NHI Is A Pressing Need To Deal With South Africa’s Health Inequalities

Health Minister, Dr Aaron Motsoaledi, has expressed growing concerns about the country’s ability to address health inequalities. 

In his address during the second meeting of the G20 Health Working Group in Durban this week, Motsoaledi says the country’s efforts to invest in accessible, affordable and comprehensive primary health care for all are threatened by the harsh realities of global economic constraints.

“We are witnessing a concerning trend: declining global health budgets simultaneously with rising costs. This is particularly acute in the Global South, where many nations are burdened by unsustainable debt servicing. These debt repayments are cannibalising health budgets, leaving millions without access to essential health services,” he says.

In this year’s budget speech, Finance Minister Enoch Godongwana emphasised the need to prevent debt costs from diverting resources away from critical social needs and investments in growth. This year’s debt cost of R389.6 billion accounts for 22 cents of every rand in revenue, exceeding the combined spending on health, police, and basic education.

The meeting is part of a series of events that will be hosted in South Africa this year as part of the country’s G20 presidency.  

Regressions in UHC 

In particular, the minister draws attention to the lack of progress towards universal health coverage (UHC) as envisioned in the United Nations’ 2030 Sustainable Development Goals (SDGs). 

UHC means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.  

“We are now just five years away from the 2030 SDG deadline, a stark reminder of the urgency required to fulfil the 2030 agenda for sustainable development,” says Motsoaledi.

“This agenda calls for a world where no one is left behind, and with limited time remaining, our actions must be accelerated, impactful, and sustainable.”

He also points out concerning trends reported by the World Health Organisation (WHO) that UHC is on the decline, largely due to setbacks in financing. Now, millions of people around the world face catastrophic health expenditure – defined as out-of-pocket spending exceeding 10% of total income.

“The regression underscores the fragility of our health systems and the urgent need for renewed action,” Motsoaledi says. 

South Africa’s NHI push

These challenging economic times call for innovative financing mechanisms that prioritise health, he says. In South Africa, the National Health Insurance (NHI) is designed to provide financial protection for all to ensure that access to quality healthcare does not depend on one’s ability to pay. 

The NHI Act was signed into law almost a year ago and has faced considerable pushback from the private sector, with some industry bodies challenging the legislation in court. The opposing groups argue that the law fails to address the critical issues of governance in the public sector and equity in the private sector. 

There is also a general lack of trust in the government’s ability to implement NHI successfully, given the history of mismanagement in health and other public services.