Steuart Pennington: Dear Minister Motsoaledi – An ordinary citizen’s concerns over NHI

As a self-described ordinary citizen with a vested interest in his health, Steuart Pennington supports the right to accessible healthcare as outlined in Section 27 of the Constitution. However, Pennington finds that the current state of public healthcare in South Africa is deeply concerning, with a dysfunctional system and many facilities failing to meet basic standards. The NHI’s implications on personal healthcare choices and the potential decline in service quality are alarming, necessitating urgent reforms.

Sign up for your early morning brew of the BizNews Insider to keep you up to speed with the content that matters. The newsletter will land in your inbox at 5:30am weekdays. Register here

By Steuart Pennington

OPEN LETTER TO MINISTER of HEALTH: Dr. AARON MOTSOALEDI

IS OPPOSITION to NHI really an exercise in SWART GEVAAR?

Sir,

I’m just an ordinary citizen with a particular interest in my health. I’m not a doctor nor involved in the medical world, but I am a member of a medical aid scheme. I believe implicitly that my health is my responsibility and that I should be able to choose to manage it the way I see fit! (pi)  I endorse Section 27 of the Constitution which provides ‘that everyone has the right to have access to health care services, including reproductive health care services and no one may be refused emergency medical treatment.’

So, as an interested citizen I acknowledge:

• We have a two-tier system with a particular challenge for the poor who don’t have universal access to functional health care facilities. 
• The current State health care system is dysfunctional, with 45% of our clinics (3479) and 60% of our hospitals (394) ‘not ideal*’
• We have a World Class Private Heath Care system with 200 private hospitals that attract patients from all over the world – Medical Tourism (350 p.a that we know about!) 

NHI

I am aware that the NHI has been signed into law with fierce opposition in that it is impractical, unimplementable and unconstitutional – and will impinge on my health care choices. I also understand that there have been several judgements in respect of the Act which have ruled against the Department of Health (DoH). I have listened to countless radio interviews with Dr. Nicholas Crisp which leave me confused. I understand that the long-term objective is to do away with, or minimize access to Private Health care, which means, if I’m right, I won’t have my choice of a doctor, my choice of a private health care scheme, or my choice of a clinic or a hospital, but rather access to those prescribed by the NHI.

I have just seen the Helen Joseph hospital video by ‘Tom London’ doing the rounds on social media…….

So, as you can imagine, I am concerned, so, as a journalist, did some research.

My research reveals that on the positive side SA ranks 56^th out of 195 countries on the Global Healthcare index which assesses a countries’ health security and capabilities across six categories and 37 indicators (SA in the top 30%)

Our Public Health expenditure at 62% as a proportion of total health expenditure ranks 15^th amongst some selected countries like: Australia 75%; Germany 78%, US 58%; China 54%; Brazil 44%.

But the devil is always in the detail. I unearthed several alarming numbers which the table below reflects:

• Our doctor to population ratio, at 1:1250 is consistent with our 56/195 ranking, but way below the WHO recommended international minimum standard of 2.5:1000. 
• The number of registered GP’s in SA stands at 50635, both Private and Public
• The Number of Clinics/Community Care centers per province
• The percentage of Clinics/Care Centers that are ‘ideal’ defined as having: 
  • Good Infrastructure. 
  • Adequate staff. 
  • Adequate medicine and supplies. 
  • Good administration.
  • Adequate bulk supplies. 

• The number of Public Hospitals per province
• The percentage of Public Hospitals that are ‘Ideal’ as per definition above 
• The number of beds available per province
• The ratio of beds per population in the province, nationally 1 bed per 700 citizens (1.5 beds per 1000 against WHO recommendation of 5:1000 minimum)

Province	Doctor/Population Ratio – Public sector	Registered GP’s	Number of Public Clinics/Care centers	% that are Ideal*	Number of Public Hospitals	% that are Ideal*	Beds available	People per bed
Eastern Cape	1802:1	3702	775	23%	90	22%	13186	506
Free State	1428:1	2053	218	65%	32	50%	6525	448
Gauteng	943:1	17399	369	92%	37	81%	17836	903
KZN	1277:1	9115	605	84%	73	30%	7900	1461
Limpopo	3046:1	1963	482	34%	41	41%	5099	1165
Mpumalanga	2403:1	1987	293	59%	33	33%	20897	226
North West	2788:1	1522	310	58%	20	50%	4432	945
Northern Cape	1535:1	861	162	21%	15	0%	1895	691
Western Cape	648:1	11304	265	75%	52	38%	10786	669
9 provinces		50635	3479	1912	394	159	88686

*Ideal: Good Infrastructure; Adequate staff; Adequate medicine and supplies; Good administration; and Adequate bulk supplies 

Source: StatsSA; The World Bank; The World Health Organisation; The Department of Health SA; Global Health Care Index; SAIRR Annual Survey 2024.

The percentages highlighted in ‘emphasis and italics’ reflect the state of our Public Clinics, Community Care Centers and Public Hospitals and gives a percentage of those which are ‘Ideal’ ie. functional as institutions of health care. It does not tell of the extent to which the ‘not ideal’ have deteriorated.

Medical Aid Schemes

We have 18 Open Medical Aid schemes in SA (can be joined by anybody) and 58 Restricted (for specific employer groups) with a total of 9 699 000 members, 16% of the population comprising (2022 figures)

• 5 100 000 Black members, 
• 486 000 Coloured members, 
• 744 000 Indian/Asian members 
• 3 369 000 White members.  

I understand there are 200 ‘Private’ hospitals in SA owned by Netcare, Medi-Clinic and Life Healthcare which service these medical schemes. While there is no data available on the ‘ideal’ nature of these hospitals, I simply can’t imagine a Medical Aid scheme sending its patients to a ‘not ideal’ public clinic or hospital.  

3 Questions:

1. Of the total of 76 Registered Medical Aid schemes how many use the State provided 3479 Clinics/Care centers and the 394 public hospitals to service their patients, if any?
2. Would you, as Minister of Health recommend a patient to a ‘not ideal’ Clinic, of which 1566/3479 (45%) are ‘not ideal’; or recommend a ‘not ideal’ hospital, of which 235/394 (60%) are ‘not ideal’? 
3. Who is going to finance the restoration of these dysfunctional clinic/hospitals to become ‘ideal’? The same Department of Health that allowed them to become ‘not ideal’?

So Minister,

What’s the NHI plan?

• To ultimately close or minimize the services of 74 Private Medical Aid schemes and ‘require’ that their members sign up for, or contribute to, the NHI?
• To close and/or ‘contract’ with 200 Private hospitals and incorporate them into the State hospital system managed by NHI appointees?
• To tell Doctors who work in Private Health Care that you will employ many of them as civil servants and tell them where to work?
• To fix the 1566 ‘not ideal’ clinics and the 235 ‘not ideal’ hospitals, when you haven’t managed to do that over 30 years?

Conclusion

The way I see it Minister, and the same applies incidentally in our Education system, is that we have a World Class Privately run health care sector servicing 16% of the population existing side by side with State sector that is largely dysfunctional servicing 84% of the population (as the above figures illustrate). This is not a ‘healthy’ (pi) situation, and in violation of Section 27, but surely the way forward is to co-opt private sector expertise into bringing those worlds closer together, raising the bar to the highest common denominator through a much improved Universal Health Care system, not forcing a slide to the lowest common denominator and in so doing taking away my, and every other citizen’s, right to make choices in respect of their health care.

Your insinuation that critics of the NHI are employing ‘Swart gevaar’ tactics does not describe their real concerns; ‘Ordentlik gevaar’ of ‘betrokke gevaar’ of ‘geskrik gavaar’ is more apt. And just asking, where did your son Lethabo go to school?

Read also:

• OUTA: NHI Bill falls well short of universal healthcare goals
• Motsoaledi’s NHI stance risks freedom of choice
• SA’s new health minister backs NHI; Woode-Smith says DA must stop the bill in its tracks

*Steuart Pennington: www.sagoodnews.co.za

Source: The bulk of these figures taken from the IRR South African Survey 2024