Parliament's opening: GNU's NHI execution a key test for government cohesion

Source: Reuters.

This was a key point in President Cyril Ramaphosa's address at the Opening of Parliament, where he detailed the new government’s agenda, priorities, and policies for the next five years.

As the government moves forward with implementing the NHI, the President said that the State will concentrate on strengthening healthcare infrastructure, enhancing the training of healthcare personnel, and utilising technology to improve healthcare management.

“In implementing the NHI, we are confident that we will be able to bring stakeholders together, and that we will be able to resolve differences and clarify misunderstandings,” he said.

Healthcare inequality highlighted

In a debriefing following Ramaphosa's address, newly appointed Health Minister, Aaron Motsoaledi emphasised that the "NHI is an obligation for South Africans who are well-to-do". "We cannot continue to live in a country where people are sick and will only have access to care based on the depths of their pockets," he said. "It's an imperative that South Africans get access to good quality healthcare."

Motsoaledi said that South Africa is one of the most unequal societies in the world.

“If you want to see what inequality means, come to the health sector in South Africa. Within the borders of the same country, some are getting world-class healthcare, while others get such poor healthcare, you may believe we live in different countries,” he said in his Budget Vote Speech.

He cautioned that the country can no longer sustain such 'gross inequality'.

But whether a multiparty government can deliver on the NHI was not covered by Ramaphosa on Thursday, 18 July 2024. However, Motsoaledi commented that he 'did not know of any parties within the GNU that stand against the concept of universal healthcare—the bedrock of the NHI.'

GNU's consensus challenge

"The question remains whether the GNU can withstand the challenges if a single party's ability to veto and the GNU's ability to achieve consensus is not met," said Wisahl Jappie, a key figure at Ethicore, a professional African government and public-affairs firm.

She was representing Momentum at a thought leadership seminar during which Ethicore shared its expectations for the NHI under the government of national unity (GNU).

Jappie said there was no reversing the approval of the NHI Bill, which was signed by President Cyril Ramaphosa on 15 May 2024, but noted that other parties and Parliament can still propose amendments to its clauses or new policies. She said that litigious actions may prompt review and changes to the NHI Act irrespective of what has been decided at the level of the national executive.

"The ANC - holding key positions including the Minister of Finance and Health - will influence health policy, aiming for consensus on the National Health Insurance (NHI) Act in its current form. If consensus-seeking remains the approach, it will be debated within the Cabinet," she said.

But she noted, divergence within the State and among the parties is to be expected, which raises questions about whether the GNU can present a unified voice and language.

"The challenge will be for them to collectively articulate a clear health policy and position regarding the NHI.

"How they handle this will be a key test for the government going forward."