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Health Minister, Dr Joe Phaahla, has described the adoption of the National Health Insurance (NHI) Bill by the National Council of Provinces (NCOP) as a historic and important milestone. 

The NCOP passed the NHI Bill in Parliament in Cape Town on Wednesday with backing from all provinces, except the Western Cape. 

“Today marks another important milestone on the journey by the country to realise Universal Health Coverage (UHC) to ensure universal access to quality and affordable healthcare for all South Africans, as enshrined in the Constitution,” Phaahla said on Wednesday. 

Click here for "All you need to know" on the NHI.

Although there are still other processes to be followed before the Bill is signed into law, the Ministry of Health said it was pleased with the progress made so far.   

“This is a landmark moment for our country and specifically for our health system as we move towards realising Universal Health Coverage through the phased-approached implementation of NHI as a mechanism to ensure equitable access to quality healthcare for all citizens,” the Minister said.

He said he is confident that with the support of all stakeholders, government will create a healthcare system that is fair, efficient and accessible to all.

Phaahla believes the provisions outlined in the NHI Bill represent a comprehensive and transformative approach to healthcare delivery in South Africa. 

“It is founded on the principle that every South African, regardless of their socio-economic status, should have access to a comprehensive set of health services without facing any financial barriers.” 

Reflecting on the positive outcome of the NCOP vote, Phaahla said it was crucial to remember the significant strides made in advancing the necessary policy and legislative frameworks to support the implementation of NHI. 

“There have been positive and negative experiences in our taxing journey for us to reach this point. The journey in the process of the NHI Bill has not been without challenges,” he admitted. 

These, he said, include financial considerations, workforce capacity, and the integration of existing, in some instances parallel, healthcare systems. 

“These are issues that we must continue to collectively work together, to find the most practical solutions, to effectively and efficiently meet the health needs of our people.”

Meanwhile, he said the State remains committed to addressing these challenges through strategic planning, collaboration with stakeholders, and ongoing evaluation of the implementation processes.

“We recognise and appreciate the role that proactive stakeholder engagement plays in implementing such an important policy and legislative reform.”

According to Phaahla, the Ministry has since developed and adopted a comprehensive approach to stakeholder engagement to ensure diverse perspectives are considered as the country forges ahead with implementing NHI. 

“Regarding the next key steps, we look forward to the Bill being forwarded to the President for consideration and promulgation. Once it receives Presidential assent, the Bill will become an Act of Parliament, creating a statutory mandate for the Minister and the National Department of Health.”

This will, the Minister said, enable key institutional and organisational structures, such as the NHI Fund, to be formally established in line with the provisions of the NHI Act. 

“However, it is important for all stakeholders and the general public to note that this does not mean the provisions of the NHI Act, once promulgated, will all be implemented once-off without due consideration of the key requirements for transitional arrangements. 

“Our intention has always been to have a rational, structured and phased approach to implementation. Without the accompanying regulations, directives, and operational procedures, the transformative impact of the Act cannot be realised,” he explained. 

The Constitution empowers the President to set different dates for the effectiveness of various provisions within the Act. 

According to the Minister, the department will prepare detailed regulations, covering all aspects of the process. 

“Accordingly, the Minister will publish these regulations for public comment, encouraging transparency and inclusivity in shaping the governance of the NHI Fund and its enabling structures. 

“Once regulations are finalised, the Minister and the department will proceed with the establishment of the NHI Fund, a process expected to take between six and 12 months post-proclamation of the Act, with subsequent phases involving additional regulations and implementation steps.”

Ideal Clinic programme

As part of preparations for the rollout of the NHI, government has, over the past years, undertaken the Ideal Clinic programme, amongst other initiatives.  An Ideal Clinic is defined as a clinic with good infrastructure, adequate staff, adequate medicine and supplies, good administrative processes, and sufficient adequate bulk supplies.

It uses applicable clinical policies, protocols and guidelines, and it harnesses partner and stakeholder support. An Ideal Clinic also collaborates with other government departments, the private sector and non-governmental organisations to address the social determinants of health.

Integrated Clinical Services Management are a key focus within an Ideal Clinic. The purpose of Integrated Clinical Services Management is to respond to the growing burden of chronic diseases in South Africa in an efficient and cost effective manner.

The Ideal Clinic programme was started by South Africa in July 2013 as a way of systematically improving the quality of care provided in Primary Health Care facilities. 

According to the Health Department's 2021/2022 Annual Report, there are 1 928 (55%) primary health care facilities that have attained ideal status. – SAnews.gov.za