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JEREMY MAGGS: Let’s bring it back to the local news agenda. National Health Insurance (NHI) could be a small step closer, and I stress small step closer, to implementation after the National Assembly passes the bill. So what then is the view of the South African Medical Association (Sama), an important voice in this big and often controversial debate. Joining us now is Dr Mvuyisi Mzukwa, who is the chairperson of the South African Medical Association. So at this stage, firstly, doctor, is this a move to be welcomed or not?
MVUYISI MZUKWA: Well, I’m not sure if we should be saying it’s closer to implementation because by their own admission, it could take even up to 15 years before we see the actual implementation because there are so many challenges, like we raised them in our submissions.
The issue is that one, for you to have such a huge reform like that, you obviously need a workforce that will capacitate the system. As you know, we’re sitting at only 30% of what is recommended by the WHO (World Health Organisation) in our country, and as you know, our hospitals as well, they need attention.
The minister said in Parliament that you need at least about R200 billion to fix the hospitals across the country.
Those are issues that need to be put in place. We still have issues of leadership and governance that need to be attended to. Do you recall the report by the Health Ombud, Professor Malegapuru Makgoba, who raised serious concerns around issues of leadership and governance.
Read: Lawmakers pass contentious NHI Bill
JEREMY MAGGS: So do you think that at this point the project is still viable?
MVUYISI MZUKWA: It’s still a long way to go because even with the Parliamentary process, you still need to go to NCOP (National Council of Provinces), have those provincial debates, go back to the NCOP again, then it’s ready to be taken to the president. But after that, you must expect legal challenges from people who are aggrieved by this whole thing because there are so many issues at stake and people obviously would want to make sure that their voice is heard.
If government can’t listen, then the other arms of government may listen.
JEREMY MAGGS: Dr Mzukwa, underpinning all of this is going to be the issue of funding and still at this point we have little idea where the billions of rands needed is actually going to come from. Isn’t that the principal problem?
MVUYISI MZUKWA: Yes, you’re quite right. We’ve been trying our best to get answers from government as to where are they going to get this amount of money. We are told that there will be a special tax, but we’re sitting at around nine million or ten million or so South Africans who are contributing to tax. Even if we were to combine that with the money that they pay to medical aid, it’s not going to touch even a small thing there.
So, we still want to know because if you recall, that even during the budget speech, there was no mention of NHI in terms of budgeting and you are looking at accommodating about 65 million people in the country. So we still want to understand from government.
Treasury told us in no uncertain terms that they don’t have money and that’s the other reason why they can’t employ healthcare workers because there’s just no money.
So I’m not sure in this dwindling economy where we are going to get that money…
Read: Is NHI the straw that will break Treasury’s back?
JEREMY MAGGS: But we still need to address serious imbalances when it comes to the provision of health services in this country, don’t we?
MVUYISI MZUKWA: There is no debate about that. We all agree on the reform, there’s a dire need for reform, but the how part is what we’re debating. Instead of us sloganeering around this issue, we should be addressing the real concerns because the real concerns are the ones that we’re raising. For example, if you are saying you are going to be implementing such a huge project, it has never been tested in South Africa, there’s no proof of concept. You had those NHI pilot projects that did not yield any answers to the questions that were posed …
So in terms of the reinvestment models and the piloting of the private sector, which had never happened. Also, some of the things that happened, they would find that doctors that were part of that project, they resigned because they were not paid by the state.
So there are so many issues that we need to be worried about, including the issue of, if you are going to be collecting about R500 billion to R700 billion, how are you going to guard against that in terms of corruption?
You can’t have that money without making sure that you have a watchdog in place before you put the money. It can be the money first and later on you think about the watchdog. So this is the very crucial for us.
JEREMY MAGGS: Dr Mzukwa, your organisation is an important voice and a respected voice within the medical community. When you engage with government over the concerns that you’ve just raised to me, are you satisfied with the responses that you get?
MVUYISI MZUKWA: Like I said, you are getting little answers from government. People are saying, ‘no we understand that you’ve got these serious concerns, but let’s wait and let’s just implement in phases and see’. We can’t have that ‘wait and see’ because we have professionals who are uncertain about their future. We need to tell them something very clear in terms of their future. That’s why some of them already, they’re packing and going.
The previous minister referred to us as fear mongering when we told him about people leaving the country.
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But now we’ve got a high number of people emigrating to other countries, specialists, highly skilled individuals.
So, I think we do need answers from government, even as we go through this process, we still have to engage with them to give us clear answers for those ones who are remaining in the country.
JEREMY MAGGS: So if this is not going to be a short-term play, what do you see then are the important immediate mechanisms that need to be put in place to try and arrest issues like the exodus of doctors and deteriorating infrastructure within hospitals and clinics?
MVUYISI MZUKWA: The very important thing is that, first of all, we need to have a listening government. I think that’s the first part, a listening government where professionals can have a platform to air their views and be heard by government. The second issue is attending to their working conditions in the employment space.
If you look at the hospitals now, they need an overhaul in terms of renovations, they are dilapidated, and you need to employ healthcare workers, nurses and doctors.
As we stand now, we’re told that we’re short of around 20 000 nurses and there’s so many of them that are sitting at home, they can’t be employed. We’ve even got doctors who are sitting at home who can’t be employed because the fiscus cannot accommodate it. So those are the real things. If you are telling South Africans that we are coming up with such a huge project, then at least you must show them by building hospitals, by employing healthcare workers, and making sure that the working conditions are conducive, and you don’t have a push factor that is going to kick out healthcare professionals to other countries.
JEREMY MAGGS: Dr Mzukwa, thank you very much indeed.
