National Health Insurance (NHI) Bill: summary of public comments

This premium content has been made freely available


22 November 2022
Chairperson: Dr K Jacobs (ANC)
Share this page:

Meeting Summary


NHI: Tracking the Bill through Parliament

In a virtual meeting, the Committee received a briefing by its Content Advisor on the submissions made on the National Health Insurance (NHI) Bill. The matrix document consolidated and summarised all stakeholder comments, recommendations and proposed amendments for each chapter and clause of the NHI Bill.

ANC Members made it clear that the ANC had considered all the comments and suggestions raised in the matrix document. Where it made sense, the ANC had incorporated some of the comments in its written submission.

DA Members said that the matrix summary did not appropriately address the concerns raised during committee deliberations plus the summary did not have feedback on what would be done to address the array of issues that have been raised.

The EFF said that some of the issues that have been raised, such as the referral system, how the funding is going to happen, bureaucracy, transparency and too much powers given to the Minister, should raise concern for all Members regardless of political allegiance and loyalty. The EFF was concerned that the Committee would approve the Bill without having any idea how it would affect the public purse.

The NFP agreed that the NHI is imperative to address inequalities, particularly in health care for the entire country. However, many questions remained unanswered, especially funding, and would need to be addressed to ensure that the implementation of the NHI would be a success.

Meeting report

Opening remarks
The Chairperson said the summary matrix consolidating all the public submissions on the NHI Bill would be presented. The summary matrix was purely for information purposes so the Committee could use this for further deliberations.

Consolidated Matrix Summary of NHI Bill submissions
Ms Lindokuhle Ngomane, Committee Content Advisor, said that the document summarises all the viewpoints, recommendations and proposed amendments of stakeholders. The submissions were made during the different phases of the public participation process, that is the provincial public hearings, the written public submissions and the public hearings in Parliament.

The matrix summarised all the public comments made on each clause or chapter of the Bill (see document). The document included additional comments on:
• Limitations of Bill to its objectives
• Constitutional issues
• Legal framework
• System design issues
• Role of Medical Schemes
• Financing of NHI
• Governance of NHI

The Chairperson thanked the Content Advisor and her team for the document presented. He noted that there were slight challenges to hearing the presentation due to general network issues, but fortunately, the document was flighted so that Members could follow. He reminded the Members that the Content Advisor was not authorised to answer their questions as she was not a politician, but that Members were able to make comments and these would be noted+.

Ms E Wilson (DA) pointed to the extent of changes proposed in the submissions and the high probability of unintended consequences arising from the Bill. This should be grounds for a technical feasibility assessment, and further public and stakeholder hearings. She felt that the document did not appropriately address the concerns that were raised; therefore, the document should be rejected.

Mr T Munyai (ANC) said that he noted the summary report of submissions, which should not be misunderstood as if he agreed with the report. For instance, he did not agree with the recommendation that the dissolution of the NHI Board should proceed through Parliament, because he felt that Cabinet has the capacity to do so through a process with the Minister.

He did not agree with the argument that the Minister would be given excessive powers, because it cannot be excessive if it was based on the Constitution. There were a number of areas in the document that he did not agree with, but he wanted to note the document so that the Committee could move forward.

Ms M Clarke (DA) said a lot of issues were raised in the summary of submissions but there was very little feedback in addressing those concerns, which she found very disappointing. She hoped that the Department would address the issues about the feasibility study, the financial model and the critical matter about transparency in the Bill. Many of these concerns were also raised during the clause-by-clause deliberations. The document did not have any real feedback on what would be done to address the array of issues that have been raised, which is what the Committee would need. She felt that the Committee did not get anything out of this meeting today.

Mr P van Staden (FF+) agreed that it was a difficult meeting, especially with the poor signal. He noted that the Committee still needed to get feedback on the 38 000 written submissions, particularly on how many of those submissions were in favour or against the NHI Bill.

Ms N Chirwa (EFF) thanked the presenter. She was concerned that the document did not fully encompass the issues that were raised in this Committee. There should be an appreciation of the work that the Members of this Committee had done over the past months on deliberating each clause. She understood that the legislative process was precise, but she thought that the report could also be an opportunity to make a contrast between the clauses and the contributions that have been made in this Committee, especially as the EFF has rejected the Bill in its totality. For instance, the Minister had raised a big red flag last week, that part and parcel of funding the NHI is the reallocation of funds in the National Department of Health (NDoH). There is no clear picture of where these funds would be reallocated.

She also raised concern about the infrastructure deficiencies and the issue of exclusion, which must be engaged on more intricately. The ANC would go ahead with the NHI whether it is liked or not, because the ANC has been entrusted with peoples' votes. People will have to learn about the power of their votes, by seeing the NHI happen, and seeing how it is going to affect them negatively. At the very least, there should be room to engage on different ideological standpoints. The EFF has said that this Bill will cater for the private sector, because it is officiating the tender system in the health care system, which is problematic. The Committee was overlooking these problematic issues. Regardless of political allegiance and political loyalty, issues such as the referral system, how the funding is going to happen, bureaucracy, transparency and too much powers given to the Minister, should raise concern for all Members, because it will have their names stamped on it as people who participated in this process. These concerns should not be side-lined, but should be encapsulated properly as those are strong points that have been raised.

She reminded the Chairperson of the request to have the Minister of Finance come before this Committee to brief it on the NHI funding system. This needed to happen as a matter of urgency, especially following last week's meeting, when the Minister of Health spoke about the reallocation of funds in the NDoH. The Committee does not know from which departments, programmes, facilities or provinces that funds will be taken and to where they will be reallocated. What will the reallocation of funds look like? She emphasised that these were basic questions that should have been answered even before they were asked, considering the implementation of an entire new public health system. The Committee should be worried that it was okaying a Bill, while having no idea how it would affect the public purse.

Mr N Xaba (ANC) agreed with Mr Munyai’s remarks. The ANC had considered all the suggested changes, and where they do make sense, then changes will be made to the Bill. The ANC has seriously analysed the submissions made by the stakeholders, and made positive changes where necessary. The ANC had noted the comments and suggestions. Where they made sense, the ANC factored some of the comments into the ANC written submission.

Ms H Ismail (DA) said that 85 to 90% of the recommendations and concerns raised by stakeholders are not effectively addressed in the matrix document. Most of the time, there are no real amendments that have effectively addressed the matters raised. There is no guidance on how a particular issue is going to be addressed, or the monies necessary to address it. The document lacked a lot of the concerns and recommendations that have been raised. No response has been provided on the financial consequences, and no financial feasibility study. The document lacked a lot of crucial information that had been raised during all of the public hearings.

Ms X Harvard (ANC) agreed that the ANC had seriously considered the comments made through written and oral submissions, including the provincial hearings. The ANC had already made use of the comments in making changes where necessary. The ANC would spend more time to recheck the contents, but otherwise, the document has been noted and the Committee can move forward.

Ms A Gela (ANC) agreed with Mr Munyai and Mr Xaba’s remarks. The Committee must listen to the voice of the masses. The NHI is the only way South Africa must take. She noted the document presented to the Committee.

Mr A Shaik Emam (NFP) agreed that the NHI is imperative to address inequalities particularly in health care for the entire country. He understood the view of the masses, that the NHI needed to be induced as a matter of urgency. Based on what was inherited after the days of apartheid, the masses have been marginalised, victimised and have not been provided with equal health care for far too long, and this needed to be addressed. However, he was particularly concerned about the funding of the NHI. There are many questions that have remained unanswered. He was concerned that the Bill would be adopted without the Committee having addressed the unanswered questions. It was this Committee's responsibility, as public representatives and legislators, to interrogate and find those answers in order to close the gaps, so that when the NHI is introduced it will be a success, as everybody would want.

The Chairperson said that there were a few Members' points that he would speak to. Firstly, this document was drafted by Parliament staff and the NDoH had nothing to do with this document. Secondly, Parliament does not do feasibility studies. The staff that drafted the document also presented it. It is part of their normal duties that they have to perform. Thirdly, it is part of this Committee's duties to have this particular document. This document was meant to make it easier for all Members to understand the points raised in the public engagement processes.

He reminded the Members that they have received the report on the clause-by-clause engagement, the thematic report and the report on the provincial public hearings. The Members should have received those reports via email. It was not true that Members were not given an opportunity to make inputs on those reports. Members' input was meant to be brought as the Committee continued with the deliberations. He noted that the report also addressed the issue of the external provider, when assistance was required by Parliament for the capturing of the public submission data. Mr van Staden’s request for feedback on the written submissions was also addressed in those reports. The matrix document presented today actually enhances the previous documents, because it now brings the most frequently expressed views in each clause.

He noted the comment that no amendments were addressed in this document. Amendments should not be proposed by Parliament staff. It was for the Members to propose those amendments. He reminded Members that they have been requested many times to send in their party submissions with proposed amendments or recommendations. Whatever was forwarded by Members of different political parties will be discussed.

Mr van Staden said that the Chairperson might have misunderstood his comment. He had the report in front of him, which was sent to the Committee on 15 March 2022. The report did mention the total number of submissions received by Parliament. However, the Committee did not yet receive a report saying how many of those stakeholders or participants who made those submissions were in favour or against the NHI Bill.

The Chairperson said that he will note this comment as it was not something he could answer now.

Way forward
The Chairperson said that the public has deliberated; the Committee has had its deliberations and the various political parties have raised their points. The NDoH is meant to note all the points raised and respond to the Committee tomorrow on 23 November. On Friday 25 November Parliamentary Legal Services and the Office of the Chief State Law Advisor will present their views on the legality and constitutionality of the points raised by Members and the public.

By Friday the Committee should have a better idea of many of the points raised, or what Mr Shaik Emam has referred to as “unanswered questions”. Hopefully all these questions would be answered by Friday.

After the Committee had received a briefing from Parliamentary Legal Services, and upon agreement by the Committee, the legal team would be instructed to start developing the A-list, which would be all the Committee proposed amendments to the Bill. Thereafter, the legal team will write up the B-Bill incorporating the proposed amendments which the Committee will decide to adopt or not adopt. The Committee will adopt its Committee Report on the A-list and B-Bill. At that stage, the Office of the Chief State Law Advisor will ensure that the B-Bill is correct in terms of the legal jargon and constitutionality et cetera.

The meeting was adjourned.


No related

Download as PDF

You can download this page as a PDF using your browser's print functionality. Click on the "Print" button below and select the "PDF" option under destinations/printers.

See detailed instructions for your browser here.

Share this page: