In South Africa, President Ramaphosa signs law establishing universal health coverage

South African President Cyril Ramaphosa signed into law Wednesday, May 15, a law establishing universal health coverage

In South Africa, President Ramaphosa signs law establishing universal health coverage

South African President Cyril Ramaphosa signed into law Wednesday, May 15, a law establishing universal health coverage. The signing of this text, which remained in development for a dozen years, comes two weeks before crucial elections.

In the continent's leading industrial power, ranked in 2022 as the most unequal country on the planet by the World Bank, public hospitals are often overcrowded and lacking resources or staff. The most privileged turn to the private sector. But in 2022, only 12% of residents were able to afford this type of expensive care. Called National Health Insurance (NHI), the new health coverage system aims to guarantee some 62 million South Africans the same access to care at affordable rates set by the State, thanks in particular to the creation of a fund financed through taxes and contributions.

“The National Health Insurance System promises to end the glaring inequalities that have long determined who has access to adequate care and who is neglected,” said Ramaphosa at the official signing ceremony in Pretoria. , broadcast live on television. According to the Head of State, the NHI will help “reduce poverty” in a country plagued by endemic unemployment which affects nearly a third of the working-age population.

Implementation of the law, strongly criticized by the opposition, could however take several years. The creation of the financing fund is planned in several phases and will not be done “in one day”, underlined the Minister of Health, Joe Phaahla during the signing.

Intense debates

The National Assembly adopted the controversial bill in June 2023, after intense debates. The opposition fiercely opposed the text, fearing that “the promise of offering everything to everyone” would cause the collapse of an already overloaded system and an exodus of health professionals.

On Wednesday, the first opposition party, the Democratic Alliance (DA), criticized in a press release the signing of a “death warrant for the country’s failing health system”. The NHI, "presented as the panacea for our health problems, is nothing other than an instrument brandished by the ANC [the ruling African National Congress] to manipulate voters in the next elections", according to the DA, which also highlighted an “exorbitant” implementation cost, estimated at the equivalent of more than 15 billion euros per year.

South Africa is holding general elections on May 29, which promise to be tense for the ANC, in power for thirty years. The historic party risks for the first time, in a gloomy socio-economic context, losing its absolute majority in Parliament and being forced to form a coalition government. The ANC is “ready to sacrifice the entire health system to stay in power for another term,” added the FF Plus, a small, predominantly white opposition party.

According to Anja Smith, an economics researcher at the University of Stellenbosch, the country, which has seen economic growth virtually at a standstill for around ten years and at only 0.6% in 2023, “clearly cannot afford such a measure at this time”.

Public health professionals nevertheless hope to see a general improvement in the quality of care with the new instrument. “The public health sector is currently underfunded compared to the needs of the population,” Tracey Naledi, doctor and professor at the University of Cape Town, told AFP. “The NHI could provide additional resources and help improve health outcomes,” she added, while waiting for details on the implementation of the universal system.