Statement of the National Health Consultative meeting of 24 August 2018

More than 300 participants from a range of organisations and institutions gathered on 24 August 2018 to discuss and work towards strengthening quality health care for all through the implementation of National Health Insurance (NHI).

President Cyril Ramaphosa, who delivered the keynote address, noted that progress had been made in expanding access to health services since the demise of apartheid but acknowledged that major challenges exist.

The President reiterated the commitment of the South African Government to strengthening the health system, including through the progressive implementation of NHI. President Ramaphosa committed himself to providing the leadership to ensure the implementation of NHI. 

Experience elsewhere has shown that NHI implementation is successful if not approached as a single ministry's or single department's responsibility, but rather an overall government responsibility. In most cases, direct oversight of the programme is exercised at the highest level in the country – the Presidency (such as has been the case for e.g. in the United States, Thailand, Canada, South Korea, Finland, Norway etc.), with effective political and technical co-ordinating mechanisms put in place. 

The Department of Health will implement the NHI as part of a number of implementation departments led by the President.  There are many components of NHI that require the involvement of other departments such as registration of  South Africans, fraud and corruption management and mitigation, inter-governmental relations, finance and delivery of health services. 

During the engagement, the President emphasised that the implementation of NHI was a priority for government that required resolute leadership, stewardship as well as transparency and good governance. 

President Ramaphosa stated that “Health must be seen as an investment and not a consumption expenditure”, adding that society should be mobilised and a clear communication strategy be developed to create awareness and understanding of how NHI will work for all South Africans. President Ramaphosa noted that the NHI should ensure that no-one was left behind in terms of access to quality healthcare.

The meeting reached consensus on the urgent need to programmatically implement NHI based on the core principles of human rights, social solidarity and universality, that is, based on healthcare need rather than the ability to pay. This will ensure that no one is left behind in accessing quality health care services. In this collective effort, South Africa will join the worldwide campaign to achieve universal health coverage. 

Several active measures will be required in the immediate, medium and long-term. They include the following:
In the short-term, quality challenges will be addressed.

The stakeholders are invited to make inputs and proposals on solutions to address the challenges in healthcare provision as articulated in the draft National Quality Improvement Plan.

President Ramaphosa has requested that a National Health Summit be held which will explore the challenges faced by the health sector. The Summit will be held in Gauteng on 19 and 20 October. Stakeholders have been asked to submit proposals for inclusion in the agenda of the Summit and many have already done so.

The Summit will be used as a platform to further explore the issues and proposed solutions raised at the consultative meeting. It was agreed that strengthening the health system will require that additional resources be mobilised to support this effort. In the medium term, NHI Legislation will be promulgated in 2019; facilities that meet requirements will be designated as NHI-ready clinics, hospitals, etc., and implementation will start in a phased manner from late 2019.  Full implementation will be reached by 2025.

The immediate objectives of the Presidency and the Health Department, working with other departments, will be able to take steps to facilitate the speedy implementation which are:
• Rapidly and visibly improving the quality of the health system;
• Ensuring that the process towards the establishment of the NHI Fund is executed timeously and efficiently; and
• Ensuring NHI Fund, once the law is passed, rolls-out the programme of covering every South African successfully.

To achieve these goals it will be necessary to establish coordinated political and technical structures that involve relevant government departments to prepare for the implementation of the NHI and quality improvement, further ensure the programme is adequately funded and protected, and successfully implemented while reducing the risks inherent in implementing such a large and complex programme.


Enquiries: Khusela Diko, Spokesperson to the President, on 072 854 5707

Issued by: The Presidency
Pretoria