI.

The ANC supported clause 57(4)(b) because it ensures the establishment of the Contracting Units for Primary Health Care (CUPs) for the institutionalisation of key structures that would ensure that the Fund is capable to execute its mandated functions and the responsibilities at a sub-district level. Also, the CUPs are critical as a component of the NHI Fund for contracting with primary healthcare service providers at the district level. She supported the submissions made by Ms Gela, Mr Munyai, and Mr Siwela.

Ms H Ismail (DA) pointed out that clause 57(2)(a) was due for amendment because the implementation timeframe in the clause had passed. If there are no amendments made, she requested that the state law advisors advise the Committee on the validity of the clause and if it was allowed, especially considering that legislation did not apply retrospectively. Considering the amount of money that will be needed to finance the NHI Fund it is essential that an up-to-date feasibility study is conducted. The Committee cannot rely on a study based on the economy prior to the pandemic because the fiscus is in a much different state right now.

Clause 57(3) is a problem because it empowers the Minister to establish interim committees, yet it does not stipulate the specific criteria on how these committees will be established and what the composition of these committees will look like. It also does not stipulate the criteria for members to be elected, disqualification of members, remuneration, term of office, and number of members allowed along with the necessary quorum. All these details must be specified and spelt out in the clause because health committees are statutory structures. In addition, clause 57(4)(f) does not include mental healthcare workers like psychologists and social workers mentioned there for the provision of primary healthcare services. She wanted clarity if mental healthcare workers would be included and how they would be accommodated.

Another issue with clause 57 is that it does not provide clarity on the role of the provincial departments of health under the NHI. This clause basically requires an amendment to the Constitution itself which points to the fact that the NHI is clearly unconstitutional. Also the move of central tertiary hospitals from provinces to the national government as well as their specific roles for academic research and training is unsettling. There will be legal implications in moving employees. Rsearch and training will be affected and products available at provincial level may not be the same at national level.

Dr S Thembekwayo (EFF) stated that the clause-by-clause engagement in its current form does not serve any value in improving the state of hospitals, especially the infrastructure problem. It is advisable to pause the process and revisit the situation on an urgent basis. No public hospital is ready to implement NHI. EFF rejects the clause including the remaining clauses of the Bill.

Mr Munyai said that the ANC supported clause 57. It is important that the timelines are clearly articulated as defined milestones linked to time. If this is not done, the transformation of the health system will be held to ransom by those who do not subscribe to the transformation of the socio-economic environment of South Africa. The ANC is satisfied that there is enough funding in the healthcare sector because 8.7% of the GDP is spent on health. This means that there must be improvements to efficiently spend resources in one system rather than in several fragmented systems. The point raised about the lack of resources to fund NHI is an unacceptable excuse considering that the UK implemented the National Health Service (NHS) after World War 2 which had economically depleted the country.

Dr K Jacobs (ANC) said that the ANC supported clause 57(1)(a) because the NHI requires an intense period of ongoing legislative and policy reforms as part of the preparatory work to create the institutional and organizational structures required to bring the NHI Fund successfully and sustainably into fruition. Adopting a phased and structured process allows for the state and stakeholders to learn lessons and improve systems and processes.

The ANC supported clause 57(3)(b) as it empowers the Minister with the latitude and discretion to establish interim advisory committees related to the National Governing Body on Training and Development to strengthen the processes of establishing the NHI. The creation of the National Governing Body on Training and Development creates mechanisms for the translation into action of the plans and deliverables stated in the 2030 Human Resources for Health Strategy.

Clause 57(1) to (4) must be retained as it provides the details of elements that must be actively pursued and considered by the National Governing Body on Training and Development to contribute to the coordination and alignment of financing strategies for the country's health sciences education.

The ANC supported clause 57(3)(d) because it empowers the Minister with the latitude and discretion to establish Ministerial Advisory Committee on Health Technology Assessment to strengthen the processes of establishing the NHI. Health Technology Assessment is an important element to be undertaken as part of the process for deciding and informing the scope of healthcare benefits and associated technologies that must be included in the formulary and essential equipment list that users are entitled to. Health Technology Assessment is also critical for determining the most affordable technology using evidence-based principles, which must be accessible to all users of quality healthcare services. In broader terms, instituting mechanisms that entrench health technology assessment is pivotal to ensuring that the Fund is sustainable.

The ANC supported clause 57(4)(e) because the sequential processes for accreditation require that the Fund must consider the information emanating from the inspection and certification processes that are implemented by the Office of Health Standards Compliance for all types of health establishments and healthcare service providers, as well as the registration and licensing of health professionals by statutory regulatory councils. This will ensure a seamless regime that is based on consistent criteria for accredited and contracted providers of healthcare services to users. This is also an important aspect of quality assurance for providers of healthcare services and part of strategic purchasing.

The ANC supported clause 57(4)(f) along with a proposal to make minor changes because the range of services to be included for prioritization must include mental healthcare services. This provision is otherwise consistent with the requirement of ensuring that the Fund covers comprehensive care that ranges from primary healthcare services all the way to the most specialized care that will be required by users. The provision prioritises the purchasing of primary healthcare services, maternity and child healthcare services and services for vulnerable communities such as those for older persons, persons with disabilities and rural communities.

This provision is the cornerstone of ensuring that equity and justice are realised. This is also the most cost-effective way of improving access. The processes for setting up the structures and mechanism for purchasing required services from health establishments and healthcare providers must be premised on ensuring that we move forward towards universal healthcare coverage. The process must also ensure that no one is left behind and that all users are provided a fair and equitable chance of access to a reasonable scope of services that effectively address their personal health care needs.

The ANC supported clause 57(4)(h)(i) to (vi) because the Acts stated in the provision are a summary of those that will require consequential amendments to support the creation of the legislative and regulatory framework for the phased implementation of the NHI. Additionally, these Acts would need to be amended to allow for the operationalisation of the various structures required to create a functional, effective and sustainable NHI Fund. These laws will be considered further during the debate on clause 58 on the repeal or amendment of law. In addition, staff pensions must be protected during the transition when they migrate from the NDoH to the NHI Fund. This must also include assets as an additional proposal.

The Chairperson reminded all Members to send their submissions and recommendations on the NHI Bill to the Committee Secretary on behalf of their respective political parties.

Ms Ismail stated that the DA had been asking for a feasibility study to confirm the amount of funds within the NHI. She kindly requested that the Chairperson indicate when the feasibility study would be made available to Members. Also there was an expectation that before the Bill would be passed the state law advisors would come before the Committee to provide clarity on the inputs that have been made on various clauses.

Dr Jacobs noted everyone’s input and replied that he would try to give the Committee some indications on the processes going forward. He was not able to indicate the due date for parties to submit their recommendations. The department would respond to the clause deliberations after the Committee had completed the clause-by-clause deliberations.

Clause 58: Repeal or Amendment of Laws
The Chairperson took the Committee through clause 58 of the Bill that dealt with the Schedule on repeal and amendment of legislation affected by the NHI Bill.

Ms Ismail said that Medical Schemes Act in the Schedule does not state what is meant by "top up cover" in item 4. Terms need to be spelt out with the utmost specificity. She asked if the National Health Act in item 1 includes hospitals. Item 3 under the National Health Act is a problem because it takes away the functions of provinces which is unconstitutional. Is section 10(1)(b) under the National Health Act not a duplication of the functions by the District Health Management Office?

The Bill proposes major changes to other pieces of legislation, which will remove the responsibility of employers to cover the healthcare costs of workers injured on duty. This will effectively change the pricing of medicines and medical devices. It will make significant changes to the National Health Act, which will affect the delivery functions of healthcare. It will change the current provincial systems and district management systems. There is no clear replacement of the two systems. These need to be specified and clarified because the implications of these repeals and amendments are not adequately clarified, explained, or specified for understanding.

Mr Munyai said that the ANC supported clause 58(2)(c) because the provision ensures legislative and regulatory integration and ensures that the gaps created in the legal framework due to the enactment of the NHI Bill are solved.

Ms Clarke asked if they could expect the state law advisors to return to the Committee to clarify the processes for the various legislative amendments forced by the NHI Bill. Can the amendments of the other Acts amended by the Bill be reflected in the A list? Also the timelines should be considered for amendment because all the timelines have now shifted.

Ms Gela said that the ANC supported clause 58(2)(b) because the provision is consistent with the Constitution in that it is premised on the expectation that no user's right or privilege will be undermined because of the enactment of the Bill. She supported Mr Munyai’s submission.

Dr Jacobs said that the ANC supported clause 58(2)(a) as the provision ensures legislative or regulatory integration and ensures that no gaps are inadvertently created in the legal framework because of the enactment of the NHI Act.

Clause 59: Short Title and Commencement
The Chairperson took the Committee through clause 59 of the Bill.

Mr Van Staden said the Committee has come to the end of the deliberations on the Bill. It has become abundantly clear over the past weeks deliberating on the Bill that the NHI cannot be implemented. The NHI is not the appropriate way to provide healthcare services to nearly 58 million South Africans. A plan for the healthcare system, which incorporates both the private healthcare sector and the public healthcare sector, must be developed to ensure that all the medical professionals across South Africa work together to put such a system in place.

It is not government's responsibility to develop a national healthcare system. It is the responsibility of all medical professionals who work extremely hard every day to keep South Africans alive and well. The country needs a system developed by medical experts and not politicians, nor government officials, and a system that does not aim to destroy one sector for the sake of the other. The country needs a system where politicians listen to the ideas of medical professionals in the private and public healthcare sectors, and a system designed by medical practitioners and passed as law by Members of Parliament. The Freedom Front Plus rejects NHI Bill in its entirety.

Ms Clarke said that the DA finds the Bill a huge infringement on people’s rights to acquire the medical treatment of their choice without government interference. The government should put a plan in place to improve the universal healthcare that already exists in the country. The country will not achieve its desired healthcare outcomes by implementing the NHI Bill. Private partnerships should be created between the state and the private sector through the guidance of medical professionals. The OHSC and the Ombudsman should be part of the system that should be developed, and they should remain independent. The Bill will not reach the outcomes for universal healthcare which is why the DA does not support the Bill in its entirety.

Mr Munyai said that he supported clause 59(1) as once the Bill has been debated it is a standard practice for the President to proclaim it through a government gazette. The Bill can pass constitutional muster because its goal is to reverse the apartheid two-tier system that segregated South African people. The Bill is trying to resolve inequality and the challenges raised by the Health Market Inquiry. The Bill must be implemented as urgently as possible because it will change the lives of South Africans and be without discrimination.

Ms Ismail stated that as the DA they totally supported universal healthcare, but the problem is that the country does not have the capacity presently to implement such a Bill. The Health Ombuds report is evidence of the country’s unpreparedness because it shows that the Department does not have measurable targets, doctors are not paid on time, there is a critical skills shortage, and dilapidated infrastructure that is letting communities down. At every public hearing all the submissions stated clearly that while the NHI seems to be a noble cause, the current healthcare system failures need to be addressed first. Health professionals stated that they had taken the Hippocratic Oath, but their oath would not be effectively honoured under the NHI and the current fragmented healthcare system.

In addition, corruption is rife in the provincial departments. The Bill gives the Minister too much power in his position and this may allow for political interference increasing the likelihood of corruption. The Bill requires a capable state and the country at present is simply not capable to bring such reform into fruition. The NHI Bill in its current form needs a lot of improvement and a new financial feasibility study must be conducted. The NHI is unconstitutional and is therefore not supported by the DA.

Ms Gela supported Mr Munyai’s input on clause 59. She commented that South Africans are ready for the NHI despite all the issues that the opposition parties have raised considering that they know they are covered and have access to a better healthcare system in the private sector. They are not attending the public health sector and therefore they do not care for the needs of poor South Africans who cannot afford medical aid. The Bill is going to ensure that there is no more two-tier system which is the correct move. In the public hearings South Africans gave politicians a mandate to ensure that the NHI is implemented.

Ms Ismail raised a point of order asking Ms Gela to withdraw her statement asserting that opposition parties do not care for the people. All Committee members have been elected to Parliament because of the votes of South Africans. All Members therefore have a mandate to listen to public input. Ms Gela continually speaks in a disrespectful manner and nothing is done to correct her.

Ms Wilson agreed and asked Ms Gela to withdraw her statement that members of the opposition do not care for the people of South Africa. She took an oath when she came to Parliament and that oath was to protect the Constitution and to protect all people of South Africa. It is an oath that she swore to God that she would take very seriously. Ms Gela was out of line and had no right to say what she said.

Ms Clarke agreed and asked Ms Gela to withdraw her statement. They were all in the Committee as elected representatives who had taken an oath to protect the Constitution and serve the people of South Africa. Ms Gela cannot say that Members do not care for the people in this country.

Mr Munyai interjected saying that he heard Ms Gela say that the opposition does not care as much as she does.

Dr Jacobs responded that Ms Ismail, Ms Wilson and Ms Clark’s points of order have nothing to do with the process in terms of a point of order. What they had brought to his attention were not really points of orders. The least he had done was to give them an opportunity to express themselves. There was no need for Ms Gela to withdraw her statement.

Ms Ismail told the Chairperson that he had allowed Ms Gela to make an assumption about Members which was incorrect.

Dr Jacobs said that Ms Gela had not made an assumption, she had made a statement.

Ms Ismail said that if Ms Gela had made a statement, it was far worse than an assumption

Dr Jacobs asked Ms Gela to repeat her statement.

Ms Gela said that there was nothing she was going to withdraw. NHI is the only way to address the imbalances of the healthcare system and to ensure that every citizen is provided with good treatment.

Mr Siwela supported Mr Munyai's statement. The ANC looked forward to the President signing off the Bill once it is done. The ANC wants to do away with the two-tier system because it is undesirable. The opposition must help the ANC to achieve the NHI instead of telling the ANC that the Bill is unconstitutional.

Dr Jacobs reminded the Committee that Members did not have to put up a battle as if it was the last day that they would be deliberating on the Bill. It was not the last day of deliberations. There was still many more weeks to discuss the Bill. The ANC supported clause 59(1) because once the Bill has been debated it is standard practice for the President proclaim it through a gazette as the law that governs the implementation of the NHI.

The public hearings have taken place, submissions have been made either by email or hard copy and the Committee has heard what the people of South Africa have to say about the Bill. The clause-by-clause deliberations have been underway. What still must be done is that the Committee must engage on the Schedule of the Bill. This will happen when the Department comes before the Committee to take it through the Schedule. There will be no more hybrid meetings which means that discussions will be strictly proceed in person.

Members must ensure that from next week onwards they are physically present in Cape Town for the meetings. The first meeting will be deliberations on the amendments to the Acts mentioned in the Schedule. The second meeting will take place with the Department and the Minister who will be in attendance to respond to the points raised in the public hearings and in the clause-by-clause deliberations. In the third meeting the Committee will hear the written inputs from the political parties. The public hearing submissions will also be looked at and they are in the process of developing a matrix for this. Following this will be input from state law advisors and the legal services of Parliament. After these processes have been completed the Committee will adopt the A list and the Committee Report recommending the adoption of the B version of the Bill. After this the Bill will go to the National Assembly to be considered for adoption.

There is the probability that if the Committee does not complete this work in time, the Committee will be the only committee that will have meetings after Parliament rises on 2 December. He urged Members to ensure that they move at a faster pace to prevent this from happening, especially as there may be another Bill that the Committee might have to deliberate on which is the Tobacco Bill.

Ms Clarke suggested that the Committee arrange to meet more than once a week because many Members have already planned to go away on their annual holiday in December. Also, a week after Parliament rises many Members have made arrangements to follow up with their constituencies.

Dr Jacobs agreed with Ms Clarke. The Committee will apply for more meetings even after plenary sessions in the evenings to ensure that they finish its work in time. They were looking forward to having the Department join them next week and they would have printed copies of these Acts during the meeting.

Dr Jacobs thanked everyone for their time and adjourned the meeting.


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