According to a report by the Rural Health Advocacy Project (RHAP), the recently passed National Health Insurance (NHI) Bill by the National Assembly is not free from the risk of corruption.

During the virtual launch of a report titled Procurement and Audit Outcomes in the South African Health Sector a discussion was held on the NHI, answering the question: Are the public procurement bill provisions enough to mitigate corruption risk?

The NHI Bill, after 12 years in construction, would represent a significant milestone in achieving universal healthcare coverage for all South Africans.

However, concerns have been raised regarding the governance arrangements of the fund.

According to the RHAP, the Zondo Commission found that procurement regulations were abused to bypass competitive bidding processes.

“So while the centralisation of purchasing of healthcare services by the NHI comes with its own risks, state capture demonstrated how excessive decentralisation of the procurement process enabled abuse by corrupt public officials.”

RHAP director Russ Rensburg said as a schedule three public entity, the proposed NHI Fund would be subject to the Public Finance Management Act 29 of 1999.

“To ensure that corruption risk is effectively managed it is essential that public procurement management and oversight is strengthened.”

Rensburg said looking at financial management trends, lack of compliance with financial management policies, particularly supply chain management policies, have resulted in deterioration of financial management indicators and an increase in the issuing of audit opinions and qualified audits within health departments across the county.

“What we have learned in South Africa over the past 30 years is that great policies don’t always result in great implementation of those policies.

“The NHI is a highly contested bill because it goes to the heart of people’s fears; we just came out of a global pandemic and we saw the value of having optimal healthcare systems and we also saw the downside of having fragmented systems.”

National HealthCare group

Echoing the RHAP discussion, the National HealthCare Group executive chairman, Dr Reinder Nauta, said the passing of the NHI Bill by the National Assembly, although a landmark development, was for many stakeholders a concern in the context of the demise of so many other state-owned enterprises.

“Progress must, however, be made in achieving better healthcare access and affordability for all citizens of the country, and any government should and would no doubt take this same approach.”

While Nauta acknowledged the excellence of the South African private healthcare system, which has consistently ranked among the world’s best, he also recognised the need for broader access and improved affordability in the current healthcare funding industry.

“Our country’s current private healthcare funding industry is predominantly focused on the higher income sectors of society and as such has reached its maturity with little or no future growth prospects.

“With only 8.9 million South Africans covered by medical schemes, there is still much work to be done to ensure comprehensive healthcare coverage for the millions of people who do not have access to reliable healthcare services.”

Commenting on the fears of corruption and misuse of the procurement regulations the Department of Health said strict systems will be put in place.

“There will be strict control systems to prevent fraud and corruption like those implemented in entities such as SARS and the Government Employee Pension Fund,” said national Health Department spokesperson Foster Mohale.