Address by President Cyril Ramaphosa to the National Health Insurance Consultative Meeting, CSIR, Tshwane

Programme Director, Minister Michael Masutha,
Minister of Health, Dr Aaron Motsoaledi,
Ministers and Deputy Ministers,
Premier of Gauteng, Mr David Makhura,
MECs and Members of Legislatures,
Health Professionals,
Leaders of Trade Unions,
Leaders of Civil Society Organisations,
Leaders of Community Organisations,
All key stakeholders in the health sector,
Ladies and Gentlemen,
 
I greet you and I’m glad to be here
 
We have convened this important National Health Insurance consultative meeting with you, as representatives of various stakeholders in our health care system, to engage in dialogue on the current health situation in our country. 
 
More importantly, we wish to emerge out of this meeting having collectively considered and exchanged ideas about the proposed reforms in the legislative and regulatory framework of our health care system. 
 
Finally, this meeting is providing us with an opportunity to broaden consensus around the core principles that will define the NHI. 
 
We have achieved a lot in ensuring access to health care for our people since the dawn of democracy in 1994. 
 
We abolished the apartheid structures of the health care system, rolled out primary health care facilities to areas where they were needed most, and waged an effective battle against HIV and AIDS.
 
We also did a lot to dramatically improve the social and political determinants of health care – including the near universal provision of clean water to millions of the poor, decent education and the provision of social grants to poor households. 
 
The global community marked the end of the Millennium Development Goals era with the adoption of the Sustainable Development Goals in 2015. 
 
The SDG target on health clearly spells out that we have a responsibility to: 
 
“Achieve universal health coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” 
 
It inconceivable that anyone could argue against the need for every South African to have access to health services on the basis of need and not on their ability to pay. 
 
It is therefore the duty of a democratic and progressive government to create policies that ensure that every South African can access quality health care – and not just the rich. 
 
This is especially important in our country with a racialised two-tier health system sustained on the basis of uneven distribution of resources.
 
The National Health Insurance is meant to ensure that all our people, black and white, rich and poor, receive the quality health services they need without the imposition on them of financial hardship. 
 
Our people should be able to access a comprehensive range of health services, including prevention, treatment, rehabilitation and others. 
 
These services – no matter who is providing them – should be of good quality.
 
More recently, the Office of Health Standards Compliance tabled a shocking report to the Portfolio Committee on Health in Parliament, which indicated that on average, health facilities inspected met less than 50% of the required quality health standards. 
 
This is totally unacceptable.
 
In dealing with the challenges raised in that report, we need to use this meeting to exchange ideas on how we can address the severe shortage of essential employees, such as doctors and nurses, and support staff such as radiographers, porters and others. 
 
Our health professionals, who constitute the backbone of the public health care system, have often indicated that they are overworked and exploited as a result of staff shortages occasioned by the exodus of their colleagues to the private sector. 
 
We must accept the reality that the quality of service cannot be improved by a fatigued and demoralised workforce. 
 
The challenges related to the shortage of medical equipment as well as theatre and intensive care unit beds in our public hospitals also requires urgent attention. 
 
The massive backlog of operations in our hospitals owing to the dysfunctionality of our operating theatres must also be dealt with. 
 
Our doctors must not be put in the brutal position of having to fight among themselves, seeking to convince one another on who must be operated on first, and by implication, who must be allowed to perish. 
 
We must change this situation.
 
We must be clear that the resources needed to provide quality health care services represent investment rather than consumption, particularly if you consider the benefits of a healthy population and a productive workforce. 
 
When the NHI was brought to the table ten years ago, some were quick to dismiss it as an “unaffordable dream”. 
 
But Nobel Laureate Amartya Sen vehemently disagreed. 
 
He argued that when properly designed and managed, the NHI is affordable. 
 
This is a view with which we agree and we are determined to prove it. 
 
Achieving universal health coverage is not just about spending more money. 
 
We need to ensure these resources are used efficiently and fairly to scale-up the supply of quality health services for everyone, with enough trained and motivated health workers, and to transform the health system to address the needs of all our people. 
 
We envisage a transformed health system that will not just have better health outcomes, but one that will also save money for individuals, households and the country as a whole. 
 
We must put behind us the era of quality health care being the exclusive preserve of those among us with deep pockets. 
 
The NHI is therefore also fundamentally about social justice. 
 
Providing universal and quality health care for all is not only a matter of moral principle. 
 
It is also a financially responsible decision that will save a lot of money while keeping our people healthier.
 
We need to build on the strengths of the public health system which, notwithstanding its persistent challenges, has helped improve the life expectancy of our people, successfully turned the tide in our battle against HIV and AIDS and rolled out the massive health infrastructure we now have across the country.
 
The NHI can and will be a success.
 
We are a country that is spending R420 billion or 8.5 percent of domestic funding on health care. 
 
This is more than any other middle-income country, and it is very close to advanced economies such as the United Kingdom and Canada.
 
We have decided to cover the whole country on an incremental basis. 
 
This means from 2019, once the bill is passed, we will start to incrementally implement the NHI and by 2025 everyone will be covered. 
 
We are determined to work together to overcome our two-tiered health system, which is the major barrier to achieve a universal health system. 
 
I wish to conclude by urging all our health professionals and general workers in the health sector to understand that the provision of quality health care – and thus the success of the NHI – is literally in their hands.
 
I urge all of us gathered here to do our best to encourage South Africans to adopt more healthy lifestyles and avoid placing themselves at risk of contracting diseases. 
 
We must emphasise that primary health care begins with individuals at a household level. 
 
Our collective approach to health care as a society must be more preventative rather than curative.
 
It is my hope that this consultative meeting will facilitate the necessary partnerships between different sectors of our society towards the NHI. 
 
Without all sectors of society working together we will not be able to build a healthy and successful society.
 
Let us build a social compact for access to quality health care for all. 
 
Let us build the NHI.
 
I thank you.