Q&A with health minister Joe Phaahla

Healthcare economists, professionals, industry bodies all say NHI is unaffordable and unworkable, but you’re going ahead anyway?

That’s not correct. Maybe the louder and those who have access to the elite media.

And who have done the maths?

What maths?

The maths that shows NHI is unaffordable. Where is the money going to come from?

Are you aware that 85% of the population of South Africa are receiving healthcare from the fiscus?

In theory, yes.

What do you mean in theory?

What quality of healthcare are they receiving?

Are you aware that 1-million babies are delivered in public hospitals a year in this country? How many babies are delivered by private hospitals? Not even a tenth of that — 1-million babies delivered in public hospitals a year, which are funded on less than what is spent on the 15% of those in private hospitals.

Is that why they have to sleep in cardboard boxes?

How many babies sleep in cardboard boxes?

Surely, the fact that any babies have to sleep in cardboard boxes ...

It happened once in Mahikeng because they ran out of cots. Are you aware than 6-million people are receiving ARVs [antiretroviral drugs] from the public health sector? Are you aware that almost on a daily basis these public health facilities treat people with hypertension, diabetes ...

Are you saying we have a public health system that is working pretty well?

It’s stretched because of scarcity of resources but it’s delivering services, it's working.

So why do we need NHI?

We need to make sure that all the resources which those of us with income are contributing we reorganise, so that you don't have a situation where out of the R500bn spent on healthcare in the country almost R260bn is spent on only 15% of the population.

Aren't you telling me the public healthcare system we have is providing adequate services?

It's looking after 85% of the population and even those who are supposed to be looked after by the private sector as their funds run out.

Is that a problem for you?

Why should that happen? The private sector makes a profit out of these people who are then told their funds have run out. They have taken their money, they must look after them irrespective. That's what we want to create, to make sure people who have income contribute to the provision of health services for all. And it's working in many other countries.

Countries that don't have 46% unemployment and zero-growth economies?

Their economies have been growing but their coverage of health services did not wait until their economies started growing.

How is NHI affordable with 46% unemployment and a flatlining economy?

I think the numbers we can play around with.

Is that what the president means when he says the financial hurdles of NHI can be navigated later?

No, no, in the policy document we've said “according to what the country can afford". It will be in stages based on the availability of resources.

Why is your Gauteng premier promising people free private healthcare the day after the elections?

We've said to him he is misunderstanding how this is going to work.