Spotlight on NHI: Mixed reaction to NHI Bill in Makwarela, Limpopo

Limpopo residents attended the public hearings on the NHI Bill in Makwarela, Vhembe district. Photo: Tshifhiwa Mukwevho

Parliament’s Portfolio Committee on Health has in recent weeks been conducting public hearings on the National Health Insurance (NHI) Bill in Mpumalanga, the Northern Cape, and now Limpopo. KwaZulu-Natal and the Eastern Cape are to follow shortly.

Spotlight previously reported on concerns regarding the politicisation of a public hearing in Mpumalanga. A hearing in Limpopo now seems to have been similarly politicised.

The hearing held on 15 November in Makwarela Community Hall at Makwarela location, in Vhembe district, Limpopo, was initially characterised by struggle songs which overtly gave praise to the “ANC government” for “bringing us a free medical scheme”.

Lost in Translation

At the hearing the chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo, explained the Bill and told those present the NHI Fund will be set up and the Fund – together with the Minister of Health – will then purchase health care services.

Dhlomo also apologised for the shortage of pamphlets that explained the Bill in Tshivenḓa.

“We only realised quite late that they were delivered to the wrong address. So you’ll only get the little of what we have.”

The “little of what we have” was a pamphlet written in incorrect Tshivenḓa without any diacritics but strange symbols which rendered the pamphlet partly incomprehensible and indecipherable. The public hearings was in the Vhembe district that include four local municipalities – Mutale, Musina, Makhado and Thulamela. These municipalities are made up of wards which are home to thousands of Vhavenḓa and Vatsonga people. No literature in Xitsonga was available, and no additional literature, nor the Bill itself, was available in Tshivenḓa – the languages spoken in the region.

On Politics and Corruption

A person introduced as an ANC-member praised the introduction of the bill as he referred to it as a “medical aid scheme”.

The district coordinator for COSATU, Shonisani Sigudu, called for the “speedy finalisation of the NHI Bill as a step towards the realisation of quality health care for many vulnerable groups”.

“Unfortunately, a few organisations with very deep pockets continue to fund the narrative that the NHI is a threat to economic growth and jobs,” she said. “This narrative unfortunately takes us backwards and denies the poor and the working class their fundamental right to quality health care.”

According to former Thulamela Municipality Councillor Grace Mahosi (ANC), South Africa’s health system has not benefited all equally, especially the poor.

The South African Communist Party’s Thanyani Sigidane unapologetically brought politics into his speech and declared the idea and implementation of NHI will boost “our chances to win the next round of local elections [in 2021]”. The SACP forms part of the tripartite alliance which include the ANC and COSATU.

The South African Democratic Teacher Union’s (SADTU) secretary in the Vhembe District Robert Maphaha supported the NHI Bill, but not without a warning to those tasked with implementing it. “The provision of this health scheme should start in the areas where most of the disadvantaged communities are populated,” he said. Maphaha also called for a clause in the Bill that can safeguard NHI against corruption. “That clause must be included so that we close the corruption valve.”

In an incident that was quite telling about the mood in the hall, one woman identified herself as a Democratic Alliance (DA) member and was booed when she pointed out that she did not support the NHI Bill. The committee chair had to intervene before she could continue.

Coming, going and hunger pains

The timing of the event (between 16:30 and 20:30) did not suit everyone. Some people arrived late and many left early. At around 17:30, an attendee who had arrived was given ticket number 327, but by Spotlight’s estimation there were about 200 people inside the hall at that time. Many people kept walking in and out of the hall during the hearing.

When Spotlight approached some of the people to ask why they were leaving early, two said they had other commitments to honour since it was quite late. Three other people said they were leaving because they were hungry and that the government didn’t provide catering for the event.

It was only towards the end of the public hearing and after the singing of many songs by people wearing ANC T-shirts, that the more critical views on the Bill were aired. By then however, most attendees had left the hall and there were not more than 100 people present.

The secretary of the Traditional Health Practitioners Association in Vhembe Matamba Mamuremi berated the government for its “continued exclusion of traditional health practitioners”. He called for the inclusion of traditional health practitioners as service providers under NHI so that they can help patients who opted for traditional health care services. According to a statement released by Parliament over the weekend, this call was echoed in the other Limpopo districts of Mopani and Sekhukhuni where hearings were scheduled.

Mamuremi said that the same opportunities and funds given to private or public health practitioners should also be given to traditional health practitioners, because they are not mere healers but “doctors” who should be recognised as such.

Mamuremi said they support the NHI.

DA councillor Mafanedza Kwinda slammed the government’s intentions and said it was not in a position to finance this Bill  and cannot succeed while the country’s health system is not on par.

“I do not support this bill,” he said. “There are hardly services in our clinics, health care centres and hospitals. Government utilises services of private doctors in its health care centres; these are the very doctors who render shoddy services in the government health care centres and go on to provide quality services in their own private practice. These doctors are only in the government health care centres to seek monies and nothing else. They don’t care about people’s health.”

Kwinda was concerned with the idea that the government would pump monies into the NHI Fund without any reputable, trustworthy service providers.

“Who is going to render those services?” he asked. “People are in need of health care services and not an NHI Fund which will benefit tenderpreneurs and their allies in government and not the people themselves.”

By the time councillor Mahosi was requested to close the hearing session with a prayer, there were no more than 15 participants or attendees left in the hall.

*This article is a joint production between Spotlight and the Limpopo Mirror.