25 000 healthcare workers plead with the President to send the NHI Bill back to Parliament…

Close to over 25,000 healthcare workers, allied health specialists, and GPs are appealing to President Cyril Ramaphosa to refer the National Health Insurance (NH) Bill back to Parliament. South African Health Professionals Collaboration (SAHPC) spokesperson Dr Caroline Corbett says they would like it to go back for discussion and active engagement with all the role players.  In addition, the Constitutional Court should be approached and it should be investigated awhether or not the Bill in its current form infringes on the constitutional rights of communities and citizens nationally. “…we’re absolutely not going to stop and sit and watch this quietly be signed off,” Dr Corbett  tells BizNews – after the National Council of Provinces (NCOP) passed the Bill this week. A major concern is that the Bill “doesn’t actually guarantee quality healthcare”. The SAHPC also has “massive concerns” around the governance of the fund in a country where corruption “is rife still, unchecked still, and unprosecuted in most instances”.  Meanwhile, the exodus of healthcare workers continues. “This for many people is the final straw. They’re not actually prepared to wait and see the impact of it attempting to be rolled out.” – Chris Steyn

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Watch here

Timestamps

  • 00:00 – Introduction
  • 00:30 – Associations represented by the collaboration
  • 01:06 – The NHI bill being voted for
  • 02:22 – Is the NHI bill an ‘unstoppable train”?
  • 03:56 – “Procedural smash and grab”
  • 05:04 – Major objections and concerns
  • 09:23 – What’s the next step?
  • 10:23 – Conclusion

Listen here


Highlights from the interview

___STEADY_PAYWALL___

Close to over 25,000 healthcare workers, allied health specialists, and GPs are appealing to President Cyril Ramaphosa to refer the National Health Insurance (NH) Bill back to Parliament. 


South African Health Professionals Collaboration (SAHPC) spokesperson Dr Caroline Corbett says they would like it referred back for discussion and active engagement with all the role players.  In addition, the Constitutional Court should be approached and it should be investigated as to whether or not the Bill in its current form infringes on the constitutional rights of communities and citizens nationally.


She spoke to BizNews after the National Council of Provinces (NCOP) passed the Bill this week.


Dr Corbett says a major concern is the lack of definition of quality. “So there’s a lot of focus on access, even though there’s not actually an outline as to how the access will be provided. But the Bill doesn’t actually guarantee quality. And that we’ve seen already being attempted in clinics that have been built with no staff, in basic primary healthcare services that exist, but with no medication or no doctors or no specialists or not enough nurses.” 


The SAHPC also has “massive concerns” around the governance of the fund. “…We’ve got one of the highest corruption indexes in the world. And we’re now going to say we’re going to put all available funds plus another 200 billion into a central fund where there’s no transparency in a country that corruption is rife still, unchecked still, and unprosecuted in most instances. 


“We’ve…got the Minister of Finance saying there’s no money, but we’ve got everybody else signing it off.”


Dr Corbett says the uncertainty is causing “an enormous amount of emotional damage to our very vulnerable” healthcare workers. “And we are seeing an exodus continue, an exodus that was already pending. This for many people is the final straw. They’re not actually prepared to wait and see the impact of it attempting to be rolled out.”


She adds: “And at the end of the day, the healthcare workers are the ones that are not only gonna roll the Bill out, but they…represent a big chunk of the taxpayers. They represent a big chunk of patients. And they’re a critically endangered, scarce skill resource that is currently holding up what is already a very wounded health system. 


“So watching it being steamrolled through, as you say, without following due process, where you would engage with experts, matter experts who are the people that…have the insight as to how public-private partnerships can or cannot work, how funding mechanisms can or cannot work, and most importantly what quality healthcare actually is supposed to look like, not just access to healthcare, quality care. The fact that none of this has happened is very concerning and we’re absolutely not going to stop and sit and watch this quietly be signed off. It would be completely remiss of all of our responsibilities to the communities we serve.”


Dr Corbett, who has described it as a “procedural smash-and-grab just pre-election”, says “it speaks to the sense of unlawfulness, the violation of dignity of the democracy that you were actually asked and elected to lead by. Without consultation, it’s very much a dictatorial approach of, we’ve drafted this, now we’re going to sign it off, we’ll talk later. That’s not a democracy, that’s not a collaboration. And that’s certainly not showing the kind of diversity of leadership that we had hoped we would see in order to actually provide sustainable universal access to quality health for all of our communities in South Africa.”

Transcript from the interview

Chris Steyn (00:00.4)

Tens of thousands of healthcare workers are appealing to President Cyril Ramaphosa to refer the National Health Insurance (NHI) Bill back to Parliament. We speak to Caroline Corbett of the South African Health Professionals Collaboration. Welcome Caroline.

Caroline Corbett (00:18.454)

Thank you very much. Thanks for having me.

Chris Steyn (00:21.028)

How many associations are represented by the collaboration?

Caroline Corbett (00:26.41)

We represent nine associations, formal associations, and within some of those, there’s subsidiary specialty groups that sit under one umbrella. It’s close to over 25,000 healthcare workers, allied health specialists, GPs around the country. So it’s a large majority of healthcare practitioners in the country.

Chris Steyn (00:52.88)

For four years, people have been fighting to stop the NHI bill, but yesterday the National Council of Provinces voted for it.

Caroline Corbett (01:04.274)

Yeah, we’re deeply despondent on multiple levels. We’ve been attempting to engage since 2019. Many of our associations actually presented to Parliament in 2021. We’ve seen countless letters, requests for direct stakeholder engagement. We don’t believe that you should sign a bill or vote on a bill before there’s been the necessary engagement to make the amendments, because otherwise what we’re voting for is not universal healthcare. It’s just a bill in a document on paper that looks more like a funding mechanism for an completely unreasonable and impossible attempt at health reform. And as a result, we’re going to not stop here. We’re gonna continue to plead that the president send the bill back to parliament or at very least look at whether or not this is a constitutionally sound bill and whether it is not indeed violating some of the Constitution itself.

Chris Steyn (02:08.528)

Do you feel that it is indeed an unstoppable train and that it’s being steam-rolled regardless of how many people feel about it?

Caroline Corbett (02:20.418)

The process has been extremely frustrating to watch unfold. We have had absolutely no attempt whatsoever of any of the Minister of Health, the national or provincial Minister of Health at any level to engage with us, vested stakeholders or business. And at the end of the day, the healthcare workers are the ones that are not only gonna roll the bill out, but they represent a big chunk of the taxpayers. They represent a big chunk of patients. And they’re a critically endangered, scarce skill resource that is currently holding up what is already a very wounded health system. So watching it being steamrolled through, as you say, without following due process, where you would engage with experts, matter experts who are the people that have the insight as to how public-private partnerships can or cannot work, how funding mechanisms can or cannot work, and most importantly what quality healthcare actually is supposed to look like, not just access to healthcare, quality care. The fact that none of this has happened is very concerning and we’re absolutely not going to stop and sit and watch this quietly be signed off. It would be completely remiss of all of our responsibilities to the communities we serve.

Chris Steyn (03:45.28)

I think in a message last night to me you described it as a procedural smash and grab before the election. Why do you feel that is the case?

Caroline Corbett (03:56.494)

So I’m not going to speak on behalf of politics. I’m just a doctor. I’m an anesthesiologist by profession. So politics is certainly not my forté. But we do know what was supposed to happen. And we do know that we were supposed to be consulted. And the smash and grab side of things, it speaks to the sense of unlawfulness, the violation of dignity of the democracy that you were actually asked and elected to lead by. Without consultation, it’s very much a dictatorial approach of, we’ve drafted this, now we’re going to sign it off, we’ll talk later. That’s not a democracy, that’s not a collaboration. And that’s certainly not showing the kind of diversity of leadership that we had hoped we would see in order to actually provide sustainable universal access to quality health for all of our communities in South Africa.

Chris Steyn (04:58.576)

Please run us through your major objections and your major concerns with this NHI Bill.

Caroline Corbett (05:05.826)

So I think mostly what we’re looking at is the lack of definition of quality. So there’s a lot of focus on access, even though there’s not actually an outline as to how the access will be provided. But the bill doesn’t actually guarantee quality. And that we’ve seen already being attempted in clinics that have been built with no staff, in basic primary healthcare services that exist, but with no medication or no doctors or no specialists or not enough nurses. So we urge closer examination of this issue. We’re very concerned about the limitation of healthcare. When you’re looking at accreditation choice and you’re looking at a certificate of need, you’re restricting access, you’re not enabling access. And it’s crucial to ensure that the bill actually promotes accessibility for all healthcare without these unnecessary barriers to health because a certificate of need is a very big issue. In itself, it infringes on a number of rights. The treatment protocols that are spoken about, we’re concerned about. That speaks to an infringement of the autonomy of clinical care. And where does the accountability sit when these treatment bundles are determined by people that are not delivering the healthcare to the patient? Where is the consent? And where is the medical legal liability set if these treatment bundles possibly at a much reduced cost that’s not necessarily putting patient outcomes above cost outcomes. Those are very big concerns for us and we’ve seen that in the managed healthcare space and the private sector. When you start putting finances before fundamental physiology of patients, nothing good comes of that, absolutely nothing good. 

We have obviously massive concerns around the governance of the fund. We’re one of we’ve got one of the highest corruption indexes in the world. And we’re now going to say we’re going to put all available funds plus another 200 billion into a central fund where there’s no transparency in a country where corruption is rife still, unchecked still, and unprosecuted in most instances. Still, we coming out of a COVID disaster when it came to health budget expenditure. And the communities, healthcare workers, taxpayers, non-taxpayers, we’re expected to trust on what basis that this fund will be correctly apportioned, especially when the insight we believe was not there in the drafting of the bill, because nobody was consulted. And, you know, just the narrative of the procedure itself and the process that has been followed has been hugely detrimental to our existing resources.

As I said to you, we’ve got a very vulnerable, very porous to negative media environment in healthcare at the moment. A lot of people are extremely unsettled. They’re suffering extreme burnout post-COVID. There’s a lot of moral injury that has come out of the health sector watching what has happened. We’ve got interns and community service doctors who don’t yet have posts. We’ve got registrars and unaccredited posts waiting for specialisation recognition.

And now to add to this, you add the uncertainty of NHI, because there really is no certainty. We’ve got the, you know, we’ve got the Minister of Finance saying there’s no money, but we’ve got everybody else signing it off. So it’s causing an enormous amount of emotional damage to our very vulnerable healthcare workers. And we are seeing an exodus continue, an exodus that was already pending. This for many people is the final straw. They’re not actually prepared to wait and see the impact of it attempted to be rolled out.

Chris Steyn (09:01.282)

So what would the next step, sorry.

Caroline Corbett (09:05.279)

We could probably talk all day about the concerns. They have all been presented with solutions, not just concerns, with solutions to Parliament. So that’s our frustration is there have been no amendments, no discussion despite the concerns raised.

Chris Steyn (09:23.695)

What would the next possible step be for you?

Caroline Corbett (09:27.734)

We would like to see the President refer it back to Parliament for discussion, for active engagement with all the role players. And I do believe that the Constitutional Court should be approached and that it should be investigated as to whether or not the bill in its current form infringes on the constitutional rights of our communities and our citizens nationally. I think that the intent is certainly not what the finer detail is speaking to. So the intent of the bill, if it is true, is access for everybody, but that’s not what the bill is offering. So we would like to see the intention actually being met, the rhetoric being translated into truth, and the engagement that was promised actually happen so that discussion can be constructive and solutions to the health crisis that we face and can be found.

Chris Steyn (10:28.848)

Thank you. That was Dr. Caroline Corbett of South African Health Professionals Collaboration speaking to BizNews. Thank you, Doctor.

Caroline Corbett (10:38.486)

Thank you for having me.

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