Hansard: NCOP: Unrevised hansard
House: National Council of Provinces
Date of Meeting: 06 Dec 2023
Summary
No summary available.
Minutes
UNREVISED HANSARD
NATIONAL COUNCIL OF PROVINCES
WEDNESDAY, 6 DECEMBER 2023
PROCEEDINGS OF VIRTUAL (OR HYBRID) NATIONAL COUNCIL OF PROVINCES
The Council met at 14:06.
The Chairperson took the Chair and requested members to observe a moment of silence for prayers or meditation.
The Chairperson announced that the hybrid sitting constituted a sitting of the National Council of Provinces.
NOTICES OF MOTION
Ms M L MOSHODI: I hereby move on behalf of the ANC that in its next sitting:
That this House debates dealing with extortions head-on to prevent the collapse of the township economy, which is a critical engine of growth for many cities in the country.
Ms A D MALEKA: I hereby move on behalf of the ANC that in its next sitting:
That this House debates enhancing countermeasures aimed at closing the usage of our ports for massive drug trafficking, especially cocaine by international crime syndicates.
Ms M O MOKAUSE: I hereby move on behalf of the EFF that in its next sitting:
That this House debates the ongoing suicide sort of psychological effect on school kids and come up with a form of a plan to deal with it at the level of the schools.
Ms S B LEHIHI: I hereby move on behalf of the EFF that in its next sitting:
That this House debates load shedding which according to the landmark judgment by the Gauteng High Court, is a human rights violation as it disrupts essential services, causes job losses, and is destroying South Africa.
Ms B M BARTLETT: I hereby move on behalf of the ANC that in its next sitting:
That this House debates the prevalence of incidents of human trafficking in South Africa and the urgent interventions needed to curb this escalating crime
WORKING ON FIRE VEHICLES RECALLED BY DEPARTMENT DURING THE WORST FIRE SEASON
(Draft Resolution)
Mr S F DU TOIT: Chairperson, I move without notice:
That the House—
(1) notes that all the Working on Fire vehicles in the Northwest Province have been recalled by the Department of Forestry, Fisheries and Environment, DFFE, in the middle of the worst fire season in living history;
(2) also notes that the community is being left in a dire situation and even worse, lack of resources than before;
(3) further notes that the North West Umbrella Fire Protection Association, NWUFPA, have not been consulted in this regard, despite numerous attempts to contact the DFFE; and
(4) finally notes that we are seating with helicopters and air-wing that have been grounded;
Motion agreed to in accordance with section 65 of the Constitution.
MPUMALANGA ROADS IN A DEPLORABLE STATE
(Draft Resolution)
Ms C LABUSCHAGNE: Chairperson, I move without notice:
That the House—
(1) notes with concern the deplorable state of the R536, R540, and the R36 roads in the Ehlanzeni District;
(2) also notes that the R536, a tourist route between Sabie and Hazyview, has been permanently closed after the storms that hit Mpumalanga earlier this year;
(3) further notes that the R540 between Lydenburg, Dullstroom and the R36 between Lydenburg and Bambi have reported numerous accidents and the loss of lives;
(4) notes that various complaints from road users and a letter addressed by myself and hon Boshoff to the MEC of Roads and Transport in the Mpumalanga legislature have borne fruits;
(5) acknowledges that a reply from the office of the MEC has indicated in writing that immediate attention would be given to these roads especially in light of the fact that these roads are business and tourism routes; and
(6) recognises and thanks the MEC for his promise to attend to these roads and that the DA will monitor the progress on these roads.
Motion agreed to in accordance with section 65 of the Constitution.
CHAD LE CLOS WINS FIVE GOLD MEDALS AT THE 2023 GERMAN SHORT COURSE CHAMPIONSHIPS
(Draft Resolution)
Mr F J BADENHORST: Chairperson, I move without notice:
That the House—
(1) notes with absolute pride the achievements of Chad le Clos at the recent German Short Course Nationals;
(2) also notes that across his events, he claimed five gold medals and in doing so reminded South Africans that his focus on Olympic preparations is razor-sharp despite the setbacks he has faced in recent times;
(3) further notes that the Olympian has openly shared that he is not only focused on the Olympics, but podium positions;
(4) recognises that despite injuries and prolonged illnesses that kept him from the World Long-Course Championship, he has remained steadfast in his goals; and
(5) acknowledges that Chad has made us all proud, time and time again, and requests that this House address a letter to him congratulating him on this achievement and wishing him well in his preparations for the Paris 2024 Olympics.
Motion agreed to in accordance with section 65 of the Constitution.
NORTH WEST IN NEED OF RESOURCES TO CURB PRIORITY CRIMES
(Draft Resolution)
Ms C VISSER: Chairperson, I move without notice:
That the Council—
(1) notes the urgent need for capacity, resources and specialised units to aid the investigation of priority
crimes, stock theft, rural safety and security to enable the South African Police Services, Saps, to comply with their mandate;
(2) also notes that I have received 74 case numbers from the past 10 years which have not been investigated or prosecuted;
(3) recognises that stock theft in North West is conducted by specialised criminal syndicates, including cable theft, and for more than a decade, arrests have been made several times but all cases being nolle prosequi by the National Prosecuting Authority, and then repeatedly continue with their criminal activities;
(4) acknowledges that the Bray “4 star” Saps station, supposedly open 24 hours per day, was closed on Sunday, 27 November, when 70 herds of cattle were poisoned where 44 died and the owner of the cattle received death threats via WhatsApp voice notes; and
(5) requests the National Commissioner, General Masemola, to intervene and rescue the compromised North West
Saps stations, in compliance with their mandate for the safety of all people of North West.
Motion agreed to in accordance with section 65 of the Constitution.
GAMAGARA LOCAL MUNICIPALITY IN THE NORTHERN CAPE FAILING TO DELIVER WATER TO ITS RESIDENTS
(Draft Resolution)
Mr W A S AUCAMP: Chairperson, I move without notice:
That the Council—
(1) notes with concern the failure by the Gamagara Local Municipality in the Northern Cape to deliver basic services such as the provision of water, as contained in Chapter 2 of the Constitution of South Africa to the residents of Olifantshoek;
(2) also notes that residents in Olifantshoek have been without water for prolonged periods of time and that the reservoirs that provides water to the people of
Olifantshoek are not being filled regularly, when temperatures in the area regularly rise above 40 degrees Celsius;
(3) further notes that water tanks that have been placed in Olifantshoek more than two years ago as a temporary alleviation to the effects of the water crisis, are to date not being filled by the municipality on a regular basis;
(4) acknowledges that no schools or clinics in Olifantshoek have enough water for basic sanitation;
(5) also acknowledges that the DA has, on numerous occasions, called on this municipality to fulfil its obligation towards the delivery of water and other basic services to the people of Olifantshoek to no avail;
(6) calls on the Northern Cape MEC for Co-operative Governance and Traditional Affair, Cogta, to urgently intervene in this matter in order to assist the people of Olifantshoek to obtain water; and
(7) recognises that should the Gamagara Local Municipality not remedy the water crisis in Olifantshoek as matter of utmost urgency, it will not only be the quality of life of the residents of Olifantshoek that will be jeopardised but also the lives of the residents that will be in jeopardy.
Motion agreed to in accordance with section 65 of the Constitution.
REPORT RELEASED BY BORDER MANAGEMENT AUTHORITY OF SOUTH AFRICA UNCONFIRMED AND MISLEADING
(Draft Resolution)
Ms M O MOKAUSE: Chairperson, I move without notice:
That the Council—
(1) notes report released by the Border Management Authority of South Africa that 400 kids were returned at the border of South Africa and Zimbabwe;
(2) also notes that this report was rejected by the Zimbabwean authorities;
(3) further notes that this claim by the South African Border Management Authority remains unconfirmed and misleading the country;
(4) recognises that even if that was the case, the action remains of a government that doesn’t care about the wellbeing, especially of a black child;
(5) recalls that the law requires that every human being must be protected, and that official legitimise that they deemed as human trafficking; and
(6) demands that these officials be brought to book and account for their actions.
The CHAIRPERSON OF THE NCOP: Thank you very much. Any objection to the motion?
An HON MEMBER: We object!
The CHAIRPERSON OF THE NCOP: There being an objection, the motion may not be proceeded with and will become a notice of a motion.
COUNCILLOR NHLALAYENZA NDLOVU PASS ON
(Draft Resolution)
Mr T J BRAUTESETH: Chairperson, I move without notice:
That the Council—
(1) notes with shock and disbelief the brutal murder of the DA Chief Whip in the uMngeni Municipality, Councillor Nhlalayenza Ndlovu yesterday;
(2) also notes that three armed men approached the Ndlovu household and fired shots before entering the home;
(3) further notes that the gunmen then entered the home and shot Cllr Ndlovu in front of his wife and young children;
(4) also notes that the gunmen left the Ndlovu home without removing any personal items;
(5) further notes that the uMngeni Municipality is deeply disturbed and saddened by this barbaric act that has left the municipality of Umgeni devastated;
(6) also notes that Cllr Ndlovu was known as a peacemaker and a reconciler, and his calm demeanor and mature approach to governance and community- related matters were amongst his most memorable characteristics as a leader;
(7) further notes that as a person Cllr Ndlovu was always available to assist, a true family man, devoted to his children, and one would never find him without a smile;
(8) notes further that Cllr Ndlovu was a close advisor to his leadership in the municipality and a pillar to lean on when all seemed a little bit chaotic or uncertain, he was a good friend and a kind person;
(9) expresses its sincere condolences to the family, friends and colleagues of Cllr Ndlovu and wishes them all the love and strength possible in this incredibly difficult time; and
(10) calls on the SAPS units tasked with the investigation to move without delay to apprehend the killers of Cllr Ndlovu, especially considering the ongoing and persistent crisis of political violence in the killing fields of KwaZulu -Natal.
Motion agreed to in accordance with section 65 of the Constitution.
BROADBAND ACCESS FUND EMPOWERS COMMUNITIES
(Draft Resolution)
Ms L C BEBEE: Chairperson, I move without notice:
That the Council—
(1) welcomes the launch of a project that connected 1 600 households to broadband services in KwaZulu-Natal;
(2) notes that this initiative enabled at least 6 000 community members to access broadband services;
(3) recalls that the launch of the first Gigabit Mesh Network at Ward 1 of the Greater Kokstad Local Municipality is part of the government’s South Africa Connect programme, aimed at achieving universal access to the internet funded through the Broadband Access Fund;
(4) reckons that the Broadband Access Fund has empowered small, medium and micro enterprises, SMME, internet service providers across the country to support the creation of direct and indirect job opportunities for designated groups such as youth, women and persons with disabilities;
(5) also reckons that already in the Harry Gwala District Municipality the Broadband Access Fund has empowered
12 subcontracted SMMEs, and created 79 job opportunities for youth, women, men and persons with disabilities; and
(6) calls for the speedy emulation of this project in other provinces.
Motion agreed to in accordance with section 65 of the Constitution.
COMMEMORATION OF INTERNATIONAL DAY FOR PERSONS WITH DISABILITIES
(Draft Resolution)
Ms M L MAMAREGANE: Chairperson, I move without notice:
That the Council—
(1) notes that on the 3 December 2023, the world celebrated the International Day for Persons with Disabilities;
(2) also notes that the government of Limpopo celebrated the day at Mokwakwaila Stadium Community Hall, Greater Letaba Local Municipality under the Mopani District, in partnership with Old Mutual Foundation which donated a water tanker with 10
000l capacity and 10 wheelchairs to Ramokgwakgwa Special School which is based in the Letaba TVET college in Kgapane;
(3) further notes that this year’s theme was Consolidate and Accelerate Rights of Persons with Disabilities into the future and that the theme resonates with the South African Constitution and the Bill of Rights which states that “everyone has the right to life, equality, and human dignity; and
(4) applauds Limpopo Provincial Government for creating opportunities to highlight the plight and success registered in the improvement of the rights of persons with disabilities.
Motion agreed to in accordance with section 65 of the Constitution.
SWIFT ARREST OF CRIMINALS
(Draft Resolution)
Mr M DANGOR: Chairperson, I move without notice:
That the Council—
(1) notes the swift arrest of eight suspects for the rape of three security guards at a transport department at Merebank depot in KwaZulu-Natal, on Monday, 27 November 2023;
(2) also notes that the eight armed suspects with firearms and knives allegedly took turns in raping the three security guards, whilst holding the other guards hostage and helping themselves to valuables belonging to the state;
(3) condemns with the contempt it deserves the heinous sexual attack of the three female security officers, worse at a time when the country is observing the 16 Days of Activism campaign;
(4) believes that men who commit these crimes against women should be condemned to long-term imprisonment without the option of a parole; and
(5) urges communities to come together in solidarity and work with the law enforcement agencies, to report
these crimes to ensure that the perpetrators of gender-based violence are brought to book.
Motion agreed to in accordance with section 65 of the Constitution.
MS JANINE VAN WYK FROM FOOTBALL
(Draft Resolution)
Mr I NTSUBE: Chairperson, I move without notice:
That the Council—
(1) notes that on 4 December 2023, the former Banyana Banyana captain, Ms Janine van Wyk took the field for the last time as a national soccer team player, after having announced her retirement from international football in October 2023;
(2) also notes that on this occasion she became the most capped African footballer, male or female, by beating the record of 184 caps set by the former Egypt international footballer Ahmed Hassan;
(3) further notes the decision by the coach to hand the two caps she needed to surpass Hassan in Women’s Africa Cup of Nations qualifiers against the Burkinabe; and
(4) congratulate Ms Van Wyk on achieving 185 caps and wish her well in her retirement and her women’s football development as she also owns a women’s football team.
Motion agreed to in accordance with section 65 of the Constitution.
BANYANA BANYANA QUALIFY FOR THE 2024 WOMEN’S AFRICA CUP OF NATIONS IN MOROCCO
(Draft Resolution)
Ms N E NKOSI: Chairperson, I move without notice:
That the Council-
(1) notes with great excitement Banyana Banyana’s victory
over Burkina Faso on Monday, 04 December 2023;
(2) also notes that Banyana Banyana beat Burkina Faso 2-0, and this allowed them to qualify for the Women’s Africa Cup of Nations in Morocco next year;
(3) further notes that Banyana Banyana came into the match with a slight advantage after scoring an away goal during their 1-1 draw in the first leg in Ivory Coast last Thursday, 30 November 2023;
(4) commends Banyana Banyana for a sterling performance, for making South Africa proud and flying the South African flag high; and
(5) takes this opportunity to wish them all the success in their future endeavours, and calls all South Africans to support and rally behind Banyana Banyana.
I so move.
Agreed to.
MOTION OF CONDOLENCE
(The late Sampie John Kalake)
Mr M S MOLETSANE: Chairperson, I move without notice:
That the Council-
(1) notes that Mr Sampie John Kalake, a prominent businessman in Roleleathunya in Rouxville, passed away last week after a long illness;
(2) also notes that Mr Kalake played a big role in his local community and contributed immensely to business development and inspired many to follow in his footsteps;
(3) further notes that the late Mr Kalake, was a man of great intellect, vision and courage who started from humble beginnings, working as a petrol attendant at a petrol garage in Rouxville, then moved up to working at a Nature Reserve;
(4) also notes that he leaves behind his wife and children; and
(5) conveys the heartfelt condolences of the Economic Freedom Fighters to the family and friends on the passing on Mr Kalake; May his soul rest in peace.
I so move.
Agreed to.
DONATION OF GENERATORS FROM THE CHINESE GOVERNMENT
(Draft Resolution)
Mr K M MMOEIEMANG: Chairperson, I move without notice:
That the Council-
(1) welcomes the donation of R170 million worth of 450 gasoline and diesel generators by the Chinese government, which were handed over to South Africa at the Eskom warehouse in Howick, in KwaZulu-Natal, on Thursday, 30 November 2023;
(2) recalls that the generators were delivered three months after the Chinese government pledged to donate the
equipment to South Africa when Chinese President Xi Jinping visited the country for bilateral talks in August 2023;
(3) understands that the generators will be used as a backup to lessen the impact of loadshedding in health facilities, schools, prisons and courts;
(4) realises that the generators are not going resolve loadshedding but will assist as an alternative supply in instances of a power failure to make sure there is uninterrupted activity at health centres;
(5) grateful to the Chinese government for the donation, and is confident that the generators will ensure an uninterrupted power supply at healthcare facilities and schools while loadshedding continues, whilst looking forward to the second consignment of generators next year in February.
I so move.
Not agreed to.
SEBOKENG REGIONAL HOSPITAL IN THE EMFULENI LOCAL MUNICIPALITY IN A STATE OF CRISIS
(Draft Resolution)
Mr K MOTSAMAI: Chairperson, I move without notice:
That the Council-
(1) notes that Sebokeng Regional Hospital in Emfuleni Local Municipality is in a state of crisis, which has been reported for years;
(2) further notes that currently exists a shortage of nursing, medical staff and medical equipment at the hospital, which is a cause of great concern;
(3) acknowledges that section 27 of the Constitution states that everyone has the right to have access to healthcare services and no one may be refused emergency medical treatment;
(4) further acknowledges that the shortage of healthcare staff at the hospital has led to poor quality
healthcare services offered, inappropriate behaviour of staff and long waiting times.
(5) recognises that the quality of healthcare is compromised by the challenges faced at Sebokeng and it impacts negatively on the quality of healthcare provided;
(6) alls on the Minister of Health to improve the quality of care provided and reduce delays at Sebokeng Hospital and all public healthcare facilities.
I so move.
Not agreed to.
The CHAIRPERSON OF THE NCOP: Hon members, we have warned against this in the past. But I won’t comment any further. There’s an objection, so, there being an objection, the motion may not be proceeded with and will become a notice of a motion.
Ms M O MOKAUSE: Chairperson, on a point of order. My point of order is relating to the facts in this House. Chairperson, we
all know that the reason why there are no medications at hospitals is because these facilities are looted ...
The CHAIRPERSON OF THE NCOP: Hon Mokause ...
Ms M O MOKAUSE: ... it’s because even if government appropriates money for medicine, it gets looted at the level of this facilities.
You object to serious issues in this House. You are so inhumane ... [Interjections.] [Inaudible.]
The CHAIRPERSON OF THE NCOP: Hon Mokause, now you have done
... you have gone beyond the pale, really.
Hon Mokause, you can’t call members of the House thugs, that’s the first thing, you can’t really do that.
Now, I want you to stand up and apologise, and failure to apologise, you should move out of the House.
Ms M O MOKAUSE: Chairperson, I will not give the ANC that satisfaction. I’m going to withdraw. I’m going to speak here today and no ... [Interjections.] [Inaudible.] ... going to
withdraw the word thugs, that is what I’m going to withdraw.
But I will address you later on.
The CHAIRPERSON OF THE NCOP: Hon members, we’ve really tried in this House to ensure that we eliminate all the rowdiness and the kind of conduct that I’ve just seen now. Please
co-operate. Please do not do things that you yourself can really become ashamed about, especially when we look at what we have said and done in the House.
We will try, especially form the Presiding Officers side, to accommodate you as much as possible. We’ll move the extra mile. But please don’t take that for granted. Please don’t do that.
We’ll move on, hon members.
Yes, Michalakis?
Mr G MICHALAKIS: Chair, I rise in terms of Rule 69, on a point of order. Although I may not be at odds with what my hon colleague from the EFF said, because the truth is a defence.
You did not give a proper ruling whether it should be withdrawn or not. So, the basis on which this is now being
dealt with, I would imagine that it would now be parliamentary to call other members thugs. And I would just like, in light of that, would like to associate myself with utterances made by the EFF member. Thank you.
Mr M I RAYI: Chair, you have ruled here. In terms of Rule 69(7) it says no point order may be raised in response to a ruling given in terms of subrule 4. So, he’s responding to the ruling that you’ve already made. Which means he’s out of order and then he must withdraw. Thanks, Chair.
The CHAIRPERSON OF THE NCOP: Hon members, there’s no need for this kind of heat that we’ve just seen now, and we’ll proceed. We’ll proceed but I’m noting all of these things that are happening and the individuals concerned. If we don’t behave, hon members, we will make the relevant ruling accordingly. So, please behave.
CONSIDERATION OF REPORT OF AD HOC JOINT COMMITTEE ON FLOOD DISASTER RELIEF AND RECOVERY
Mr A J NYAMBI: Chairperson of the National Council of Provinces. Because of the quality of the connection, with your permission, I will abide by the rule of having the picture
instead of the video so that I can stay properly connected when submitting reports.
The CHAIRPERSON OF THE NCOP: Please proceed.
Mr A J NYAMBI: Thank you very much. The Chief Whip of the NCOP, House Chairperson Ngwenya, having taken note of the devastating floods in the Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Mpumalanga and Northwest provinces from December 2022 to February 2023 and the resulting declaration of a national state of disaster on 13 April 2023, Parliament established the Joint Ad Hoc Committee on Flood Disaster Relief and Recovery. Th committee establishment gave effect to Parliament constitutional obligation to oversee the implementation of government relief measures to address the flood impact.
The committee was expected to report back on its work to both Houses of Parliament by the 30th of November 2023. And its report was duly tabled on the 29th of November a day before the due date as per the Announcements Tabling and Committee Reports, ATC, 168 of the same date.
The work of the committee followed on from the work of the previous Joint Ad Hoc Committee, which was set up to assess and respond to the extent of damage in the KwaZulu-Natal, Northwest and Eastern Cape provinces following the floods in April and May 2022. A follow up was made to the relevant sector and parliamentary committees to determine what action has been taken with regard to the findings and recommendations of the previous committee.
Hon members, the fact-finding visit to the provinces affected by December 2022 and February 2023 floods were then conducted as to verify the information receive against the lived experience of the affected communities. They visited the provinces where the sites were the National State of Disaster was satisfied and subsequently declared and comprise the provinces of Gauteng, KwaZulu-Natal, Eastern Cape, Northwest, Free State, Mpumalanga and Limpopo. In summary, the committee found as follows Chair: The City of Tshwane political administration showed no interest in prioritizing the plight of communities affected by recurring floods around the municipal area. This attitude is devoid of basic humanity and empathy and is out of place in the context of a disaster.
The committee also regret the poor co-operation received from the Free State political leadership and the provincial government’s lack of preparedness to furnish the committee with the relevant information. The Mopani District and Greater Tzaneen local municipality mayor’s non-co-operation further rendered the committee’s oversight visit to the area futile return as in could not engage meaningfully with the acting representatives who demonstrated little understanding of the content they were delegated to present.
The well organised reception by the City of Joburg school political and explosives contingent inspired confidence and indicative of the municipal readiness to co-operate with the relevant role players towards more effective post floods disaster rehabilitation.
Hon members, the Northwest provincial government has made minimal post disaster intervention programmes since the previous Ad Hoc Joint Committee visit to the province. More than a year later critical disaster relief measures are still planning phase. Poor communication with the affected citizen has contributed to violent protests and destruction of municipal property. The destruction of service delivery
infrastructure is counterproductive, and the committee condemns such acts of criminality.
The Gauteng provincial government proactive and forward- looking approach to dealing with disasters including the introduction of permanent search and rescue teams is welcomed and supported. This is an example of good practice that should be emulated. The intergovernmental co-ordination initiative, as was clearly outlined by the premier is also encouraged. The slow spending of disaster grants by the flood affected municipalities is a cause for concern considering that the committee has fought hard for funding to be made available.
Chairperson, the key issue is no longer the lack of resources but the inability to spend allocated funds due to absence of necessary skill. Stage obedience appear to subject emergency disaster projects to normal procurement processes.
Notwithstanding the fact that there is a special dispensation that allows for deviation which should be reported within 14 days. Government decision to shift the focus away from temporary residential unit, TRU, to the provision of a permanent structure is welcome and is in line with the government previous pronouncement where temporary structures lasts for long time, they lose meaning.
Against these findings, the committee report makes the following recommends: The first one is that flood disaster intervention by organs of state will include climate change, as a key consideration to foster a better understanding of the broader context in which the flood crisis unfolds. Taking cognizance of the recurrence of flooding incidents due to climate change, the relevant State organs should embark on a continuous community awareness and education programme to ensure that communities are ready and knows how to respond to an impending flood disaster.
The second point, hon members, disaster-prone municipalities such as City of Johannesburg should foster a close working relationship with the Council for Geoscience for a more informed response to a geological aspect of disaster vulnerability.
The responsive state organs should also place more emphasis on municipal infrastructure maintenance, including clearing of storm water drainage system and calves prior to the onset of rainy season,
The water service authorities should prioritize the provision of regular reliable supply of drinking water to communities
affected by flood disasters. The responsive spheres of government should find a way of accelerating the process of releasing post-disaster rehabilitation funds. Funds are often released long after a disaster occurs. And these nullifies the impact as new disasters should have occurred by the time funding is made available. At the same time Chair, municipal and provincial capacity to spend disaster funds when eventually released is a cause for concern. In this regard, national government should intervene and convert these funds into indirect grants and spend it on the municipalities and provinces’ behalf.
Parliament should scrutinize more carefully the extent in which the rental leases for temporary emergency accommodation have been concluded in accordance with the system that is fair, equitable, transparent, competitive, and cost-effective.
The Auditors-General’s office should improve within its audit scope, the project being implemented with funding released in connection with the February 2023 flooding incidents as to ensure that there is value for money at all times.
In conclusion, once again, the co-operation received from the relevant national, provincial and local government and other
organs of state is gratefully acknowledged, and they have made it possible for the committee to fully execute its mandate.
The contribution and participation of committee members irrespective of political affiliation, as well as the support received from the community support staff is highly appreciated.
It is recommended that the House adopted this report and the details have been tabled and hon members can go through the report. Thank you very much hon Chairperson.
Debate concluded.
Question put: That the Report be adopted.
[TAKE IN FROM MINUTES]
Report accordingly adopted in accordance with section 65 of the Constitution.
JUDICIAL MATTERS AMENDMENT BILL
(Consideration of Bill and of Report thereon)
Ms S SHAIKH: Hon Chairperson, greetings to your good self and greetings to all hon members. The Judicial Matters Amendment Bill provides for amendments to 19 different Acts administered by the Department of Justice and Constitutional Development.
The proposed amendments are intended to address practical and technical issues upon non contentious nature. The Bill also proposes that appeal of the common law crime of defamation.
The repeal will, however, not affect civil liability under the common law in the case of defamation. The Bill also seeks to decriminalise admission of guilt, fines and the expungement of minor offences, as well as certain offences committed in terms of the Disaster Management Act 2002.
Other noteworthy amendments include the amendment of the Matrimonial Property Act 1984 to ensure that the regimes of all existing customary law marriages are now regarded as being in community of property and the Interstate Succession Act 1987, and the Maintenance of Surviving Spouses Act 1990 to include a partner in a permanent life partnership in which the partners have undertaken reciprocal duties of support under the definition of a spouse for the purpose of inheritance and maintenance, respectively. The Billis tagged as a Bill to be dealt with in terms of section 75 of the Constitution.
The select committee received a briefing on the Judicial Matters Amendment Bill on the 18 October 2023, in response to the committee’s invite for public written comments, the committee received one submission for one individual. I the submission, the individual agreed to the Bill and was pleased with the amendments to the Criminal Procedure Act 1977 in respect of their admission of guilt and the expungement of criminal records. The individual was of the view that the amendment will greatly help the youth or people who generally paid admission of guilt without knowing the legal ramifications thereof.
On the 22 November 2023, the select committee received a briefing from the department on the written submissions received on the Bill. On the 29 November 2023, the committee considered and adopted the Bill. The committee also considered and adopted the committee report on the Bill. The committee is of the view that the various amendments contained in this Bill will indeed go a long way in. addressing technicalities in various pieces of legislation. In particular, the admission of guilt and expungement of criminal records will lessen the economic burden on persons convicted of offences.
The Bill further strengthens and ensures the effective functioning of the criminal justice system. The Select Committee on Security and Justice, having considered the Judicial Matters Amendment Bill, referred to it on the 19 September 2023 and classified by the Joint Tagging Mechanism, JTM, as a section 75 Bill, recommends that the Council pass the Bill with proposed amendments. Thank you.
Declarations of Vote:
Ms M DLAMINI: Chairperson, I rise on behalf of the EFF that at the outset we would like to caution against this form of lawmaking that groups together a whole range of legislation that individually are aimed at distinct ends. This does not provide for a thorough process of public participation and does not permit for an intense engagement with the text of the legislation. The Judicial Matters Amendment Bill, although altogether seeks to amend about 19 Acts dealing with a whole range of issues affecting the administration of justice, liquidation and distribution of assets, matrimonial matters, issues relating to the prosecution of crimes, matters relating to the ... [Inaudible.] ... Disaster Management Act and the so-called crimes committed under that Act.
Notwithstanding, we support the proposed amendments to the Magistrate Court Act in as far as it empowers the courts to subpoena witnesses in civil matters - who may help with the courts to make informed decisions. We are also in support of the amendment of the administration of Estates Act to grant the chief master powers to review decisions made by the master in appointing executors, curators and other appointments. The criminal record book is clogged up by names that should not be there. So, in this regard, we support the amendment of the Criminal Procedure Act.
The amendments of the Interstate Succession Act and the Maintenance of Surviving Spouses Acts are specific pieces of legislation that required extensive public participation.
These amendments, if passed into law, will change the institution of marriage as we have come to know it. Now, people who were never married will be able to claim benefits from the estates of their partners as if they were married. The word spouse would be interpreted to mean people in life partnership relationships who opted never to get married. This is a societal matter that ought to be reflected in the diversity of view in society and not just views of a selected few. Despite our support for some of the amendments, we are unable to offer our full support to the Bill as we think some
of the issues needed to be engaged with, more thoroughly. We reject this Bill. Thank you.
Ms B M BARTLETT: Hon Chairperson, members of the House, compatriots, the ANC supports the Judicial Amendment Bill. The key aim of the Bill is to amend numerous Acts administered by the Department of Justice Constitutional Development and are designed to address practical and technical issues of a non- contentious nature, as well as constitutional judgments.
The majority of changes planned includes relating to the internal functioning of the judicial matter in a very specific sense. Such as the rules regulating payment methods ... [Inaudible.] ... regulation of calling witnesses in multiple extensions or definitions. The clauses contained in Amendment Bill seek to remediate identified shortcomings and constitutional defects in current Acts. The proposed amendments will also boost the smooth administration of justice. Two of the most notable planned amendments include the Criminal Procedure Act and the Domestic Violence Act.
The Criminal Procedure Act, the Bill provides changes to the Criminal Procedure Act, especially the provisions detailing the admission of guilt and the payment of fines. It further
provides for a judgement, the payment of a final out and appearance in court, and the previous conviction. The Bill provides the removal of a criminal record for person who is deemed to have a convicted and sentenced respect of an offence contemplated in any regulations that have been made in terms of section 27 (2) of the Disaster Management Act, 2002, if they had paid an admission of guilt, fine or appeared in court.
Summarily, the Bill removes the criminal records of people who paid their fine for breaking Covid lockdown laws. In the Domestic Violence Act, the Judicial Matters Amendment Bill seeks to amend Domestic Violence Act, 1998, so as to penalise the making of a false declaration. A person can make the application just by declaration, not by affidavit. To prevent false declarations, there have to be consequences. In the interest of smooth and effective administration of justice, the ANC supports the Bill. I thank you, hon Chairperson.
Debate concluded.
Question put: That the Bill be agreed to.
Declarations of votes made on behalf of the Economic Freedom Fighters and African National Congress.
Bill agreed to in accordance with section 75 of the Constitution.
REGULATION OF INTERCEPTION OF COMMUNICATIONS AND PROVISION OF COMMUNICATION-RELATED INFORMATION AMENDMENT BILL
(Consideration of Bill and Report)
Ms S SHAIKH: Hon Chairperson, greeting to all members. On 4 February 2021, the Constitutional Court handed down judgment in AmaBhungane Centre for Investigative Journalism Nonprofit Company, NPC, and Another v Minister of Justice and Correctional Services and Others 2021. The Constitutional Court confirmed the declaration by the High Court of South Africa, Gauteng division, that the Regulation of Interception Of Communications and Provision of Communications-Related Information Act of 2002 is unconstitutional to the extent that it fails to provides adequate safeguards to protect the right to privacy as addressed by the rights of access to courts, freedom of expression ... [Recording stopped.]
The CHAIRPERSON OF THE NCOP: Hon Shaikh, just a second! I’m told that those who are on virtual cannot hear. So, there’s a bit of a problem about the system.
An HON MEMBER: We can hear you now, Chair.
The CHAIRPERSON OF THE NCOP: Are you able to hear now?
An HON MEMBER: Yes, Chair, now we can hear.
The CHAIRPERSON OF THE NCOP: Please proceed, hon Shaikh.
Ms S SHAIKH: ... to provide for procedures to be followed for processing, examining, copying, sharing, disclosing, sorting through, using, storing or destroying of any data; to provide for principles for the safeguarding of data when dealing with the management of data; and to provide for matters connected therewith.
Hon Chair, the select committee received the briefing on the Regulation of Interception of Communications and Provision of Communication-Related Information Amendment Bill on 15 November 2023. At this briefing we were also informed that the department wanted to completely overhaul the Regulation of
Interception of Communications and Provision of Communication- Related Information Act. However, this did not occur due to unforeseen pressures within the department, and in particular due to COVID-19. The Minister is still committed to the complete overhaul of the Regulation of Interception of Communications and Provision of Communication-Related Information Act. However, the current amendment Bill is an interim measure to rectify constitutional invalidity and until the broader overhaul is done.
In response to the committee’s invitation for comments, the committee received four submissions. On 29 November 2023, the committee received a briefing from the department and the written submissions received on the Bill. On 30 November 2023, the committee considered and adopted the Bill. The committee also considered and adopted the committee report on the Bill.
The committee deliberated on the inclusion of public advocates in clause 2 of the Bill. However, the committee agreed with the department that this matter requires a comprehensive analysis of the role of the public advocate and to determine whether this should be introduced in the Regulation of Interception of Communications and Provision of Communication- Related Information Act and how best to do so is a matter that
requires time, deliberations and consultations. This process will therefore be best dealt within the process for comprehensive overhaul of the Regulation of Interception of Communications and Provision of Communication-Related Information Act. This would allow the department time to consider various practices. It would also allow for time to consult with stakeholders and craft an appropriate model for the public advocate. This is especially so given that the public advocate would be a completely new concept in the South African law. To tis end, the department has conducted research on the concept of public advocate looking to other jurisdictions for a competitive analysis and also consider academic text on the role and challenges of the public advocate. This research was shared with all members of the committee and would be addressed when the department undertakes the overhaul of the Regulation of Interception of Communications and Provision of Communication-Related Information Act. The committee was therefore satisfied with the explanation given by the department on this issue and therefore agree to the Bill without amendments.
The committee is of the view that the Regulation of Interception of Communications and Provision of Communication- Related Information Amendment Bill addresses the
Constitutional Court’s judgment and now provides adequate safeguards to protect the right to privacy as practiced by the rights of access to courts, freedom of expression, the media and legal privilege. The committee further encourages the department to speed up these processes in respect of the general overhaul of the Regulation of Interception of Communications and Provision of Communication-Related Information Act and encourages the department to work speedily towards its introduction to Parliament.
Hon Chair, I should also indicate to the House that the committee had received public comments in relation to the subscriber identity module, Sim, card packaging amongst others which was first noted by the department as a general comment to the Bill and not specific to the clause of the current amendment Bill. The same comment was also made in the Portfolio Committee on Justice and Correctional Services in the National Assembly. The department indicated that this submission relates to an issue which has been raised in the governance cluster consultations. The department is considering not only the proper packaging of the Sim cards, but is also looking more broadly at the entire value chain and all role-players in the Sim registration process. This have been identified for consideration during the comprehensive
review of the Regulation of Interception of Communications and Provision of Communication-Related Information Act process which the department is currently undertaking.
The Select Committee on Security and Justice having considered the Regulation of Interception of Communications and Provision of Communication-related Information Amendment Bill referred to it on 14 November 29023 and classified by the Joint Tagging Mechanism, JTM, as a section 75 Bill, recommends that the Council pass the Bill without proposed amendments. I thank you, Chair.
Debate concluded.
RULING
(Amendments Proposal)
The CHAIRPERSON OF THE NCOP: Thank you very much, hon Shaikh. Hon members, there is an amendment that is being proposed by hon Michalakis. I want to take you through a ruling I am making having looked at the matter. I ask hon delegates to be patient as I go through the relevant ruling.
First on facts, the Office of the Secretary to the National Council of Provinces received proposed amendments from hon Michalakis on 5 December 2023. The proposed amendments were purportedly submitted in terms of Rule 203 of the Rules of the National Council of Provinces. The proposed amendments seek to amend the Regulation of Interception of Communications and Provision of Communication-Related Information Amendment Bill, B 28B-2023. In terms of Rule 203, after a Bill has been placed on the Order Paper but before the Council decides on the Bill, any member may place proposals for amending the Bill on the Order Paper. It is in terms of this Rule that the hon delegate purportedly submitted the proposed amendments.
On the ruling itself, the purported proposed amendment seeks to amend certain provisions of the Regulation of Interception of Communications and Provision of Communication-Related Information Act which are not covered by the amendment Bill. The Bill is classified as a Bill not affecting provinces. It is therefore to be dealt with in terms of section 75 of the Constitution.
The Bill was passed by the National Assembly and referred to the National Council of Provinces as required by section 75
(1) of the Constitution. Section 75(1)(a) of the Constitution
enjoins the National Council of Provinces to pass the Bill subject to the proposed amendments or reject the Bill. The Bill was referred to the Select Committee on Security and Justice for consideration and to report to the House.
Rule 177(1)(a) requires the committee to which the Bill is referred to, to enquire into the subject of the Bill. And the committee has done so. According to the report presented by the chairpersons of the committee, the committee reports the Bill without proposing amendments.
In terms of Rule 203(1)(a), after a Bill has been placed on the Orde Paper but before the Council decides on the Bill, a delegate may place proposals for amending the Bill on the Order Paper. It is in terms of this Rule that the purported proposed amendments were placed on the Order Paper. Rule 203(4)(c) prohibits amongst others, proposed amendments that may render a Bill constitutionally or procedurally out of order within the meaning of Joint Rules 161 for amendments that are out of order for any other reason. Rule 177(1)(h), which applies to the representation of the Bill by the committee is similarly worded. It prohibits a committee from proposing an amendment that may render the Bill constitutionally or procedurally out of order within the
meaning of Joint Rule 161. In terms of Joint Rule 161(2)(a) to which Rule 203 refers, a Bill is procedurally out of order if the procedure prescribed in either the Assembly or the Council rules as precondition for the introduction of a Bill in a particular House has not been complied with.
As indicated above, the Bill was classified as a Bill not affecting provinces to be dealt with in terms of the procedure prescribed in section 75 of the Constitution. Needless to say, the Constitution does not envisage the introduction of these types of Bills in the National Council of Provinces. Unlike Bills affecting provinces which the National Council of Provinces may amend, the House is only confined to passing these type of Bills subject to proposed amendments.
To be precise, section 68(b) of the Constitution that deals with the powers of the National Council of Provinces empowers the National Council of Provinces to initiate or prepare legislation falling within a functional area listed in schedule 4 or other legislation referred to in section 76(3). The Regulation of Interception of Communications and Provision of Communication-Related Information law does not fall under a functional area listed in schedule 4 or within the category of legislation referred to in section 76(3).
The Bill that set before the committee seeks to amend certain provisions of the Regulation of Interception of Communications and Provision of Communication-Related Information Act of 2002. In particular, the Bill seeks to amend sections 1, 35 and 37 of the Act. Further, the Bill seeks to insert section 2(a), section 23(a), section 25(a), section 37(a) and section
62(d). These provisions do not appear in any of the hon Michalakis’ purported proposed amendments or deal with matters that the hon delegate seeks to insert in the Bill. On the other hand, the hon delegate’s proposal seeks to amend long title and sections 40 and 50 of the Act.
Having had regard to the purported proposed amendments by the hon delegate, they cannot be properly classified as proposed amendments within the meaning of Rule 203 of the Rules of the National Council of Provinces. They effectively amount to a new Bill which the hon delegate seeks to introduce through Rule 203. This will be inconsistent not only with the Constitution, but also with the Rules of this House. As indicated above this a matter that does not affect provinces within the meaning of the Constitution and can therefore not be introduced for the first time in the National Council of Provinces. Should these proposed amendments be allowed, they will render the Bill both constitutionally and procedurally
out of order. These proposed amendments will suitably be introduced in the National Assembly.
In conclusion, having considered the purported proposed amendments by the hon delegate, I have come to the conclusion that they are constitutionally and procedurally out of order. In terms of Rule 203(5), the ruling by the Chairperson on whether an amendment is out of order is final. Had the hon member’s proposed amendments been in order, I could have been compelled by Rule 203(7) to either recommit the Bill to the committee or to put the proposed amendments to the House before the Bill as a whole is decided on. Because of the conclusion that I have reached, I find it unnecessary to do so. I shall therefore proceed to put the Bill before the House for consideration.
Mr G MICHALAKIS: Chairperson, I rise on Rule 69 for a point of order. Firstly, Chairperson, let me thank you for making sure that the procedure is corrected and not as it was, specifically initially, on the order paper. I also wish to refer you to Rule 203(5) that says the Chairperson’s ruling on whether an amendment is out of order is final, and I respect that rule and your ruling as well, Chairperson. I do, however, want to point out that the ruling has to effect on, in other
words, that all subject matters of section 75 Bills, the committees and the members of this House are in effect, from here on, further rendered toothless, and I would like to take this up, but I will do so in writing with you after this.
Thank you very much.
Declarations of vote:
Ms M O MOKAUSE: Chair of the Council, the EFF would like to put it categorically clear that we are 100% behind this Bill. This Bill, Chair, is also a product of protracted litigation and we are legislating it today because the Constitutional Court found something wrong with legislation that was passed through this House. In the Amabhungane Centre for Investigative Journalism and other, versus Minister of Justice and Correctional Services and others, the Constitutional Court ruled that the Regulation of Interception of Communications
and Provision of Communication- Related Information, RICA, Act, was unconstitutional because it failed to provide adequate safeguard to protect the privacy of the individuals in the country.
These rights are fundamental, Chair, to human freedom, and knowing the depth of abuse of state resources by the Ruling Party, the unamended Act gave those in power unfiltered powers
to use state resources to keep all of us under surveillance without our knowledge and without the full vetting of the interests of the presiding judge responsible for authorising the surveillance. Chair, we are therefore in support of the provisions in clause 15(a) of the Bill, which provide for an appointment of a designated judge. We welcome that this judge must be a retired judge and that before an appointment, the Minister must get the views of the Chief Justice to attest the independence of this designated judge.
Chair, we welcome the checks and balances applied in the appointment of the review judge as well, including the functions of this judge. More importantly, Chair, we welcome the amendment that will ensure that those doing the surveillance are obligated to inform those who are put under surveillance. However, the provision that the authorities must only notify the subject of the civilians only 90 days after the surveillance has been done, it’s still not enough to provide the kind of protection to privacy needed. We acknowledge the importance of giving the state powers to conduct civilians to keep the nation safe, Chair.
We, however, know that the Ruling Party uses this power to spy on opponents, and to use this information to eliminate
competition. Going to elections of 2024, we know that they will only intensify their civilians’ activities over civilians and other political opponents. There ought to be severe sanctions, Chair for this kind of behaviour, ... [Interjections.] ...despite these misgivings, we are in support of the Bill.
Voting:
Ms K M MMOEIEMANG: On a point of order, Chair, hon Mokause said that they are supporting the Bill, but I see hon Lehihi voting against.
The CHAIRPERSON OF THE NCOP: Hon Mmoeimang, on what point are you rising?
Ms K M MMOEIEMANG: I was saying that, in hon Mokause’s declaration, she indicated their support for the Bill, but now hon Lehihi is voting against.
Ms S B LEHIHI: Sorry, that’s an old hand.
The CHAIRPERSON OF THE NCOP: No, that’s not a point of order.
Question put: That the Bill be agreed to.
[Take in from Minutes.]
Bill agreed to in accordance with section 75 of the Constitution.
CONSIDERATION OF NATIONAL HEALTH INSURANCE BILL AND REPORT OF SELECT COMMITTEE ON HEALTH AND SOCIAL SERVICES THEREON
Mr E Z NJADU: Hon Masondo the Chairperson of the NCOP, hon Mohai the Chief Whip of the Council, hon Minister Dr Joe Phaahla and the hon Deputy Minister Dr Sibongiseni Dhlomo, hon MECs, hon members and delegates, let me take this opportunity this afternoon 6 December 2023 marked a special day in the history of South Africa in the struggle for a better health system for all, the poor, the working class and the unemployed, free quality health care for every South African. The National Assembly adopted the National Health Insurance Bill and referred it to the NCOP. The NCOP select committee through its processes, the National Health Insurance Bill [B11B–2019] section 76 that the National Department of Health briefed the committee on 20 June 2023. All the provinces had
briefings and public hearings on the Bill between 28 July and
30 October 2023.
On 31 October, 7 and 9 November 2023 respectively, the select committee held meetings with the Department of Health to deal with the written submissions on the National Health Insurance Bill and the committee received 23 000 to 25 000 individual submissions from across all the provinces supporting the National Health Insurance Bill. The summary document on written submissions was circulated to the committee on 27 October 2023. The Department of Health responded to the issues raised by the various organisations and this is how the Department of Health’s presentation was categorised.
The committee deliberated on the discussions during the meetings of 31 October, 7 and 9 November 2023. These written submissions were addressed by the Department of Health extensively. On 14 November 2023, the select committee held a meeting on the negotiating mandates, of which eight negotiating mandates supporting the Bill and their reports were timeously distributed to the Department of Health, the parliamentary legal advisor and the state law advisor. At this meeting, eight provinces supported the Bill and one province did not submit its negotiating mandate. The Department of
Health had indicated that comments from the provincial mandates and their reports were already covered in the extensive discussions held with the committee during the meetings of 31 October, 7 and 9 November 2023.
On 21 November 2023, the committee held a meeting on the final mandates of which eight provinces supported the Bill, and one province did not submit its final mandate. The committee adopted the Bill without any amendments and the report was published on 21 November 2023. On 28 November, the committee convened to consider the negotiating and final mandates of the Western Cape Legislature, which was unable to submit their mandates. The committee reported as such, eight provinces supported and one province had not supported. The committee adopted the Report on the National Health Insurance Bill without amendments. The report was sent to for publication on
28 November 2023, to incorporate the revision.
The majority of the people at the public hearings across all the nine provinces supported the National Health Insurance Bill eight provincial legislatures voted in favour and only one, the Western Cape Legislature voted against. The adoption of the Freedom Charter in 1955 had a profound impact on the vision of the health care system in post-apartheid South
Africa. It recognised health care as a fundamental human right and called for an end to racial discrimination in health care. The Charter emphasizes the need to extend and improve health care services, ensuring that they reach all the people. It is also advocated for free medical care and hospitalisation for all, with a focus on the wellbeing of mothers and young children. We are proud of the progress we have made this far and believe it is time to move forward with the implementation of the National Health Insurance, a health care system that all South Africans can take pride in. Our people deserve better, and as our President Cyril Ramaphosa has stated, the National Health Insurance will be implemented ...
IsiXhosa:
... bethanda, bengathandi.
English:
... whether some may like it or not, this report is to be considered. Thank you very much, Chairperson.
Mr D R RYDER: Chair, affordable quality health care for all is an admirable goal to work towards. As the government’s key role is to intervene to support those in society who cannot support themselves, a responsible government should strive to
bring public health care closer to private health care, but surely that should mean raising the standard of public health care and not breaking down of private sector. The National Health Insurance, NHI, in its current form, seeks to break a system that has been improving over time, as demonstrated by the increased life expectancy in South Africa, but this has been in spite of the government’s role in the health system and not because of it.
Just look at the frequent reports of mismanagement, corruption, and the breakdown of the government health services. The Charlotte Maxeke Hospital can’t perform surgeries because equipment is decommissioned, or the heating system is broken. Imagine how that wonderful icon and symbol of overcoming the odds feels now that her legacy is tied to a dysfunctional hospital where substandard care is given to patients and psychiatric patients are routinely abused. Look at the Tembisa hospital, which used its budget to buy skinny jeans instead of medical equipment. Look at Rahima Moosa Hospital, where the CEO spent only 182 days at work since her appointment in 2021 until April 2023. That equates to a day and a half a week. Aunty Rahima would be mortified to see the disrespect she is shown by the cadres of the organisation she once fought for. Do we want our health to be in the hands of
incompetent people? No! Our health is our most important asset.
South Africa’s health care was world-renowned with such names as Dr Chris Barnard, Dr William Soga, Dr David Cooper, and Dr Abdullah Abdurahman. A proud history with great achievements and innovations. The CAT scan, the retinal cryoprobe and the perfection of the heart transplant are all proudly South African innovations. Does anyone believe that these innovations would happen under a government-controlled system like the NHI? No. Yet the ANC seeks to close the sector down through Stalinist centralisation policies and place a Minister in charge without checks and balances. Centralising procurement is a key initiative of the NHI, yet the ANC has shown that under their watch the procurement of a R26 wooden handled mop can be manipulated to inflate the price to over R200 000. Now we want to give the keys to the candy shop to the sugar addicts. The PPE feeding frenzy was legendary. Now we want to give the keys to the candy shop to the sugar addicts. May I pause here and pay tribute to Babita Deokaran, who died at the hands of those in government for standing up against the exact issues that you are entrenching with this piece of legislation? Corruption is the reason this NHI will never work under an ANC government. The ANC government has the
Sadim touch, everything they touch turns to waste. The polar opposite of the Midas touch, and they wish to touch our health system. This Bill is so unclear in its implementation plan, that there is no picture of how holistic treatment can be achieved. There is no indication on which services would be covered by the NHI, or how the poor and vulnerable will afford the services that aren’t covered by it. In the place of answers, we have failed pilot projects.
Talking of failures, the public participation that took place in the provinces during the NCOP was as flawed as those of the National Assembly, with staged performances by some attendees, and a lack of understanding by others. Even the mandating by provinces process was riddled with controversy as the committee chair shut down the discussion and did the work of the executive. Have you learned nothing from the Zondo Report and the countless Constitutional Court judgements saying that Parliament has failed in their duty of care? As the health sector, medical aids, and many other businesses in the broader industry have indicated, this Bill has not been properly thought through and its implementation will result in a half- baked mess that we cannot afford to fix. Now let’s not misrepresent the industry, they have repeatedly said that they
are in full support of universal health care, but just not this model and certainly not implemented by this government.
That of course brings me to the most compelling argument against this Bill. An argument that does not come from me, and also doesn’t come from the DA, but from the heart of the ANC executive. Minister Enoch Godongwana, the Minister of Finance himself, is firmly on record saying that the NHI is unaffordable. As South Africans battle to put food on the table, how can we possibly think about raising taxes to fund an NHI, that’s the scary truth.
This ANC vanity project is a last-ditch effort for votes that will affect our pockets deeply if implemented. Not only in foregone tax credits by medical aid contributors, but also as a result of the need to raise additional funding to cover these costs, but even higher taxes will not be enough to fund universal health care while the emulators of the Zumas and Guptas continue to help themselves without restraint. The ANC has misled their constituents on the potential benefits of this Bill. The ANC has not grasped the negative implications of this Bill. It’s nothing more than a ploy to fulfil a congress resolution and it will be passed today despite the
fact that this NHI can never be implemented. Stop fooling the voters and yourselves. Vote against this destructive Bill.
South Africans, if your elected representatives choose to support this Bill today, you can choose to send them where they belong next year at the election polls. I will say it once again ...
IsiZulu:
Woza 2024!
English:
Thank you.
Ms N METH (Eastern Cape): Hon Chairperson of the NCOP, hon Deputy Chairperson of the NCOP, the Chief Whip of the NCOP, the House Chairperson, the Minister of the Department of Health, hon Phaahla, Deputy Minister, hon Dhlomo, hon members of the NCOP, SA Local Government Association, Salga delegates, Special Delegates, MECs from all provinces, HODs and senior government officials, good afternoon.
On behalf of the Eastern Cape, we welcome this opportunity to participate on this critical debate, which speaks directly to
quality healthcare system that is equitably shared for all. This debate takes place just a day after we commemorated the 10th anniversary of the passing of our first democratically elected President Nelson Mandela, an icon who once said I quote:
Health cannot be a question of income. It is a fundamental human right.
In the province of Eastern Cape, over 90% of the population depends on public health care. Therefore, our hope is in the passing of this National Health Insurance, NHI. Thus, people of the Eastern Cape came out in numbers to be part of the recently concluded NHI Bill public hearings meetings. We can, without a shadow of doubt or without fear of contradiction, unequivocally state that the majority of our people are fully behind the NHI.
We applaud Cosatu and affiliated trade unions for their solid support on the NHI Bill since the adoption of this Bill by the ANC over the decade till to date. It is an honour to be part of this history that the Sixth Administration of our government is about to realise. This year has been indeed the
year of decisive action to advance the people’s interest and
renew our movement as proclaimed by the ANC.
Hon Chair, from the onset allow me to assert that the ANC-led government is based on the will of the people and emanating from the people’s document, the Freedom Charter. The Charter is positive that:
Free medical care and hospitalisation shall be provided for all, with special care for mothers and young children.
The ANC in its National Health Plan for South Africa in 1994, envisaged an integrated, equitable and comprehensive health system based on the primary health care approach. The Constitution of the Republic of South Africa buttress the right of access to health care in section 27.
To make these directives a reality, the ANC founding documents, the first President of the Democratic South Africa, the late President Nelson Mandela, within 90 days in office, declared free health services for pregnant women and children in all public health hospitals.
IsiXhosa:
Sihlalo, kaloku thina siyakhathala.
English:
Hon Chairperson, the ANC has made a commitment 66 years ago in Kliptown that I quote:
The aged, the orphans, the disabled and the sick shall be cared for by the state.
This government has built an architecture that ensured that these commitments of the people are realised. The White Paper for the transformation of health system in South Africa in 1997, articulated the principles and test by the Reconstruction and Development Programme of the ANC. South Africa has embarked on a golden new direction with its National Health System to the NHI Bill. The NHI intends to ensure that everyone has access to appropriate, efficient and quality health services.
The NHI Bill proposes interventions such as a complete transformation of the healthcare services provision and delivery, a total overhaul of healthcare system, a radical change of administration management, the provision of
comprehensive package of care underpinned by re-engineered primary health care. This is the momentum step forward for South Africa and of is reminiscent of the 1948 proposals of the national health care system in the United Kingdom, UK post World War 2.
The South African health care system is one that was fragmented and racially biased, which largely benefited the white minority population. Following democratic elections in 1994, the process of creating a single nondiscriminatory health care system was thwarted somewhat by the development of two-tiered system of health care, public and private and largely based on social class determinants which perpetuated health inequalities.
Currently, the expenditure in both private and public sectors are roughly the same, about R100 billion each, and together makes up to 8,5% of the gross domestic product, GDP. But the inequity is in the coverage. The private sector serves 16% of the population whilst the public sector serves 84% of the population, who are largely poor and black. The NHI Bill contends that, the two-tier system is unsustainable, destructive, very costly and highly curative and hospicentric.
The objective of the NHI is to provide improved access to quality health care for all South Africans. It bases its approach on the Brazilian experience largely and focuses on a re-engineered primary health care system, that will focus mainly on community outreach services using a defined comprehensive primary care package of services.
There is also provision on the policy for the delivery of Primary Health Care, PHC through private providers that are accredited and contracted within districts. Hospital-based benefits are also described according to the designation of the hospital which ranges from district, to regional, to tertiary as well as central hospitals and specialised hospitals.
Hon Chair, inequalities and inequity in South Africa between the public and private health sectors in terms of availability, acceptability and affordability is well documented. As the Eastern Cape, we are fortunate to have OR Tambo District that was identified as a national pilot site and is supported by National Department of Health, to prepare facilities to be ready for the implementation of NHI. We have learnt a lot from this process and a lot of progress has been made so far.
We are happy to report that in the Province of the Legends, more of our facilities are achieving ideal status, which is a prerequisite for NHI. We have since enrolled out the NHI throughout the province. The Eastern Cape Department of Health has facilities that have obtained ideal status over the years, although the natural disasters do hamper progress and cause damage to primary health care facilities. A lot of progress has been made. Out of 775 facilities, that is clinic sensations 406, which is 52% cumulatively, have achieved the ideal status.
This is a quality improvement programme that is implemented to make our facilities ready for accreditation by the Office of Health Standards and Compliance. More of our facilities are achieving ideal status. During the half-yearly report period, the perfect permanent terms of ideal clinic realisation and maintenance programme conducted status determination in 769 primary health care facilities including community health centres. The provincial average score that was obtained was 77%. Three districts obtaining an average score of above 80%. The total number of public healthcare facilities that obtained an ideal status is 293.
At the end of Quarter 1, we had 89 facilities that were accredited by the Office of Health Standards and Compliance, OHSC. By the end of Quarter 2, we had 143 accredited facilities. This translates to improvement of 45 facilities, just in a few months. This is yet another indication that we are almost ready for NHI implementation.
On infrastructure, the Eastern Cape Department of Health has also embarked on a massive infrastructure development and maintenance programme. Section 27 of our Constitution states that:
Everyone has the right to have access to health care services, including reproductive health care.
We have built 513 youth zones across the province in order to improve access to sexual reproductive health and rights. Hon Chair, we are here as the Eastern Cape to say, we have 3 382 community health workers, CHW’s that are conducted by us and 789 conducted by nonprofit-making organisations, NPO’s. We are saying also South Africa has shown its resilience in terms of its system architecture and infrastructure, and this was tested during advent of COVID-19 that attacked populations of the world.
The public health system experienced strain during this period, but it displayed strong resilience to meet a huge negative impact of the disease. It became very clear that private health care has no ability and strength to withstand calamities brought by COVID-19.
As I land hon Chair, I urge all patriotic hon members to rally behind and NHI, if they are truly concerned about levelling the playing field for all. However, we must warn that even if they do not get on board, those who are seemingly opposed, we are forging ahead, full steam, no one can stop this train.
Naysayers will continue with desperate attempts to try and ensure that NHI is not realised. NHI, which is the Freedom Charter of the health sector, will be realised and will achieve universal health coverage as we committed to our people as the ANC. I thank you, hon Chairperson.
Ms N NDONGENI: Chairperson, hon Masondo, Chief Whip, hon Mohai, hon Minister Phaahla, hon Deputy Minister, Dr Dlomo, hon delegates, special delegate, guests, and all community members ...
IsiXhosa:
... molweni ngale mvakwemini.
English:
NHI is a stepping stone towards achieving South African development agenda. Our Constitution recognise health as a fundamental human right. Under section 27, the Constitution proclaimed that everyone has the right to health care services, including reproductive health care services. As a human right, this means that an individual’s right to access health care is automatically guaranteed at birth and should not be ... [Inaudible.] ... or taken away. No one may deny anyone access to emergency medical treatment based on one race, gender, geographical location, economic status, or any other differentiation quality. This is because we have descended from divisive system where health care was discriminatory offence and stood against the majority who received poorly resources substandard healthcare.
In this, we have observed how the two-tier system is unjust in the private sector, which is better funded, and resources serves few people and make up to 16% of the population, while the overburdened and poorly funded public sector serve the majority of our people, making up about 84% of the population. The contradiction ... [Inaudible.] ... themselves on the background of further stratification along the lines of
education, employment, class, and racial bias, which drives the higher inequality level in the country.
It is against the historical context that the ANC-led government has been dedicated to transform - not only the health system -but also the broader society to reflect the aspirations enshrined in our Constitution and the Freedom Charter guided by our development strategies, such as the national development. The ... [Inaudible.] ... competitiveness between the private and public sector is not compatible with the National Democratic Society along this proportionate age, financial spending and competition for scarce resources such as health professionals. The government’s commitment towards the advancement of a just and equitable health system is noted to be both a moral and legal imperative.
In this regard, the state is obligated to ensure that the necessary legislation is developed, which sets as a framework of how provision on healthcare will be dealt with, along with ensuring that sufficient infrastructure, human resources, financial allocation and other imperatives are made available for the realisation and fulfilment of all basic human rights.
Therefore, the introduction of NHI has provided South Africa with a unique opportunity to create an accessible and equitable system which is underpinned by principle which form the backdrop of the democratic government of health being a public good, social solidarity, efficiency, effectiveness and affordability. The passing of the NHI Bill represent a turning point in the country ... [Inaudible.] ... assuring that the ANC-led the government can lead society in ensuring that our current health reality’s future is ... [Inaudible.] ... to access quality and equity.
The NHI also serves a broader mandate of ensuring that South African realise universal health coverage, which has been called by the World Health Organisation. Under Universal Health Coverage, the ANC government seek to ensure that no one is left behind and all citizen and those in need are not prohibited from accessing any health services they may need.
Where and when they need them without the burden of the financial implication. This will go a long way in closing the inequality gap in a fractured country such as ours, which is riddled with the levels of poverty, with the majority of our people subjected to early death, and their prospects restricted due to limitation imposed by health-related
constraints which are often ground issues access and affordability.
Such incidents drive a wedge against social cohesion and exacerbate social ... [Inaudible.] ... rooted in race and social economic disparities, with the private sector continuously locking funding, resource and skilled medical protection for a privileged minority. NHI will provide a unified pool of healthcare funds for both the private and public sector with the NHI Fund paying both, public and private healthcare providers as practitioners the same for similar treatments. This means that people in lower income community may consult doctors in private practise and use private hospitals because the NHI fund will pay for this care, relieving the burden from an individual or a specific sector.
The NHL is not just health legislation, it has the potential to positively contribute to the development of the country and address socio-economic factors which continue to grapple with our society. For example, the Bill emphasis on accessible and equitable health care in critical for ... [Inaudible.] ... social cohesion and reaching the social divided which allegiance South Africans from different economic works of lives by ensuring that everyone, despite their social statue
will receive care from the same facilities. This will tear down the disparities created by the two-tier system and can be a tool to foster reconciliation and alleviate social tension which exists between the various social group in the country.
Therefore, as a country ... [Inaudible.] ... by a plight of socio-economic factors which stand our growth and development, such as the notable triple challenge of poverty, inequality and unemployment. The critical role which in NHI can play in the realisation of the country’s development aspiration, such as the nation building needs to be appreciated. This is because health is the cornerstone of national development fundamental. At the core of all intervention, is the need for a health enabled workforce which is dedicated to our collective aspiration to occupy various sectors in society, to provide the necessary skill and services to stimulate economic growth.
Therefore, the inroads made under the first phase of NHI to build a stronger and healthier nation must be applauded, as evident in HIV intervention as it is one of the biggest challenges threatening - not only our healthcare system - but our communities and national stability. Under this first NHI phase, we have observed incredible investment towards the unit
95-95-95-95 global target where South African ensure that about 94 of people living with HIV knows their HIV status. Eighty percent of the people diagnosed with HIV receive sustained antiretroviral therapy, and 86 of people on antiretroviral therapy have viral suppression.
As we conclude the NHI Bill, we are concerned with ensuring that it is divisive legacy, where inheritance from the colonial and apartheid government are broken. We can no longer carry on with two-tier system with financial benefit few as assessed by few privileged minorities, while the majority of our people are sidelined and subjected to a substandard system. There is no development nation thriving with each socio-economic development aspiration built on the fractured healthcare system.
As the ANC, we are determined to build a South African and promote a strong health system as means of investing in the development of the country. As the ANC, we value the need for global corporation in the quest for an improved universal healthcare system. We are committed to ensure that there are global synergies, and this is why South Africa supports the United Nations Sustainable Development Goals. Particularly, goal three only achieving good health and well-being, which
includes aspiration to ending the epidemic of Aids, tuberculosis, malaria and neglected tropical disease and combat hepatitis, water bone disease and other communicable diseases, as well as reducing 1:3 of premature mortality from non-communicable disease through prevention and treatment as it promotes mental health and well-being by 2030.
Having a National Health Insurance is not unique to South Africa. There are over 100 countries across the world that. have made the decision towards implementing NHI. In the continent, we are inspired by effort of Ghana, which established its National Health Insurance in 2003, with a view to meet this national objective of universal access to healthcare. Notable by 2014, Ghana had covered 10,5 million people or 40% of population, which is 2021 census indicated that the percentage of the population with the National Health Insurance rolls to 268,6%.
Furthermore, one notable country which have successfully implemented NHI, including the United Kingdom, Japan, Colombia, Mexico, Rwanda, Kenya, Indonesia, Thailand and Costa Rica. The only demonstration and possibility which lay ahead at for South Africa and the ANC government are encouraged by overwhelming support the Bill has received from ordinary
citizens during the public hearing, which demonstrate the public desire for such a system. The global progress on health also affirms that the NHI should be the future of all nations in the interest of justice and the development of more efficient and equitable way for healthcare.
As an ANC government of the people - by the people - to the people - we commit ourselves to ensure a people centred healthcare system through the NHI, as a means of empowering and restoring the dignity of our people, will be realised. We commit to create a system where our people are empowered to make decisions about their health and bodies without systematic, structural and financial barriers. In turn, this feedback of the productive of our country through health labour force, which can invest back into the country’s physical and foster productivity, which led to improved quality of our people. The ANC supports the Bill. Thank you, Chairperson.
Ms N SIMELANE (KwaZulu-Natal): Thank you very much, hon Chair, greetings to you, Chair to the Minister, Deputy Minister and all the hon members in the House. It is with great pleasure that as the province of KwaZulu-Natal we participate in this wonderful debate that the people of this country have been
long waiting for. We really appreciate the opportunity to deliberate upon an extremely important matter that concerns the very fabric of our society, which is the healthcare system in our country and in our province. Our Constitution recognises the healthcare as a fundamental human right, as articulated in the Freedom Charter. Our Constitution states that:
Everyone has the right to have access to healthcare services and that the state must take reasonable legislative and other measures within its available resources to achieve the progressive realization of this right, and to ensure that no one may be refused emergency medical treatment.
This Chairperson from where we are standing is actually what the sitting in the debate today is about. The NHI Bill therefore seeks to achieve these noble goals by ensuring that no one is deprived of the above mentioned right, because of their socioeconomic status. The Bill seeks to ensure that one public health fund is created with adequate resources to plan for and effectively meet the health needs of the entire population, not just a selected few and ultimate and the ultimate goal is to achieve the universal health coverage.
Currently, there are a number of disparities in the provision of health care access in this country, and the truth is that they disproportionately affect the black majority, which is the case, and the matter that we cannot ignore. On one hand, you have the private health care system, which is subsidised by the state but caters for only 13% of the population. On the other hand, there’s the public healthcare system whose resources are severely strained because it is responsible for the healthcare needs of the remaining 87% of the population.
Chairperson, there are many instances whereby people get injured on the road, but they cannot be picked up by a private ambulance just because they can’t produce the medical aid card, which quite frankly, is outrageous. Even those that do get picked up by a state ambulance or get transported by their own private vehicle to get help, they are forced to drive past private hospitals that have the personnel and equipment to save their lives, until they get to a state hospital, which could be located further away just because they don’t have a medical aid. This is the clearing defiance of our Constitution. We have to ask, why is this accepted as the norm? Moreover, many people who have medical aid often find out that their funds get finished prematurely at a certain time of the year. When this happens, they get immediately
kicked out from the private hospitals, regardless of their health care needs or how critically ill they are. You could be lying in an ICU Unit fighting for your life, but once your funds are over, your family asked to make a plan and bring you to a public healthcare facility. Yet, we never hear a public outcry about this. Why is that the case?
Furthermore, there are many elements that these medical aids simply refuse to provide medical cover for - despite charging exorbitant fees in medical aid premiums. Therefore, our considered view as the entire government is that NHI is an idea whose time has come. We believe that to uphold a system that perpetuates inequality and exclusion of people from quality healthcare, purely on the basis of the size of their pockets is simply wrong and not sustainable and not what we fought for and was achieved in 1994. To uphold such a system goes against the principles of justice and fairness, which are the bedrock and the cornerstone of our Constitution.
The NHI embodies the noble vision of an inclusive health care system, where every individual, regardless of their background, enjoys the same quality of care. Through NHI, the government will establish a unified healthcare funding pool that caters for both private and public healthcare providers.
We think, it’s important that we explain this over and over again so that the propaganda that is perpetuated out there about what NHI is, is eventually dispelled and our people are not confused by those who are able to articulate that propaganda.
The fund will reduce the current healthcare systems exorbitant costs, which are amongst the highest globally. When the individuals seek medical care, the NHI fund will cover the expenses, eliminating fees and healthcare facilities in a similar manner to how medical aid cover their members. The NHI fund will be financed through general taxes, contributions from higher-income earners and monthly employee contributions. Therefore, by breaching the healthcare quality divide between affluent and underserved communities, the NHI strive to effectively narrow the gap between the rich and the poor.
There are a number of countries where NHI is working extremely well and I think the comrade in front of me who has just debated, mentioned them, and we are very proud that some African countries have also started implementing NHI and therefore it is doable for South Africa to also implement it. The state acknowledges the massive responsibility that comes with the implementation of NHI. We are not blind. We are fully
confident that we have the capability to ensure the efficient administration of healthcare services and that this new system with proper planning, transparency and accountability mechanism in place, NHI will be implemented successfully and will benefit all the people of South Africa at large.
IsiZulu:
Sihlalo siyafisa njengabantu bakwaZulu-Natal ukusho ukuthi kulesiShayamthetho abantu bakujabulele kakhulu ukuthi iNHI iphasiswe. Yingakho amalungu amele iKwaZulu-Natal eNCOP afika avumelana noMthethosivivinywa. Abantu akwaZulu-Natal kubajabuliswa kakhulu lokhu ngoba sibonile thina KwaZulu-Natal ukuthi sesiqalile ...
English:
... with the implementation of NHI or in preparation for implementation of the NHI.
IsiZulu:
Siyazi ukuthi kukhona abashoyo noma i-DA ithi ...
English:
... the implementation of the NHI is a pipe dream. From where we are sitting that is definitely not the truth. The ANC
government in this province and in other provinces, has started implementing or has started readiness towards the implementation of NHI.
IsiZulu:
Sihlalo into eyenzekayo kumakliniki asemakhaya sesikwazi ukuthi sibe nodokotela abavakashela lawo makliniki, into ebingenzeki phambilini. Sikwazi ukuyenza noma ikwazi ukwenzeka ngoba isu nohlelo lweNHI lisivumele lasinikeza amathuba wokuthi sikwazi ukuthola odokotela abaxhasa i-NHI bavakashela amakliniki asezindaweni zasemakhaya. Abantu baKwaZulu-Natal bayakujabulela kakhulu ke lokho ngoba kuyabasiza kwenza ukuthi bangaze bahamba baye ezibhedlela ezikude ukuze bakwazi ukuthola odokotela.
English:
The state of readiness towards the NHI doesn’t end there. We started some years ago, to upgrade and improve the infrastructure of our clinics and hospitals so that when we start to implement the NHI we are in the state of readiness and have our facilities which will be able to use and will respect one’s privacy and dignity.
IsiZulu:
Okosho ukuthi izibhedlela ezizimele akuzona zodwa manje kulesifundazwe esezikwazi ukuhlonipha isithunzi somuntu. Sikwenza lokho ngenxa yokuthi silungiselela ukusebenza kweNHI.
Ngiyafisa ukusho ukuthi nazo zonke izibhedlela esesiqalile ukuzakha noma esesizakhile kuleminyaka emibili eyedlule besizakha njengohulemeni ohola uKhongolose ngomgqondo wokuthi besazi ukuthi siyogcina silusebenzisa uhlelo lweNHI. Ngiyafisa ukukunika isibonelo la esifundazweni saKwaZulu-Natal esithi isibhedlela esifane neNkosi Chief albert Luthuli ...
English:
... it is a hospital that you can compare with any private hospital in terms of infrastructure. But in terms of services that are provided there, it goes way beyond what is provided in any other private hospital.
IsiZulu:
Asigcini lapho sinesibhedlela esisha ebesivulwa uMongameli emavikini amabili edlule esibizwa ngokuthiwa i-Dr Pixley Ka Isaka Seme Memorial Hospital uma usibuka ingqalasizinda saso asikho ngisho nesisodwa isibhedlela esizimele esifika kusona. Asigcine kuphela ngengqalasinda ...
English:
... even the equipment and services that are provided in that hospital are of a level that far surpass the treatment and services that are received in a private hospital.
IsiZulu:
Abantu baKwaZulu-Natal uma bethi bayayijabulela ngempela iNHI abakusho lokho ngoba bepolitika. Bakusho lokho ngoba u-African Congress uyabasiza ngempela. Sengidedile Sihlalo. Ngiyabonga.
English:
Thank you very much.
Ms M O MOKAUSE: House Chair, the Economic Freedom Fighters oppose the National Health Insurance Bill, NHI, presented here today under the pretext of achieving universal health coverage. This Bill in its current form aims at nothing more than enriching the private health sector at the expense of the South African people.
Today, our country is being led to believe by the ANC-led government that this Bill is an attempt to address the collapsed health system in the country, knowing full well that this Bill will not solve the infrastructure crisis in the
public facilities in the townships and rural communities. As EFF, we have highlighted the problematic clauses in the NHI Bill and its fundamental stance on the development of a national funding pool on various platforms.
This Bill claims to correct the injustice of inequality, access to healthcare and the provision of universal healthcare to the people of South Africa, while at its core it is far from these aspirations. It is far from what it purports to be. It is not about abolishing the two-tier system instead, it is about outsourcing healthcare to the private sector.
Chairperson, the NHI Bill envisages that the funding of all our health needs will be centralised and providers such as general practitioners, private hospitals and public hospitals will take care of the needs of our population, with payment for services administered from the NHI national funding pool. This system is not sustainable, as we have seen with numerous ANC-led government programmes. The NHI stands, but as an admission by the ANC-led government that it has failed to build a functioning health system in South Africa.
Our people currently have no access to quality healthcare. There is a shortage of healthcare professionals and
infrastructure is a problem that needs to be addressed urgently. It is important to condemn the poor state of healthcare system in South Africa as it contributes to the quality of health access. It prevents timely and effective treatment of diseases and hinders progress in achieving better healthcare outcomes for all citizens of the country. This situation is particularly alarming given the high burden of diseases such as HIV/Aids and Tuberculosis. Yet the ANC chooses to outsource healthcare and the wellbeing of our people to the private sector.
The NHI is a direct reflection of the Ramaphosa government’s administrative policies, a comprehensive programme to privatize everything that renders the state powerless. The ANC-led government has privatized dams, national parks and state-owned companies such as South African Airways, SAA, which have gone bankrupt. It has sold the assets of Transnet
and is in the process of privatizing Eskom. It is continuously disempowering the state of its powers. It no longer has control over anything. Because the aim is to make the state incapable of providing for the needs of our people and to make us dependent on the private sector in every aspect of our lives.
As EFF, we once again express our concern about the requirements that the NHI calls the remittance system. What is meant by this clause? It states that all persons must go to the nearest health facility for medical treatment. This means that people living in rural areas, townships and informal settlements will be subjected by the diabolic state of public hospitals and clinics whilst the affluent and cosmopolitan areas will have their utmost benefits, due to their proximity to the private health care facilities. This then does not make access to healthcare any easier on poor people, as it simply means that the NHI stands to benefit only those people who already afford their own health care through medical aids.
Whilst the poor remains with the health facilities in far off abundant areas.
Furthermore, it is unconstitutional for a Bill to dictate that the only way for our people to get medical intervention is on the basis that they are registered users of the NHI. The inability to be a registered user or the choice to not be a registered user should never mean the dissolution of a basic human right for accessing health care. There is no Bill that should have the power to strip away the right to health care services. This right is a protected right by the Constitution of this country. The EFF maintains that the only genuine way
to ensure that access to quality healthcare is resolved is the intentional focus on prevention and Primary Health Care Services.
As for the EFF, we still maintain that we need to implement genuine ways to ensure that our people access healthcare services. The solution to our public health care collapse crisis will never be that we tenderize healthcare and outsource the well-being of our people through the NHI. For an example, in the National Assembly, as the EFF, we tabled the Private Members Bill, the National Amendment Bill that would see clinics open 24 hours and seven days a week. This Bill, however, was rejected by the ANC and the DA, who have no interest in ensuring that our people in destitute and remote areas receive due medical intervention when they need it.
As the EFF, we are off the firm view that the NHI is yet another avenue by the state to surrender critical services to a private sector whose sole priority is that they accumulate profits. This Bill does not offer the benefits of universal health care as portrayed here today by the ruling party. It doesn’t cover any of the needs of our people. Therefore, as the Economic Freedom Fighters, we cannot align with anything
that do not provide quality healthcare for our people. We reject this Bill with the contempt it deserves. Thank you.
Ms D C CHRISTIANS: Hon Chairperson, hon Minister, hon members, fellow citizens, as representatives of the people and guardians of their interests, we cannot ignore the glaring red flags associated with this proposed legislation. The ANC-led government may champion the National Health Insurance, NHI, as a panacea for our health system, but we must speak truth to power and point out the serious flaws and risks that this Bill entails.
Let us not mince words, Chairperson, the NHI is a perilous gamble, a reckless leap into the unknown that threatens to intensify the very issues it purports to solve. The fundamental question before us is whether we can entrust a government with a dismal track record of mismanagement, corruption and ineptitude to manage entire health system.
The issue of trust is not a mere elephant in the room. It is a stampeding herd that cannot be ignored. We are asked to trust the government that has failed to deliver basic services across the board, from water to education, from policing to electricity. The litany of broken promises and decayed
infrastructure serves as a stark warning that entrusting our health to this administration is a perilous journey into the unknown.
Chairperson, let us be brutally honest about the ANC’s record. The dismal state of most hospitals across the country, despite billions being pumped into them, speaks volumes. The rot runs deep, nurtured by cadre deployment, aggressive affirmative action and a pervasive culture of corruption that permeates every government contract. Not only has this government failed to deliver services, but it has allowed our infrastructure to crumble to the point where rebuilding it seems an impossible task. The ANC now tells us that the NHI will centralise purchasing to reduce costs, but we have seen grotesque examples of Eskom’s wasteful spending on mops and kneepads, a clear indication of the rampant inefficiency and corruption that plagues our government at every single level.
The NHI is presented as a cure but let us dispel these illusions. Under this Bill, citizens will lose the ability to choose their own treatment. Brace yourself for a heavy tax burden while you are expected to say thank you for every morsel of services put in front of us. The poor will be at the mercy of the ruling clinics and hospitals, perpetuating a
system in which waiting to be treated for strep throat becomes the norm.
Promises to the population to immediately improve the miserable services, crumbling infrastructure and shortage of doctors are nothing more than a smokescreen.
House Chairperson, the reality is that the NHI rollout will take years. The ANC has misled the very people it claims to represent. The ANC’s attempt to absorb or alienate the private health sector is a dangerous game. The expansion of the private health sector is a symptom of the failing public sector and not the cause. Rather than scapegoating the private sector, the ANC should focus on eradicating corruption, creating conditions for private investment in the public health sector and holding accountable those responsible for the dire current state of affairs of our public health systems.
In conclusion, we are at a crossroads where the ANC-led government wants to bulldoze through the NHI, but we must not participate in this risky venture. Our duty is to protect the interests of the people and that means rejecting this Bill in
its entirety. It is not the solution, it is a clear recipe for disaster. I thank you, House Chairperson.
The ACTING HOUSE CHAIRPERSON (Mr M I Rayi): Thank you very hon Christians. May I ask the members who are on the Virtual Platform to please mute their gadgets.
Dr P RAMATHUBA (Limpopo): House Chairperson, the ...
The ACTING CHAIRPERSON (Mr M I Rayi): Just a minute Member of Executive Council, MEC. Hon Tafeni, please ensure that your gadget is muted, please. You can proceed ... hon Tafeni.
Please proceed MEC. Hon MEC, you can proceed. Hon MEC, Ramathuba ... is she still on, please proceed? Ok, we’ll come back to hon Ramathuba. Let’s move to hon G Pretorius, Western Cape, Chairperson, Standing Committee on Health and Wellness.
Mr G PRETORIUS (Western Cape): Chairperson, the decision by the Western Cape to vote against the National Health Insurance, NHI, Bill, was a deliberate one, rooted in the principal concerns and a commitment to the well-being of the citizens of the Western Cape and South Africa.
The NHI Bill has been a topic of intense discussion, sparking debates across the country. At its core, the Bill aims to restructure South Africa’s broken healthcare system. Aiming for universal health healthcare coverage to ensure that all citizens have access to essential healthcare services.
Chairperson, I wish to be clear, on this matter. My party believes that this Bill is undoubtedly commendable and aligns with fundamental right to health. And we wish for a day in which all patients receive the same superior standard of healthcare they do, where the DA governs.
But the approach and implementation strategies within this Bill, have raised significant concerns. The Western Cape Standing Committee on Health and Wellness conducted 10 public hearings across our beautiful province. Let’s get practical Chairperson. While hundreds of participants in these hearings stood against the Bill, several attendees gave presentations based on the fallacy that NHI would introduce immediate superior healthcare for all, including and especially in
far-flung rural areas.
Chairperson, several of these participants announced
themselves as ANC representatives. I don’t have an issue with
that. What I do take issue with and what I find incredibly sad, is that these members of the public have been deliberately misled.
Imagine the indignation when the NHI version sold to them, never materializes. Imagine the anger when instead of a utopian system of free and equality healthcare, our people find themselves trapped in a system devoid of funds, skills, and proper management. The ANC has settled a bolting horse Chairperson. How dare the public be misled in this fashion?
The decision not to support the Bill was not taken lightly. It was based on a series of valid reasons deeply rooted in the principles of fairness, efficiency, and sustainability of the healthcare system.
Our first and foremost concern is simple, the numbers just do not add up. The implementation of this Bill would require substantial funding. And there has been serious questions raised regarding the feasibility of the funding model proposed by the Bill.
The concerns are not merely about cost but also about the potential strain on an already stretched national budget. Last
week, the Western Cape Minister of Finance tabled our provincial adjustment budget. That document painted a clear picture of a provincial treasury, forced to stretch the limits of its innovation to keep basic services afloat.
Years and years of ANC sponsored load shedding, looting failed, economic policy, inaction on crime and the growing culture of lawlessness have combined to decimate our economy, perhaps to the point of no return. How long does it take to destroy a country’s economy. Well, it seems the ANC is on the verge of finding an answer.
And against this background Chairperson, of extraordinary national budget challenges. It is incomprehensible that the government is even considering the NHI without a proper plan in place and with no idea where a funded budget will originate from.
And the Western Cape’s issues with the Bill do not stop at funding. Serious concerns about the potential centralization of healthcare services and decision-making processes have been raised. The proposition of load losing the autonomy and efficiency of the well-oiled, well run, and professional healthcare system in the Western Cape, which every province
deserves, is difficult to contemplate and of deep, genuine concern.
The diversity of healthcare needs across different provinces, necessitates flexibility in the delivery of healthcare services. And the one size fits all approach will create the same problems we see in policing, energy and other competencies which have suffered from the ANC’s obsession with control and hunger for power.
Transparency and accountability in the management of healthcare resources are paramount. Reservations about the governance structures proposed in the NHI Bill with concerns about potential inefficiencies, bureaucratic hurdles and the mismanagement of resources remain valid.
In its current format the NHI will enjoy a monopoly on procurement and price fixing of all possible resources and commodities required at health facilities. One doesn’t have to be a legal expert Chairperson, to see that the envisaged procurement model alone cannot and will not pass the test of existing legislation or the Constitution.
It is essential to underscore that the decision not to support the NHI Bill does not mean a lack of commitment to healthcare reform. On the contrary, it reflects a commitment to finding a more inclusive, financially viable and efficient approach to achieve universal healthcare coverage.
Chairperson, the DA advocates constructive dialogue and alternative proposals that address the concerns raised while ensuring equitable access to quality healthcare for all South Africans.
We, in the DA are committed to achieving universal healthcare coverage. However, we believe that this goal can be achieved through alternative, more sustainable means. Our vision emphasizes collaboration between the private and public sectors, leveraging existing resources efficiently and empowering provinces to tailor healthcare solutions at best suit their unique circumstances.
This Bill represents the opposite of that. It is not only worthless as the resolution to our current healthcare challenges. It is in fact the measure which will make those challenges far, far worse. And it is not alone Chairperson, NHI, Basic Education Law Amendment, BELA, expropriation,
Employment Equity Act at best, these Bills, will establish a future in which naval national government controls every aspect of our lives from cradle to grave.
At worst, they are a large ditch attempt to steal what little is left from a sinking ship. Chairperson, the ANC has stolen the soul of South Africa. With the passing of this Bill, they will have eaten it. How dare they? Thank you.
Dr P C RAMATHUBA (Limpopo): Hon Chairperson, hon Minister Dr Joe Phaahla, our Deputy Minister Dr Dhlomo, colleagues from all our nine provinces and members of the NCOP, receive our warm and fraternal greetings from the people of Limpopo who are here and who feel honoured to join other colleagues in welcoming and supporting the National Health Insurance Bill. As Limpopo, we believe that by adopting this progressive Bill, the ANC government aims to continue to move South Africa forward towards universal health care coverage because we believe that this is a Bill that will see the revolution of health care and the transformation of health care in our country.
We should remind ourselves that even the transition from apartheid to democracy was never easy and there were many
doomsayers who indicated that it would not happen ... that painful transition. Today, all of us are sitting and saying that it had to happen and all of us welcome it. We believe that the National Health Insurance, NHI, ... I have to take members back to pre-1994 where, if I were to count, we probably had almost 15 departments of Health, where you’re talk about Transkei, Ciskei, Bophuthatswana, Venda, Gazankulu, South Africa, KwaZulu. You can count them. The ANC-led government managed to amalgamate all of them in 1994 and we find ourselves with one national Department of Health together with the nine provinces that support the national Department of Health.
However, we must indicate that since then ... it's unfortunate that over these years we have seen capital being very smart.
We have seen the two-tier system developing from all those many departments where people were discriminated ... based on your geographic location, the colour of your skin, the language that you speak ... to say which facility could assist you. Hon members here are speaking about the best operations that used to happen. You ask yourself in which facility? Were they happening in Groote Schuur or were they happening in Khayelitsha? These are some of the questions that we've got to deal with. Were they happening to poor black South Africans at
that time or were they only restricted to white people in the rich areas? We need to deal with that.
So, what we are saying here is that the two-tier system that came here, and which the NHI wants to abolish, is another capitalist system that developed over the years, where private health care got to be elevated at the expense of public health care. I'm saying that because if you look at South Africa in terms of its funding for health ... the gross domestic product, GDP, we are spending 8,5% of which 4,2% goes to public ... which services more than 84% of the population. You can use mathematics which will tell you how much you are benefitting. The reality is that South Africa is one of those countries that has been able to meet the Abuja Declaration in terms of 15% of all government spending on health care.
However, are we seeing that benefitting the poor and the majority of the people of this country of which the majority of poor people are black?
As Limpopo, we are saying that the current two-tier health system is also a legacy of apartheid and we are saying it has painted a very bad picture of the health care system in this particular country. It took a lot of time for us to deal with that. It's not ironic that you find many here complaining that
we want to fix what is not broken. ... people glorifying and celebrating the very same private health care, which we want to argue today is equally broken. Equally, it has also got its challenges, just like public health care has its own challenges.
There are those in the private sector who indicate that unfortunately, the public ... is full of corruption and unless we deal with corruption we are not going to implement NHI. Yes, corruption is a cancer that all of us must work together to deal with, but equally at the same time, I have listened to some organisations that belong to the medical professions and other health care professions attacking the very same NHI based on what they are saying ... it's underresourced and understaffed. My question which I want to ask you, Chair and the honourable House ... these are some of the medical specialists who are working full-time in government but because government is progressive, we even allow them to do what we call remunerative work outside the Public Service, RWOPS. They leave the public ... patients, the poor patients, and go to private ... and when they get to private ... who pays them? It's double-dipping because they get paid by the same medical aid that is subsidised by the same state. They come to government and we pay them their salary, which is
equally the same taxpayers’ money, at the end of the month. So, we are simply saying that we need to deal with this double-dipping because it's your taxes. These people are being paid twice and the people who suffer the most are the public
... patients who, whether you see them or you don't see them, you still get paid. Now, we're saying we don't mind you doing your RWOPS but let's get this funding model, because NHI is just a funding model that will deal with all these challenges, where we are saying we will pay you ... you will claim from the very same insurance, whether you are in public ... whether you are in private ... If we are able to do that, we will deal with some of these challenges that we are facing.
Of the other parties that I listened to here, I must especially indicate the DA. You we have never supported anything that will cater ... majority of black ... and the poor. That is a fact and that's why we are not surprised when they do not support this particular Bill, because to them, as long as they are comfortable ... and all you hon members here are comfortable because you have medical aid that is subsidised by the very same poor people. So, as the ANC in the Limpopo province, we are saying that we fully support this particular NHI Bill because we know that it will be able to assist us.
Some of the issues that hon members are raising outside is that we questioned whether ... when we respond to them by saying that there are private sector organisations that also operate ... approved general practitioner or a specialist network. This is what we call a managed care organisation.
What will be the difference when we come here? We are saying that this NHI fund, which is a pool fund, is a medical aid scheme. How does it differ? Is it not a pooled fund? Are we not selfish by saying that we want medical aid for ourselves; we don't want the poor to also be insured because the NHI ... we want to ensure both the poor and the rich ...
The practice of pooling funds to share the financial risk is not a new concept. We do it in various insurance schemes. We don't know if we ever claim but we pay for risk protection. Then, on the day ... Today, when you have insurance on your house, you are doing it for the day when your house burns down. You are not saying that you are doing it because you’re sure that your house will be burnt. So, all of us must contribute towards this NHI fund so that we can win.
Hon Chair, before you cut me, as a province we are doing a lot of work in preparation for this NHI. We know, because public health care can never play ... What I like about us in public
health care is that we always accept our problems. We are saying that it is not supposed to be like that. That is why, as part of preparation, we are focused on infrastructure.
Working with the national Department of Health, they identified the Vhembe District. They are saying that they will revitalise. To date, they've been able to assist us with clinics like Magwedzha, Mulenzhe, Makonde and Thengwe. Go and see how beautiful those clinics are. You should see Elim Hospital now. It's already on a ... [Inaudible.] ... plate as they continue to build Elim Hospital. You must also go and see Tshilidzini Hospital and Siloam ... [Inaudible.] Tshilidzini and Elim are next in line. Not so long ago our Minister was in Limpopo to do sod turning. [Time expired.]
Afrikaans:
Mnr S F DU TOIT: Agb Voorsitter, net soos die President met wensdenkery van slim stede en elektriese voertuie op Suid- Afrikaanse paaie droom, probeer hy en die Ministers hierdie fabel van Nasionale Gesondheidsversekering, NGV, aan kiesers verkoop. Dit is iets wat nie eers in ’n eerste wêreldland soos die Verenigde Koninkryk kan werk nie.
Die NGV, wat poog dat alle burgers mediese behandeling op ’n gelyke basis kan ontvang, is ’n droom wat nie gaan slaag nie.
Ons moet die realiteit in die oë staar. Gelyke behandeling waarna verwys word is in effek min tot geen behandeling vir Suid-Afrikaners.
English:
The fact is that currently government cannot provide proper basic medical assistance to patients in state hospitals due to mismanagement, corruption and the failure to put the needs of the people above the ideological, socialist and communist targets of the ANC.
Afrikaans:
Die verdoemende verslag van die ANC oor die gruwels in staatshospitale, wat twee weke terug deur die VF Plus bekend gestel is, is ’n duidelike bewys dat die staat nie in staat is om na die welstand van landsburgers om te sien nie en ook die gevaar loop om binne die volgende vyf jaar sonder effektiewe mediese fasiliteite te sit.
English:
The Bill does not pass constitutional muster. Over the past few months, my colleague in the National Assembly, hon Van Staden, highlighted all the pitfalls, flaws and constitutional shortcomings in the Bill. This Bill has become a populist
election tool for the ANC and will cost human lives and waste millions of rand.
How can such a Bill be passed if the baseline funding of dilapidating medical facilities has been reduced in the Division of Revenue Amendment Bill that we will be discussing and debating on Friday? Clause 2 of Chapter 1 of the National Health Insurance Bill provides that the NHI fund will serve as the single purchaser and single payer of health services. This provision may possibly infringe on section 22 of the Constitution, in that the NHI fund may very well monopolise health care facilities in the country.
Afrikaans:
Hoe belaglik dat die NGV gemagtig sal wees om klagtes teen homself te ondersoek indien daar enige oortredings is? Die magte, regte en verantwoordelikhede van mediese skemas is steeds ’n groot vraagteken wanneer dit by die NGV kom. Indien persone wat tans aan mediese skemas behoort verplig word om hulself onder die mag van die NGV te soteer en van die staat se-dienste gebruik te maak, sal die las op die staat nog groter wees as wat dit op die oomblik is. Dit is ’n omgewing waar die regering op die oomblik nie in staat is om basiese mediese dienste aan miljoene Suid-Afrikaners te lewer nie.
Daar is vele geldige griewe wat deur opposisie politieke partye, burgerregte-organisasies, individue en ander ingedien is want hierdie wetgewing voldoen nie aan die oppergesag van die reg nie.
Neem kennis dat die deurdruk en aanvaarding van die wetlike grondwetlike uitdagings en gevolge wat die regering inhou, wat die land se ekonomie en die regte van landsburgers in gedrang gebring word en die waardigheid en gesondheid van alle Suid- Afrikaners negatief deur hierdie wet geraak sal word, waarvan die befondsingsmodel op hierdie stadium onduidelik is en uit die aard van die saak ook onmoontlik is ...
English:
A government that accommodates newborn babies in cardboard boxes will have to stock up on caskets if this Bill is passed. The FF Plus cannot support this Bill. Thank you, Chair.
Cllr M MOGOJE (Salga): Hon Chairperson of the National Council of Provinces, Minister of Health, hon Deputy Chairperson of the National Council of Provinces, hon House Chairperson and Chief Whip of Council, hon permanent and special delegates, ladies and gentlemen, our Constitution guarantees everyone the right to have access to healthcare services, including
reproductive healthcare and that state must take reasonable legislative and other measures within its availability resources to achieve the progressive realisation of this right, acknowledging health as the human right recognise a legal obligation on state to ensure access to timeously acceptable and affordable healthcare.
A right based approach to have requires that health policies and programmes prioritise the need of those fed us behind towards better equality. A principle that has been echoed in the 2030 Agenda for sustainable development and a universal health coverage. The right to have must be enjoyed without discrimination on the grounds of their health needs irrespective of the socioeconomic status or any other factor. This disadvantage and marginalised serve to exclude certain population in society from enjoying good health.
According to the World Health Organisation, three of the world most fatal communicable disease, malaria, HIV and tuberculosis disproportionally affect the world poorest population and in many cases are compounded and acerbated by other inequalities and inequalities including gender, age, sexual orientation or gender identity and migration status.
Conversantly, the burden of non-communicable diseases is largely associated with lifestyle and behaviour factors as well as environmental determinates such as safe housing, water and sanitation that are inextricable link to human right.
Hon members, as the sphere of government closest to communities, we are alive to the struggle confronting many citizens when it comes to access to healthcare services. Many time currently do not enjoy access to some services due to their social economics status and other factors.
The general household survey published in August this year indicated that 73% of the household first consult public healthcare facilities when members fall ill or get injured. The type of healthcare facilities consulted by household members are influence by factors such as household proximity to facilities as well as personal preferences based on factors such as affordability and the perceive quality of services. At the same time, only 15,8% individuals in South Africa are members of medical aid schemes.
In contrast to this, the significant funding goes to the private sector while the public status is characterised by understaffing and long working times.
Hon Minister, while we acknowledge that the National Health Insurance Bill is a legislative instrument, which the department is using to address South Africa to tier healthcare system with a large public sector and a small but very higher quality private sector. The Bill is silent on the critical component of health services, which is prevented disease health services.
The report that figures on the use of public health facilities and access to medical aid schemes suggest that we ought to pay equal attention to preventative health services. Health is not only achieved at health facilities but is determined by social determinants of health.
The recent upgrades in the form of listeria outbreak of COVID-
19 pandemic, cholera outbreak and the most recent food poisoning cases are examples of why it is important for the Bill to pay equal attention to preventable healthcare services.
In order to prevent diseases outbreaks, the Bill must strengthen the funding of preventative health services which seeks to regulate the provision services such as water, sale of food, waste management, health surveillance of premises
surveillance and prevention of communicable diseases, rectal control, environmental pollution control and safe disposal of the death amongst others, all which impact on the health outcomes.
Hon House Chair, in view of the above and a fact one of the purpose of this Bill is to ensure that sustainability of funding for healthcare services within the Republic.
The SA Local Government association, Salga, call for the insertion of clause 7(2(g) as follows: In order to ensure the seamless provision of health services at the community level. The Minister must regulate the administration, management, budgeting and governance of preventative health services at all spheres of government. The Minister must by regulation set standard for the provision of services which impact on health outcomes.
Hon members, strengthening the provision of preventative health services is another means of protecting individuals and their families from financial hard hit as it will mean fewer people end up in health facilities. Strengthening preventative healthcare services will go a long way in saving government a
lot of money spend on curative healthcare services. I thank you.
Mr N M HADEBE: Hon Chairperson, the IFP has been a voice that strongly advocates for a system of universal access to healthcare system in South Africa. We have believed that people have the right to universal healthcare that maintains the asymmetry quality and cost effectiveness ensuring accessibility to all citizens.
Our believes have always aligned with the right to healthcare enshrined in section 27 of the Constitution. However, we are assert that the current version of the Bill under consideration is impractical. Moreover, the prevalent concerns about our existing healthcare system were heavily on the minds of all South Africans who fear potential government mandated changes that could lead our healthcare system into a state of despair, decline, degradation meandering the challenges faced by other state-run entities.
Insanity surrounding the service deliveries particularly in the healthcare factor is shocking. For instance, Bethesda Hospital in KwaZulu-Natal has been grabbling with the lack of consistent water supply since 2018. Complains from health
workers about inadequate water and sanitation as well as shortages of medical supply has been voiced by unfortunately these concerns seem to be fallen on deaf ears.
Citizens across our country do not want to seek their right to quality healthcare in exchange for a government that has not constantly inspired by confidence in terms of service delivery.
Our stand is rooted on the following consideration: Firstly, affordability, acknowledging healthcare as a progressively attainable right. We must also recognise the state obligation not to jeopardise the existing provision of public healthcare services. The proposed Bill in our evaluation risk impeding access to current healthcare facilities due to essential funding requirement attempting to cover the nine million individuals presently covered by private medical aid is financially unattainable potential causing the Bill failure if enacting into law.
Access to healthcare, the IFP expresses deep concern not only about current inadequate state of access to medical services in rural areas and communities but also about the potential of the NHI to further limit access through its suggested referral
and accreditation networks potentially excluding specific clinics Ministerial Outreach of the Bill grants the Minister of Health powers beyond the scope of their political office. This serve the stage for undue influence, cadre deployment and may adversely affect oversight potentially leading to fraud and corruption albeit without casting doubt on the Ministry integrity.
Shortage of medical professionals, South Africa urgently requires more medical professionals including doctors and nursing staff. Regrettable, the current form of the HNI does not address this need.
Resent surveys such as one conducted by the insurer, the Professional Provident Society, PPS, indicated that over 72% of medical professionals would consider immigrating if the current NHI were implemented.
As I conclude, in conclusion, hon Chairperson, after careful consideration and despite our unwavering support for universal healthcare particularly for the disadvantaged in South Africa, the IFP for the outlined reasons cannot endorse the present form of NHI Bill. I thank you.
Ms S J MANZINI (Mpumalanga): Hon Chairperson of the NCOP, the Minister and the Deputy Minister of Health, other presiding officers, the Chief Whip of the NCOP, permanent delegates of the NCOP, fellow MECs of Health, and fellow patriots, I am deeply honoured to represent the more than 5,1 million people of Mpumalanga in this historic debate on the National Health Insurance, NHI, a policy intervention which will go a long way in making sure that the people of South Africa have universal access to health care.
Today is a historic day for me for two reasons; the first being that we are passing this Bill in the month when we are celebrating 80th anniversary of the seminal African claim document, which was approved by the then ANC president, Dr A B Xuma on 14th December 1943. It is explicit on the responsibility of the state to provide health care to South Africans and to establish the funds to do so. The African claims document reads as follows:
We regard it as the duty of the state to provide adequate medical and health facilities for the entire population of the country. We deplore and deprecate the fact that the state has not carried out its duties to Africans in this regard and has left this important duty to
philanthropic and voluntary agencies. As a result of this gross neglect, the general health of the entire African population has deteriorated to an alarming extent.
One of the factors suggested the following:
We strongly argue the adoption of the following measures to meet the health needs of the African population: A co- ordinated control finance of health services for the whole Union; and the appointment of districts surgeons in rural areas with a large African population.
Today, by passing this Bill in this august House, we are honouring the memory of the great African leaders who were part of drafting this seminal document like Prof Z K Matthews and president A B Xuma, who was a doctor by profession.
Today’s act is a clear sign that the ANC is still committed to its historic mission of liberating black people in general and Africans in particular, from all calamities of colonialism and apartheid. Today’s movement is also historic because it neatly fits itself in what Karl Marx wrote when it argued:
Men make their own history, but they do not make it as they please; they do not make it under self-selected circumstances, but under circumstances existing already, given, and transmitted from the past. The tradition of all dead generations weighs like a nightmare on the brains of living.
The ANC-led government is today making history of breaking barriers of access to quality health care for all South Africans, especially the working class and the poor; not under circumstances of our own choosing but because of an economy that is not performing optimally in the country and resistance from the beneficiaries of elitism and privilege. We are not going to talk about private sector here, but we are going to talk about the people of the province, like others are saying, the interests of the private sector over the interests of our people. We are making history by passing a law which will enable for the establishment of the National Health Insurance Fund in the Republic, funded through monetary prepayment that aims to achieve sustainable and affordable universal access to quality health care services, as envisaged by Prof Z K Matthews in 1943.
The Bill is explicitly clear that user of the fund entitled to receive health care services purchased on his or her behalf by the front from the accredited health services provider or health establishment free at the point of entry. The passing of this Bill is historic as it also seeks to address risk global powers have ignored for decades, which are inadequate health system, gaps in social protection, and structural inequalities, especially in the health sector. The Bill seeks to address some of the most pressing challenges of our times in the health sector, which amplify health inequalities, such as private hospital, businesses and even individuals holding precious equipment that is urgently needed for everyone, but only caters for the few. This is victory for the many South Africans who do not have medical aid - and for your information, even those that are having medical aid, before they treat you while sleeping in that bed, the private sector hospital that you are talking about, they need authorization before they touch you - We have evidence where private sector will first say that this medication, we have given you more than what you can pay for, and let me transfer you to Rob Ferreira, and Rob Ferreira would not ask you how much do you have. We are saying what is it that you need. As we speak about the very same private and medical aid that they are talking about and a medical aid ... April ... you have a card,
but you do not have services. They are not using it. They are coming to the very same hospital. That you are saying people are going to die only because there is NHI, but the Minister has stats daily of where majority of our people are discharged on the very same hospital that we are saying ... they only die when it is their time. But currently majority of people are servicing them in the very same hospital in clinic. This is victory, and it is a victory for many South Africans who will still have to travel hundreds of kilometres to access certain medical services which are not available in public facilities in their area, but only offered by private health care providers. This Bill once passed into law, it will go a long way in ending the unpalatable situation we find ourselves in and was properly described by the secretary-general of the United Nations, Mr Antonio Guterres, and he argued:
While we are all floating on the same sea, it is clear that some of us are in superyachts while others are clinging to the drifting debris.
I have no doubt in my mind that South Africans needs the NHI, allowing to advance a few rations and scientific reason to support my claim as opposed to those who oppose it by empty slogans and rhetoric. The first relates to the unequal
structure of the national health system. It is characterised by stark inequality based on race, class, and gender, for example, from the Statistics SA General Household Survey in 2018, reveals that only 60% of South Africans have access to medical aid. And this membership is dominated by white citizens, which is 70% while only 10% of Africans have access to those medical aid in the whole household - as Sasekani, I am the only one who has medical aid at home. My mother, my father and everyone else does not have a medical aid - So, you think you must continue like that and where communities only favour a few people. But for white people, the whole family can be covered. But for white people, it is only that one person that is working. And we are saying as ANC, in the interest of the people that voted for us, we are going to support this Bill, especially as Mpumalanga province.
Furthermore, South Africa’s health finance is very skewed when contrasted with other countries, as ... [Inaudible.] ... in the 8,5% of the gross domestic product, GDP, spent and overall health services, but this is consumed by private health sector, users, and providers. How does a country justify a
two-tier health system, in which half of the overall health expenditure is spent by 16% of its population? This figures also debunk the myth of limited resources within our system –
as you have all been singing the very same song that South Africa’s health expenditure exceed World Health Organization’s as we speak ... recommended that the expenditure which is 5%. So, the NHL seeks to address this structural inequality within the system by providing an alternative – the universal health care service. This is how we are going to fund the NIH. And secondly, South Africans need NHI for accepting primary health care. Numerous studies proved that South African health system is overly curative. This has significant implications for health service, cause, and the nation’s disease profile. A clear example is the continued rise of non-communicable diseases and lifestyle disease. South Africa requires a preventative health paradigm and system which is not overdependent on curative health technologies and intervention. The NHI provides the building block for such a system through prioritisation and institutionalizing primary health care model. It focuses on health service, decentralisation through community health care workers, schools, health teams, and district health structures. These institutions’ arrangements are more suitable for achieving primary health care within our communities. This shift towards primary health support and health module, which advance the MISTRA’s publication titled “Epidemics and the Health of African Nations” and this model connect disease burden to
social, economic, environmental, and cultural factors. The proponents of NHI overlooked this critical pillar of their ... [Inaudible.]
As I conclude, let me indicate that as the Department of Health in Mpumalanga, we are inviting you to go to Gert Sibande as a district where the national department has piloted NHI, ad intervention by the department in building the state-of-the-art clinics in Vukuzakhe and other areas in the province. We are also building a hospital as the province ensuring that as a province we are ready to implement the NHI, and we are saying that if countries like Botswana, Ghana and Rwanda are already ahead of us in terms of implementation of the NHI model, there is absolutely no reason for South Africa lagging in implementing this important instrument of universal access of quality health care in our province. This is a compelling argument. It does not convince the opponent of the Bill to support it. It can only mean that they are dealing with people ... African novelist Ben Oakley spoke about when he said:
People who refuse to face any of their awkward and deepest truth, who have chosen to become deaf and blind towards the truth, these are people who silence their
dreams, and the dreams of others. And these are people who have died in life.
The people of Mpumalanga refuse to die and support the Bill. Thank you very much.
Ms C LABUSCHAGNE: I see I have 10 minutes here. [Laughter.] Hon Chair, hon Minister, hon members, today might be seen as a win for the ANC, but it is a sad day for South Africans. The NCOP had a chance to listen to the public, to experts, to stakeholders, to reason, and vote against the National Health Insurance Bill. Instead, it was bulldozed through this House, just as it was bulldozed through the National Assembly. If we ignored the fact that the executive intervened with the business of Parliament, last week.
The select committee of the NCOP did not amend a single clause of this Bill based on the input from extended public hearings. For that matter, only a few sections 76 Bills have been amended by the NCOP in the past ten years. The current practice on negotiating mandates paves the path for the ANC to negate the voice of the people, in fact, reduce the costs of public participation in provinces to fruitless and wasteful expenditure.
I agree with Business SA’s chief executive officer that this process, and I quote: “Makes a mockery of the due process and portrays the NCOP as nothing more than a rubber stamp.
The ANC is trying to legislate an ideal instead of implementing a thoroughly considered evidence-based plan. A report from the Department of Health exposed the failing of the multibillion-rand project. Government has spent
R4,3 billion between 2012 and 2017 on 10 National Health Insurance pilot sites with no clear monitoring and evaluation framework, making it almost impossible to determine the effect. I want to make it clear, the DA supports universal health care, and universal access to health care. We do not support the NHI Bill, which will destroy the little of what is left of the public health sector and will ameliorate the private health sector. The ANC would cause the suffering of millions without ever, not even today, answering any of the following few questions: How will this monstrosity be funded? No recent feasibility studies have been done regarding the financial impact of the NIH post-COVID. Simply put, South Africa cannot afford it and the Minister of Finance said it blatantly on numerous occasions. The Office of the Health Standards Compliance is struggling to inspect accredited health facilities in timely manner as it is. Hospitals already
tender to 80% of South Africans. They are already failing to meet minimum norms and standards. The only hospitals in the country that comply to the ideal clinic specifications within this Bill are in the Western Cape. The NHI will abuse patients’ rights to quality health care. The NHI fails to address skills and personnel shortages in less desirable or more remote areas in the country. Hospitals are completely understaffed, and the NHI does nothing to combat or correct this. Referral pathways, as described in this Bill will put further strain on the system and impede quick access to specific health care interventions. Treatment protocols might impede the treatment of certain conditions and patients. There is no clarity on which services the NHI would cover, despite repeated requests for information on these. Medical legal claims will skyrocket even further due to the maladministration of the NHI Fund, which will collapse the health industry. There is no doubt that the NHI Fund will be extremely vulnerable to thieves and corruption.
Today’s debate is the ANC’s idea of an olive branch to the Business Unity, Business of SA, and organisations who wrote to the Chair of the NCOP and the Deputy President with an urgent appeal to reject the NHI Bill in the NCOP, last week. Are we ever going to get reasons why the vote was deferred, last
week, Chair? No, probably not. The ANC knows the NHI is the ideal promise to voters in 2024. They do know. Well know that they cannot afford to implement it, and they also know that the Bill will land in court. So, notwithstanding all these, today, a vote against the NHI Bill will be the only sane option to stop the devastating consequences for South Africa, the economy, and every citizen for generations to come. Thank you.
Ms N E NKOSI: Hon Chairperson, greetings to your good self, the Minister, the Deputy Minister and the Chief Whip of the NCOP, my colleagues in this House and on the virtual platform and my MEC from Mpumalanga. Well done my MEC we are proud of you. The contextual analysis of the contemporary challenges in the health care system noted by President Matamela Cyril Ramaphosa during his remarks at the Presidential Health Summit in 2018, is a painful reminded of the persistence of our challenges and the urgency which we should be implementing the National Health Insurance, NHI.
The President noted that in a country with more than seven million people living with HIV, a nation with rising diabetes, hypertension and cancer rates, high maternal deaths and neonatal death rates, poor mental health status and prevalent
disability rates, we cannot afford to have a faltering health system. Too many people do not receive the quality preventive, promotive, curative and rehabilitative health care services they deserve. While others on the other hand receive superior health care services.
Chief among the causes of the problem is inadequate resourcing of the public health system. There is a need for strategic direction to steer the ship through turbulent waters. It is because of the above mentioned gaps that we are debating on the National Health Insurance Bill, today.
Through its concern, the ANC-led democratic government has been tirelessly championing the passing of the National Health Insurance Bill as a fundamental building block for a robust and responsive health care system for providing critical and continuous services and care of our citizens in alignment with the guidelines of the World Health Organisation, WHO.
In anticipation of the implementation of the NHI, numerous advancements have been made towards transforming the health system. The transformation of our health care system is not a recent priority. Since the advent of democracy, the ANC-led government has made tremendous strides towards transforming
not only the health sector, but broader society to read it of the oppressive and divisive legacies of colonisation apartheid.
The undertaking by the ANC-led government have yielded many positive accomplishments such as the positioning of public health as the first option for seven out of 10 households in the country.
To affirm this Statistics SA noted that a number of households’ members who first consult medical practitioners in clinics and hospitals when unwell increased from 44,5% in 2004, to 55,6% in 2012, to 73% in 2022.
The ANC’s 29th manifesto review attributes this to our government’s provision of free primary health care services which include family planning HIV and Tuberculosis diagnosis, treatment and support as well as mental and reproductive health services, just to mention a few.
The ANC-led government has made numerous developments towards revamping and building new infrastructure over the years to ensure that our people have access quality health care. The ANC 2019 Manifesto Review notes that in 1994 and in 2014,
1 600 clinics and 18 hospitals were build. From 2014 to recently 149 clinics and 38 hospitals were build. In these developments the government has strategically targeted development-centred in rural and township communities to ensure that local essential services are brought close to our people.
We have observed these developments first hand and take deep pride in them as seen with the Dr Pixley Ka Isaka Seme Memorial Hospital in KwaMashu, which was launched by the President Cyril Ramaphosa on 24 November 2023. The hospital provides 500 beds and will provide round the clock services that will include paediatrics, gynaecology, general surgery, psychiatric and mental health.
The efforts towards improving infrastructure remain ongoing. We are encouraged by the continuous commitment of the ANC-led government to improve infrastructure as evident with the construction of the central academic hospital in Limpopo Polokwane set to be completed by 2026 with 688 beds. The construction of this hospital is also anticipated to have a positive economic impact where it is expected to produce about
2 000 jobs and about 2 000 more once it is fully operational.
Chairperson, the foundational phases of the NHI initiated numerous projects including ideal clinics realisation and maintenance aimed at ensuring that the status of our clinics are in line with the envisaged standards of health care infrastructure for the complete roll–out of the NHI.
To this end, government has undertaken a process of assessing a number of primary health care facilities and noted that there was an increase in the number of health care facilities that qualify as ideal clinics from 56% in 2021-22 to 59% at the end of 2022-23 financial year. This means that 2 003 out of 3 464 facilities achieved ideal clinic status.
During the public hearings of the National Health Insurance Bill, opposition parties tried very hard to paint a false narrative that the passing of this Bill poses a threat to health workers and this result in them fleeing the country. In contrast we have seen an outpour of support from the medical community in support of this Bill and offering their skills and services after the passing of this Bill.
Furthermore we have noted how the ANC-led government continues to make inroads regarding the strengthening and capacitation of health care workers as evidenced by the Nelson Mandela
Fidel Castro Medical Training Programme which is a result of a bilateral co-operation agreement signed with Cuba in 1996 aimed to provide an opportunity for South African students to undergo medical training in Cuba.
To date South Africans have been able to produce 371 doctors through the Nelson Mandela Fidel Castro Medical Training Programme and continues to also have good relations with local higher education institution on the enrolment and the success of medical students to feed the workforce.
By September 2021, more than 56 health care workers were recruited and more than 46 community health care workers integrated into the public health system. Such interventions are critical in ensuring that the country has an adequate supply of medical practitioners closing the gap of scarce skills as well as playing a role in ensuring that there is representation in the field as noted by 404 graduates of the Nelson Mandela Fidel Castro Medical Training Programme, where 40% of them were women.
Although such progress deserve to be applauded and celebrated, more can and must be done to ensure that there is a greater representation in our industries, not only health, but other
sectors of society along the lines of race, gender, age, persons with disabilities and members of the Lesbian, Gay, Bisexual, Transgender, Intersex, Queer Plus, LGBTIQ+ community.
Hon Chairperson, again in the anticipation of the implementation of the NHI and as part of the ANC-led government’s commitment to implementing a system which is driven by delivering people-centred service, 11 pilot projects are undertaken across all nine provinces in the country and have made numerous advances including in the O R Tambo, Eastern Cape where as a result of various interventions the district recorded a year-on-year improvement in cervical cancer screening for women over 30. This improvement also showed a much increase in the ranking of the district as compared to other pilots and nonpilot districts.
Umzinyathi in KwaZulu-Natal, there was an improvement in the immunisation rate of children under the age of one, with a further indication that directed efforts needed to be implemented to prioritise mother and child health intervention.
In Eden in the Western Cape, key achievement for the district was that it consistently reported the lowest levels of drug stalk outs amongst all the pilot districts.
According to the national Department of Health, the majority of NHI districts made significant progress in the establishment and roll-out of wall-based primary health care outreach cases which aims to ensure the overall success of NHI.
As of September 2017, there were 3 519 wall-based primary health care outreach teams covering 12 million 816 162 homes. At the end of the 2017-18 financial year, there were a total of 3 323 wall-based primary health care outreach teams around the country.
Over the years, the ANC-led government has also been working tirelessly to establish an integrated health information system which will enable health institutions to access patience medical records as part of providing good patients care. To this end the national Department of Health designed and implemented the health patient registrations system which generates and assigns patient identification numbers.
Since 2014, substantial work has been done to use the health patient registration system in public health facilities and there has thus implemented in 3 220 public health institutions as of August 2023.
More than 59 million people are registered on the health patient registration system. Such interventions will go a long way in improving patients care and improving health outcomes.
However, despite the tremendous progress made, it is undeniable that our health care system still remains largely unequal with a lot of room for improvement. We are encouraged by the continuous efforts of the department to the roll-out of NHI as evident in the improved performance where out of the four planned targets in the 2022-23 financial year the department achieved three that is 75% up to 75 up, from 40% in the previous financial year.
It is in this light that the ANC remains resolute towards the NHI as an opportunity to ensure that a more just system is created towards the achievement of universal health care for all. The ANC supports this Bill.
Chairperson, I think it will be much proper to tell the DA that what they are saying is not correct. In the public hearings, many or most of the people that were there were supporting NHI. Even here in the Western Cape, here!
IsiNdebele:
Laphe bahlala khona.
English:
The NHI was supported in huge numbers. So, there is no way that they can say today we do not listen to the views of the people. Which views of the people must we speak about? For the majority is supporting NHI! Must we listen to the minority?
That cannot happen! We are here to represent the people’s views! That is why we are saying today we are supporting this Bill! Whether they like it or not! We are supporting this Bill! Thank you very much, Chairperson.
The MINISTER OF HEALTH: Hon Chairperson of the National Council of Provinces, hon Masondo, the Deputy Chair, the Chief Whip of the NCOP, hon Mohai, the chair of the select committee, hon Njadu, members of the Select Committee for Health and Social Services, Ministers, Deputy Ministers, members of executive council of provinces who are here, hon
Manzini, thank you very much for honouring your promise that you will be physically here, and also all the colleagues, MECs who are on the virtual platform, hon members of this august House, ladies and gentlemen, good afternoon ...
Sepedi:
... dumelang ...
IsiZulu:
Sanibona!
English:
We appreciate this opportunity indeed to participate in the final stages of enacting this National Health Insurance Bill into law. I want to thank the hon members who have participated in the debate before I came in. Before I go into a number of substantive issues, let me just deal with a few issues which came from some of the misdirected hon members.
Hon Ryder from the DA, unbelievable that improved life expectancy can be attributed to private health. Where do you get that? I mean the private health only caters for about 14% of the population. So, if we have an improved life expectancy of 14% of the population, it won’t even have a dent. The
improvement from 2004 to 2005 when life expectancy had gone down to about 50 years, to where we were just before COVID at the average of 66% upwards. This was not the private health.
The major intervention was from public health in terms of infectious diseases such as HIV, AIDS and TB, where there were rollouts of major community-led interventions. That’s what raised the life expectancy. You are really misled. Your colleague there, hon Pitorious, to come and believe that the thousands of people in the Western Cape who supported the NHI Bill were basically misled. I can tell you without a shadow of doubt, that he’s referring to black people. So black people, whatever ... you are still stuck in apartheid. When black people were fighting for freedom, when we were fighting for freedom we were called terrorists. Today, when the people of the Western Cape, the majority black people, want to have access to universal health coverage, they are said to be misled. They don’t know what they ... so black people can never know what they want because only white people will know what is good for them? That is the typical mentality of the DA. That’s why even a few brilliant young people who joined the DA don’t last. Where is Mazibuko? Where is Maimane? Where are they today? Simply because they are bright young leaders,
they have been discarded by the DA. So that mentality still continues ...
Ms C LABUSCHAGNE: Chair, I rise on a point of order and I would like to know if the hon Minister will take a question.
The CHAIRPERSON OF THE NCOP: Will you take a question, Minister?
The MINISTER OF HEALTH: When I am done.
Ms C LABUSCHAGNE: You know you don’t have the answer ...
The MINISTER OF HEALTH: Thank you very much, hon Chair. Clearly the hon members are stuck in the past. Of course, these hon members are also stuck in the balkanisation of the Republic. They believe that all the interventions ... because health is a concurrent function, policies and programmes are driven from the national and implemented at all provinces. So, when we talk about various programmes, we work together. I can tell you ... you can ask your Western Cape MEC Mbombo, just yesterday we had our National Health Council. She participates like all other MECs, MEC Manzini, MEC Ramatuba, MEC Simelani
who also spoke here and all others. We consider ourselves as a team; we don’t balkanise each other.
When you look at the Office of Health Standard report in terms of your central hospitals, it’s not the Western Cape hospitals which come tops – Steve Biko Hospital, cutting edge, but they are not competing but work together. The professors at Steve Biko work with Groote Schuur and all the hospitals across the country. We want to really discourage you from this idea of balkanisation.
Hon Chair, I want to thank the committee which led this process of processing this NHI Bill. I want to specifically thank the chair of the committee, hon Njadu, for really steering this ship to where we are today and able to debate this Bill. I want to really pay tribute to him because he was thrown into the deep end. You all know that he came in just at the time when the Bill was passed by NA and referred to the NCOP after the unfortunate demise of the previous chair of the committee, hon Gillion. He really got into it and swam with it, and here we are today. Thank you very much, hon Njadu, for steering this process.
I am sure that, may her soul rest in peace, hon Gillion would have been very proud of you because of the way in which you looked after this. To others, today may look like any other sitting, I am not saying that debating other policies is not important, but really in terms of where this intervention of transforming the health system comes from, this is indeed a historic day and a historic achievement because here today we are putting into place statute framework to create an opportunity where we can be able to transform the health services, create equity and make sure that the perpetual divisions of South Africans, at least in the area of health, can come to an end.
As already said by hon Manzini and other members, this comes a long way. The transformation of the health services has been part and parcel of our struggle for freedom from the African Claims to the Freedom Charter and, of course, found its way into our Constitution, as encapsulated by section 27 of the Constitution.
Of course, we are not alone, as members have mentioned that the entire world is also pushing, from the World Health Organisation to the United Nations. On 21 September we were together with the President. I believe that the advisor,
Professor Shahzada, was also in New York with the support of the President, amongst others, where the UN Secretary-General, who hon Manzini referred to, had called all heads of state to come and reinforce their commitment to the achievement of universal health coverage for their citizens. This was the second time; the first time was in 2019, this was now again to come and call all heads of State to come and reinforce this so that it is not left simply to its other arm, which is the World Health Organization.
When you also look at the Sustainable Development Goals, as other members have referred to, sustainable development goal 3, especially 3.8, which says we must achieve universal health coverage, including financial risk protection, to access quality, essential healthcare services and access to safe, effective quality and affordable essential medicines and vaccines. This commitment cuts across not only us here in South Africa but across the globe, and a number of world leaders have also asserted the fundamental importance of making sure that we can achieve universal health coverage.
In the process of processing this Bill by the select committee, our department has been quite active making sure that we have our ears on the ground and listening to the
people. We can attest that the large majority by far of citizens supported this NHI Bill. I want to say that those people knew what they are looking for and they were not misled as others would want us to believe. We want to appreciate all those thousands of people who came forward.
Let me take some time to deal with some of the issues which some members raised, some from people who had some concerns. We dealt with them during the process of the committee.
Amongst others, there were those who shared concerns or particular sentiments similar to some of the uninformed members here against social solidarity. Who felt that it is not correct that there should be social solidarity, that the rich should subsidise the poor. That is the essence of Ubuntu. When we say that South Africa is about Ubuntu, is to say that when your neighbour is hungry, you don’t just eat alone with your children and throw away what is left - you share. That is the essence of Ubuntu.
So, NHI is about Ubuntu, so we want to say social solidarity is important. I’m just mentioning some of the issues which some members have touched on that there’s too much power for Minister in the Bill. This is part and parcel of our Constitution that when the President appoints the Cabinet
there are particular responsibilities, enshrined in the Constitution, which the President must give to those Ministers so that they can be held accountable. If you say that there is
... in other words, the Minister of Health must be responsible for all other policies, but not in terms of universal health coverage. When it comes to universal health coverage, its implementation must come to Parliament every time? Whoever is being appointed, the boards and so on must be appointed by Parliament, but that Minister must be held responsible ...
We have so many other institutions which we look after where we appoint almost every few months. Whether it’s a South African Health Products Regulatory Authority, SAHPRA, Medicines Regulator, National Health Laboratory, the Minister does appoint those boards and they perform national functions and come report here in parliament. So, we don’t agree with that. the Minister is held accountable collectively as a Member of Cabinet but also individually.
Others were concerned about roles of provinces. Those roles
... the only thing this Bill will be changing is in terms of the pulling of funding, but functions in terms of provision of services will still be at different levels of government, at
district and province and at local level, there will still be provision of services and they will be funded accordingly.
Capacity to manage the funds ... other say we don’t have the capacity like they were saying here. They ignore the fact that when COVID came, those naysayers didn’t believe that we can rollout vaccination. We started the system under very high pressure, developed the system, acquired the vaccines and we insisted that it must be a public good, that the vaccines should not be based on who has the money. We have procured as a state and distributed and everybody who wanted to get vaccines were able to get them. We developed the systems of registration and monitoring. We have reported to Parliament and up to today we have not had a single claim that some vaccines were stolen by somebody. I don’t know why now there should be such hullabaloo.
We have many working institutions in terms of ... I’ve already mentioned the National Health laboratory Services. We have excellent institutions which are doing good work. The National Health Laboratory Service provide services for the entire public health system, which is 90% of the people of South Africa. They get their laboratory system from the National Health Laboratory. If you look at Medicine Control, Sahpra and
Medical Research Council are all institutions which function under the Department of Health.
The economy ... others believe that we must wait until economic growth but is at a time when things are difficult that we must pull together and make sure that we can share the resources which are available.
Because my time is running out, let me just deal with one issue. The issue of the scarring of health professionals to say they are going to leave the country ... any health professional who is working ethically and looking after patients ethically will know that they have nothing to fear. Even those who are in private practice, except if you do some cheating, otherwise you will be registered, be service provider and you’ll be provided.
As I conclude, I want to thank the House and all the eight provinces who have supported the Bill. As I said, farewell and thanks to you. I also want to say have a good rest during the festive season. Continue to look after yourselves. For those who will be driving, make sure that you don’t drink and drive. Our hospitals are already overwhelmed with casualties, so please look after yourself. As you celebrate ...
The CHAIRPERSON OF THE NCOP: Just a minute, hon Minister. Hon du Toit, on what point are you rising?
Mr S F DU TOIT: Hon Chair, the hon Minister said that he will take a question when he is finished, and he is nearing that part. I want to pose that question unless he feels he is not up to giving up an honest answer ...
The CHAIRPERSON OF THE NCOP: Please take your seat, hon du Toit.
Mr S F DU TOIT: Can you let the hon Minister answer himself please, Chair?
The CHAIRPERSON OF THE NCOP: Please take your seat. Thank you very much. Please proceed.
The MINISTER OF HEALTH: Thank you very much, Chair. As a final conclusion I want to say that as you go on holiday, go and rest and make sure that you come back refreshed because I know that next year is going to be a tough year as we are all going to the battlefield. As you rest also not only make sure that you live healthy, also practice safe sex. Make sure that you
use condoms. Our reports indicate that we have high incidents of sexually ...
The CHAIRPERSON OF THE NCOP: Hon Minister, just a second again. Hon Aucamp, on what point are you rising?
Mr W A S AUCAMP: Chairperson, I rise to ask whether the member is willing to take a question. Let’s see if he has the guts to do so. I just want to find out whether he agrees with the Minister of Finance who says that there is no money for this. Do you agree with the Minister of finance? Yes or no, sir?
Thank you.
The MINISTER OF HEALTH: All I can is that the Minister of Finance is a colleague in Cabinet. This Bill was approved by Cabinet. The Minister of Finance operates under the auspices of a collective decisions of the Cabinet and ... Thank you very much. [Interjections.]
Mr S F DU TOIT: Hon Chair, the Bill hasn’t even yet been passed and he is already going back on his word. It is a disgrace ... [Interjections.]
The CHAIRPERSON OF THE NCOP: Proceed, hon Njadu.
Mr E Z NJADU: Good afternoon, hon Chairperson, hon Minister of Health, hon Dr Joe Phaahla, hon Deputy Minister of Health, hon Dr Sibongiseni Dhlomo, hon MECs, hon Chief Whip, hon House Chairpersons, hon members, I am not going to ... The Minister has said it all. So, I am not going to repeat what the Minister has said because he is the political head in the department, I will just stand here to say ... [Inaudible.]
Chairperson, I am standing before you today filled with immense gratitude that we have finally made a bold move to building a formidable foundation for the provision of universal health for our people. First and foremost, I would like to express my deepest appreciation to all the hon members who took part in this debate and multitudes of our people who boldly declared their indisputable support for the National Health Insurance Bill. I would like to particularly thank the Minister of Health, hon Dr Joe Phaahla and his Deputy, hon Dr Sibongiseni Dhlomo, and the most dedicated official from the Department of Health for taking his time to clarify many of these issues that were raised in our committee meetings and the various public hearings that were convened by nine provinces. Eight out of nine provinces supported the Bill. I confirm that the Minister has made my task much easier by clarifying all the issues that I would have responded. I would
like to also thank all the members of the Select Committee on Health and Social Services for the meticulous way and dedication in which they processed this Bill. I would like to extend my profound appreciation to the Chief Whip of the Council, hon Seiso Mohai, whip of the committee, hon Ethel Nkosi, and yourself, hon Masondo, for your unfailing guidance and tireless support.
As I have said that the National Health Insurance Bill is aligned to South Africa’s values of justice, fairness, and social solidarity in line with the 2013 National Development Plan, NDP. We aimed to achieve universal health coverage through the implementation of the National Health Insurance, NHI. This is going to ensure that no one is left behind and that all South Africans can live long and lead healthy lives. With the passing of the National Health Insurance Bill today, we are declaring to our people that our health care is in our hands, we must continue to lay the foundation for truly universal, accessible health as we build the country, all of us, I thank.
An HON MEMBER: The opposition is trembling.
Question put: That the Bill be agreed to.
[TAKE IN FROM MINUTES]
Agreed to.
Bill accordingly agreed to in accordance with section 65 of the Constitution.
CONSIDERATION OF FIRST REPORT OF JOINT RULES COMMITTEE ON PROPOSED AMENDMENTS TO CHAPTERS 1 - 2B OF THE JOINT RULES OF PARLIAMENT (6TH EDITION), 2023
Mr A J NYAMBI: Hon Chairperson of the National Council of Provinces, Minister, Deputy Minister, hon members of the executive council, MECs, representative of SA Local Government Association, Salga, Chief Whip of the National Council of Provinces and hon members, section 45 of the Constitution states that Parliament, the National Assembly and the National Council of Provinces, must establish a Joint Rules Committee to make rules and orders concerning the joint business of the two Houses. The purpose of the rules is in principle to set up a framework within which members and political parties who are often opposed to each other can engage and interact in a democratic and meaningful way, one which gives expression to the will of the people. Indeed, without rules it will be very
difficult for Parliament to discharge its constitutional mandate.
The Joint Rules deal with, among other matters, order in joint sittings and rules of debate, joint committees, the legislative process and the code of ethics for parliamentarians. Hon members, the Joint Rules were last comprehensively reviewed over 10 years ago. Of course, the rules are living articles and Parliament has evolved. New practices have developed, not least owing to the recent pandemic and the fire. In this context, the Joint Rules Committee decided that a comprehensive review was necessary.
This review was first initiated in the Fifth Parliament but could not be concluded. The Sixth Parliament therefore resumed this endeavour.
The Joint Rules Subcommittee on Review of Joint Rules has since finalised Chapter 1 and Chapter 2 of the Joint Rules of Parliament, as stated by the hon Chairperson of the NCOP which deals with definitions, sources of authority and application, Joint Sittings of the Houses, Joint Rules applicable to virtual and hybrid joint sittings, and the rules on order and joint sittings, and the rules of debate. Work was also done on other chapters, but this requires further scrutiny. Owing to
the limited time this year, the Joint Rule Committee opted to consider Chapter 1 and 2 in the interim.
In summary, substantive changes proposed to Chapter 1 and 2 include, among other sections: One, the inclusion of sources of authority for the rules; two, public participation in Parliament; three, the opening of Parliament and the state of the national address; four, the responsibilities of presiding officers; five, the conduct of members; and the last is the point of orders and question of privilege.
Hon members, the rules can only achieve their purpose if members understand and appreciate their intent. It is therefore always preferable for the rules to be based on consensus. Therefore, I can report that discussion on the draft were typically constructive and practical with members drawing on their collective experiences and knowledge. One of the key issues raised in the discussion concern decorum and the conduct of members. It would be remiss of me not to acknowledge the repeated instances of disorder in joint sittings. To address such challenges the Rules Committee proposed that the rules be clarify so that members know the powers conferred and limitations imposed on them.
What is more, the authority of the presiding officers has been reinforced, but members, as I have said, it is incumbent on all of us to respect the rules and the good standing of Parliament. Hon members, by way of conclusion, let us make use of the rules to advance our agenda and the people’s business. With these comments, I would like to endorse the proposed rules and commend them to the House for adoption. I thank you, hon members and hon Chairperson, as I table the rules. Thank you very much.
Debate concluded.
Question put: That the Report be adopted.
In favour: Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, Northern Cape, North West, Western Cape.
Report accordingly adopted in accordance with section 65 of the Constitution.
The CHAIRPERSON OF THE NCOP: Thank you very much. Hon members and delegates, let me take this opportunity to thank the Minister - he has already left - for his participation in this debate and for being here as we looked at various kinds of
issues in detail. I also like to thank the permanent delegates, MECs, special delegates, and the Salga representatives for availing themselves for the sitting as indicated. Hon delegates, that concludes the business of the day. The House is now adjourned.
The Council adjourned at 18:25.