National Health Department curbs Minister’s powers in NHI

When universal health care kicks in, illegal foreigners in South Africa will be limited to only using emergency services and treatment for ‘notifiable diseases of public concern.

This was proposed by Dr Nicholas Crisp, Deputy Director General:?National Health Insurance on reviewing clauses in the National Health Insurance Bill before the parliamentary portfolio committee on Wednesday, 30 November 2022.

The NDoH input strongly reduces the powers of the health minister, increases accountability, and introduces new balances and checks in the administration and operation of the massive NHI fund.

Fine-tuning the definition of people whom the bill excludes as qualifying for free universal healthcare, (such as tourists, refugees, and asylum seekers), Crisp suggested using the single term, “illegal foreigners,’ as defined in the Refugees Act.

The NHI will provide free healthcare to all South Africans, irrespective of income, once they’ve registered for care, requiring only proof of identity.

“We agree with the legislators that failing to properly define who qualifies for care will have negative consequences on our ability to deliver health services in the country,” Crisp told the committee.

Central to the bill is the establishment of a massive single services- and product purchasing fund, enabling economies of scale, and correcting the current huge inequities in access to healthcare.

Crisp’s department is proposing several amendments that dilute the almost absolute powers of the health minister by using parliament and other bodies. His department says there is ‘great merit in adding authority and diversifying the minister’s powers,” by making him or her first submit recommendations to cabinet for approval. This was fully in line with current practice where the cabinet reviews the appointment of senior public officials, he said.

His department also wants to prevent the minister from being able to summarily dissolve the NHI Fund’s Advisory Board when ‘good cause is shown of failure to discharge its fiduciary duties, poor or non-performance or abuse of power.’

Observed Crisp, “it’s quite radical for the minister to be allowed to dissolve the board.”

“We also don’t want the minister to be responsible for the operations and practices of the fund. He must be responsible and accountable for the polices of the fund, so in future he can deal only with the financial and administrative practices of the fund.”

Crisp said his department believed the minister and the Director General of Health should meet with the NHI Fund CEO and the NHI board at least twice per year, though probably more frequently during the early implementation of the scheme while fine-tuning changes. As was standard practice with all boards, the CEO could not fire any member of his board without executive approval.

The NHI Advisory Board, with its own committees (risk, finance, remuneration), plus technical committees would operate along similar lines to the boards of the South African Health Products Regulatory Authority, the Council for Medical Schemes, and the SA Medical Research Council.

However, the NDOH proposed a new sub clause that all members must be impartial and act without favour, fear or prejudice and not expose themselves to risk of any conflict of interests, nor use their position or privileged information for self-enrichment or improperly benefit any other person.

Other advisory committees would be set up to ensure that whenever an official of the fund developed some NHI practice, it was interrogated and objectively assessed before being forwarded to the minister.

This was crucially important when it came to benefits, Crisp said.

No changes were proposed to the current wide-ranging stakeholder advisory committee.

Speaking to Medbrief Africa afterwards, Crisp said he and his department were “very happy that our plans for the NHI are on track.”

“If there are political issues that’s for the parties to comment- but from a health systems reform perspective we at NDoH are happy. We won our court case against Solidarity with costs and are well on our way to filling our key posts and have finally had a chance to refute the many inaccurate comments made during the clause-by-clause discussions.”

Solidarity earlier this month brought an urgent interdict before the North Gauteng High Court trying to prevent the government from implementing the NHI.

It wanted to prevent the NDoH from filling the advertised 44 NHI vacancies crucial to establishing a fully functioning NHI while the NHI Bill is being finalised.

Solidarity’s argument was that advertising while the Bill still has to pass parliamentary processes is unlawful.

It said the government viewed the passing of the NHI Bill as a ‘fait accompli’ and was taking steps to ‘operationalise it,” an approach it described as “irrational, unconstitutional and unlawful.

The court strongly disagreed, awarding costs to the NDOH.

Crisp’s department said this was in the best interests of 85% of the population who were without medical aid and relied on the public health system to receive health services.

Deputy Minister of Health, Sibongiseni Dhlomo, told the portfolio committee he was aware that some healthcare facilities would be delayed in accreditation, but this was being dealt with.

“Those with reservations on the NHI might reflect on our responses. All countries who have gone this route, have reconfigured it to go with their local conditions,” he added.