South Africa's First NHI Regulations Set for Public Scrutiny

The South African Health Department has indicated it is gearing up to unveil the first batch of draft regulations associated with the much-anticipated National Health Insurance (NHI) Act. Within the next month, these draft regulations are expected to be open for public comment, marking a significant step toward overhauling the country's health system.

The NHI is a flagship policy of the African National Congress (ANC), designed to facilitate universal health coverage across South Africa. This comprehensive health reform seeks to dismantle the existing two-tier health framework, characterized by stark disparities where a minority of the population affords private healthcare through medical schemes, while the majority are dependent on overstretched public health facilities.

A senior health department official, Nicholas Crisp, the deputy director-general for NHI, spoke to members of the National Council of Provinces regarding the ongoing preparation for the full implementation of the NHI scheme. Crisp highlighted that draft regulations for sections 12 to 30 of the NHI Act, which address the establishment of the NHI Fund's governing board, are in progress.

Once the relevant segments of the Act are promulgated, these proposed regulations will be published in the gazette, kicking off a three-month period where stakeholders can submit their comments. The establishment of the NHI Fund Board is pivotal, as it will be responsible for appointing a Chief Executive Officer and creating the administrative infrastructure necessary for the Fund's operation. However, Crisp noted that setting up these functions could span up to three years, given the requirements for statutory amendments and budgetary planning.

In parallel, the health department is collaborating with provincial health departments to pilot novel contracting methods in primary healthcare services. The pilot programs engage both public and private healthcare workers and focus on essential services like maternity and child healthcare, elderly care, and support for individuals with disabilities, particularly targeting rural areas.

Crisp emphasized that financing for NHI-related activities is currently drawn from a dedicated budget earmarked for the health department's NHI unit. In time, these financial and functional responsibilities will shift to the NHI Fund itself. The deputy director-general underlined the need for a cautious approach to implementing such sweeping reforms, acknowledging the multiple years it will take to transition fully and the imperative to manage change incrementally.