While the African National Congress (ANC) welcomed Cabinet's decision to release the National Health Insurance (NHI) green paper for discussion on Thursday, the opposition contended it would not achieve its purpose.

ANC spokesperson Zweli Mkhize said measures were needed to overcome the huge inequalities characterising the fragmented, inefficient two-tier health care system.

There was also a need to fundamentally change the way health care was funded and provided in both the public and private sectors.

Given the huge health care resources at the country's command, the question was not whether NHI was affordable, but about making quality health care affordable to everyone, he said in a statement.

This included funding for health services such as antiretrovirals on a sustainable basis.

"It is possible to establish a publicly funded and publicly administered NHI which provides comprehensive and quality care to everyone and accessible free (no user-fees for services covered by NHI) at the point of service."

A single, integrated health care system strongly founded on the principles of a primary health care approach, the right to health care, social solidarity and universal coverage, and a not-for-profit and publicly administered NHI fund had to be built, Mkhize said.

However, Mike Waters of the Democratic Alliance said that while solutions for health care problems needed to be openly debated, the presently mooted, cumbersome NHI plan would not reach the required outcome of achieving quality health care for all.

Around 85 percent of South Africans relied on the public health care system for all their health care needs, and as it stood, the public health system was crumbling, he said in a statement.

The rising costs of private health care were beyond the means of the vast majority of South Africans.

The poor level of public health care would be a major problem even in a healthy society, but considering South Africa's heavy burden of tuberculosis and HIV/Aids the problem was seriously intensified, said Waters.

"It is crucial that a means to deliver quality health care for all is identified," he said.

"While the DA supports individual aspects of a NHI such as compulsory medical aid contributions, we believe that an expensive, complex, and layered system is not the solution to tackling the health care problems facing our country."

Congress of South African Trade Unions (Cosatu) spokesperson Patrick Craven also had reservations about the green paper, but in this instance about the "reassurances the minister gave to the private health care sector" that it had a role to play in NHI.

Others were that the intent of the NHI was to draw on the strengths of both health care sectors (public and private) to better service the public; that people would be able to continue to buy medical scheme cover; and private sector health care providers would be free to choose whether or not to contract with the state.

"In particular, Cosatu is totally opposed to the proposal to introduce a 'multi-payer' system, under which private medical schemes will be allowed to charge the government for a proportion of the treatment they deliver to their clients," he said in a statement.

The South African Communist Party said it welcomed the document's release, but would nevertheless continue its campaign on health which demanded, among others, well-resourced public hospitals with basic medication and other facilities.

Other demands included functioning community health clinics with staff and medication, accelerated implementation of the government's comprehensive HIV/Aids programmes, and improvement of the wages and conditions of service of all health workers, including community health workers.

"We will furthermore seek to create structures to strengthen people's participation in the transformation of our public health system and its institutions," it said.

The ANC Youth League said the "chapter of massive inequalities on health care provision should gradually be closed, because the lives of all South Africans are valuable and can never be compromised because of socio-economic standing".

"It is sad that in South Africa the inequalities in health care provision are defined along racial lines and this is evident through the fact that the life expectancy of black South Africans stands at 48 years, while the life expectancy of white South Africans stands at 71," spokesperson Floyd Shivambu said in a statement.

The NHI should therefore guarantee all South Africans access to quality health care in all medical and health care facilities, he said.

The National Education Health & Allied Workers' Union welcomed the release of the green paper.

"This is long overdue as it takes place nearly a year after the ANC's National General Council categorically stated that there was a "strong social and economic case to implement a national health insurance (NHI) in South Africa without delay," Nehawu said.

"Nonetheless, the release of the Green Paper is a major milestone for the ANC-led alliance and the country as a whole towards fulfilling one of the five national priorities set out in the election manifesto supported and mandated by the overwhelming majority of our people in 2009."

Nehawu particularly welcomed the minister's unambiguous reaffirmation of the essence of the NHI as providing access to health care "as a human right" and based on the principles of universal coverage for all citizens of South Africa.