In my book, “Walking the Road of Healthcare in South Africa”, I reflect on my experiences as a senior bureaucrat and what I term the “argument for meaningful debate”.
A parliament is defined as a “formal conference for the discussion of public affairs” while a legislature is defined as “body of persons having the power to legislate or make laws”. My expectation of the deliberations in such a body or a committee of such a structure, was that there should be a meaningful debate with the exchange of logical and consequent ideas. However in my experience, meaningful debate is often a scarce commodity in the chambers of the South African Parliament and the various Provincial Legislatures. It seems that haranguing a speaker is more often seen as a positive contribution and logical arguments to convince the fellow members of a committee or indeed the chamber of a differing view is almost non-existent. The question can be asked whether the members of the “formal conference for the discussion of public affairs” as a parliament is defined have fulfilled their obligations.
Standing committees which are intended to hold both political office bearers and government officials to account have, in my view, largely failed in this responsibility. At both provincial and national legislature level, my experience of the members of these committees, either MPL’s of MP’s, was that they were mostly ill-prepared and incapable of meaningfully engaging with departmental documents. Often they were arrogantly unaware of the contradictions and irrelevance of their questions put to the department of which I was the head. Nevertheless, governed by the niceties of parliamentary etiquette, I and my staff were obliged to respond with deference to even the most outrageous comments. There were exceptions and their questions and comments reflected the fact that they had studied documents thoroughly and genuinely sought clarity on matters relevant to health care. I enjoyed my interactions with these politicians and although there may have been differences related to policies and interpretation of facts and figures, there was a respect for their views which I hope was reciprocated. It is essential that the public service is held accountable but this is only possible if those tasked with this responsibility are both capable and dedicated to do so. In many instances, it was not my experience that this was the case.
The first two Zondo Commission into State Capture reports reveal a similar pattern of an unfortunate failure of public representatives to hold those in high office political office and political appointments to the boards of State Public Entities to account. The conflict between political loyalty and allegiance with an ability to view facts dispassionately separated from whether or not the individual or individuals concerned are of the same political party is painfully obvious. The most recent interviews of candidates for the position of Chief Justice by the Judicial Service Commission (JSC) comprised of legal practitioners and political party representatives has raised similar concerns. In the latter instance not only were some of the questions posed to the candidates problematic but party politics appeared to colour the nature of the questions posed.
So why on my website devoted to health issues am I raising this matter? Currently a parliamentary committee, composed of politicians, is considering the numerous submissions received related to the National Health Insurance Bill. In a recent media report, the fact that debate at these hearings seemed to focus on whether the input either supported NHI or opposed it rather than the substance of the inputs. This was similarly reflected in public hearings held across the country where political mobilisation was evident with displays of party colours and placards. Members of the committee, in general not experts in the area of healthcare but elected political representatives, it appears have adopted a binary party-linked approach that there can only be support or opposition to the Bill linked to party affiliation. This despite the fact that this legislation has the potential to drastically alter how and by whom healthcare is provided to the South African population. I am concerned that unless there is a meaningful debate understanding the nuances of healthcare, the result may not meet the lofty ideals to which the NHI purports to strive which is universal (quality) health coverage for all in this country.
In a matter of such complexity, it is unlikely that there will not be areas of the draft legislation that would not benefit from meaningful debate where a logical argument backed by facts would alter fixed opinions and political allegiances. Indeed if the draft bill submitted to parliament is not substantially amended after this process, I would question whether a meaningful debate has occurred. Given the shocking abuse of funds originating for Public Entities in South Africa as reflected by the reports of the Zondo Commission to date and the fraud and corruption post so-called State Capture that occurred related to various state contracts for personal protective equipment (PPE) during the COVID-19 pandemic, I am concerned that the pooling of all of South Africa’s health resources in a single public entity, the NHI Fund as envisaged in the draft bill, poses a serious risk. The checks and balances that should have existed with public entities looted during State Capture will be no different than those envisaged for the NHI Fund and should set alarm bells ringing. As one who has devoted his entire professional career to the South African Public Health Service, I support many of the aspects of the NHI Bill, but in my humble opinion the current bill poses unacceptable risks to healthcare in South Africa in its current form. I trust that meaningful debate will triumph and result in an improved Bill that will indeed ensure affordable quality universal health coverage in South Africa. I remain however a concerned South African health professional.
