As the battle to improve the country’s health system rages on, so do the differing opinions around the impending implementation of the National Health Insurance plan (NHI).

It has been called one of South Africa’s most controversial plans, meant to impact the very core of thousands by some, and as a panacea for the poor by others.

The plan, which was in the making for over a decade before being signed into law by President Cyril Ramaphosa in May, has been controversial for what it presents. Some say it is exactly what those without medical aid and no access to private hospitals need; others hold that the system could dump the health sector further into darkness.

It was further plunged into controversy when last week, the Gauteng High Court ruled that the provisions forcing doctors to register for a “certificate of need” were unconstitutional.

Trade union Solidarity and other representatives of private practitioners took to the courts over the need for the certificates, afer which they said they were relieved that sections pertaining to the Certificate of Need were ruled invalid “in their entirety”.

They said these were part of the Department of Health’s attempt to exert more control over where doctors and medical professionals could practise in the country.

The ruling followed Ramaphosa saying, during his opening of his parliamentary address earlier this month, that equitable, accessible, affordable, and quality healthcare would be high on the agenda of the administration over the next five years.

Said Ramaphosa: “An important task of the next five years is to ensure that we also reduce the high cost of living by ensuring that everyone in South Africa has equal access to equitable, accessible and affordable quality healthcare.”

This, he said, would be done through the NHI, where the state would concentrate on strengthening healthcare infrastructure, enhancing the training of healthcare personnel, and utilising technology to improve healthcare management.

But, stakeholders said, he was presenting a system in which everyone would participate whether they liked to or not.

They rubbished his promise to bring stakeholders together to find common ground on the NHI, and said it was more a government plan to win over the masses.

“If there was a plan to improve health sector conditions, there has been plenty of time to do so, in small pockets. Fixing a hospital here, employing staff there, ensuring that drugs were in good supply, bringing facilities to those who desperately need them, that could be a start,” one public doctor, who asked not to be name, said.

And then, he added, there was the stark reality of what it could cost the taxpayer: “The bill will require of everyone an additional up to R3 000 for it to run efficiently, and who has that money when the state does not,” he asked.

The FW de Klerk Foundation’s executive director, Christo van der Rheede, said last week: “The NHI Act, as it stands, falls short and requires substantial revision to align with the Constitution and support effective service delivery, not make it more difficult, to ensure a fair and equitable healthcare system for all South Africans.”

ActionSA, in reiterating their lack of support for the NHI, said at its core it was an attempt to overburden healthcare practitioners with a cumbersome bureaucracy centred in the already constrained Department of Health.

“ActionSA has long argued that NHI, while well-intentioned, is ill-conceived and will not address the shortcomings of the healthcare system in South Africa,” said Dr Kgosi Letlape.

He added that it would only add a third tier to the existing public and private healthcare system and creat a loophole for budgetary irregularities that could enable corruption and further collapse the healthcare system.

Meanwhile, staff, among them doctors and nurses, and other various healthcare workers, said they continued to work in unfavourable conditions as they were short staffed, overburdened, had no medical equipment; and as those who rely on public clinics and hospitals continue to be subjected to long queues, shoddy care, and deaths.

ntando.makhubu@inl.co.za