The government’s response to the Covid-19 pandemic is a building block towards South Africa’s healthcare future under the National Health Insurance (NHI) programme. 

This is according to President Cyril Ramaphosa, who gave the strongest endorsement yet of the NHI, emphasising that the pandemic that has gripped the world would not derail efforts to implement the controversial universal healthcare programme. 

In fact, Ramaphosa said, the government’s reliance on a private-public partnership to deal with the coronavirus outbreak adequately prepared the ground for the NHI.

"Because of Covid-19, we have had to quickly improve our health system to be ready to serve everyone, regardless of their ability to pay - which is a fundamental principle of the NHI," he said. 

The president was engaging with editors and senior journalists during a virtual forum organised by the South African National Editors' Forum (Sanef) on Sunday. 

He repeatedly spoke of the NHI as the silver lining to this unprecedented healthcare crisis.

"This could well be seen as the genesis of an NHI, because no one who has been infected by Covid has been turned away. They have been accepted and admitted to our health facilities. This is precisely what the NHI is aimed at doing," Ramaphosa said. 

Health Minister Zweli Mkhize has repeatedly referenced the importance of the NHI when talking about government’s response to the Covid-19 pandemic.

Public sector union Nehawu has argued that the implementation of the NHI had to be sped up in the wake of Covid-19. But the private sector has been less than optimistic. 

Less than optimistic 

While Ramaphosa remains optimistic about the NHI, tensions between government and the private sector over Covid-19 have been simmering. 

News24 reported last week that government had offered private healthcare providers a flat rate for treating Covid-19 patients, but the private sector has not accepted the offer.

Negotiations between the sectors has been ongoing for months, with a mutual understanding that they would need to work together to prevent the healthcare system from being overwhelmed once the epidemic reaches its peak, about late August.

Documents seen by News24 show that the department has offered private doctors and specialists a R2 493 per diem rate for their services, excluding extra costs like intubation, if they treat "state responsibility" patients in private facilities.

The tensions over agreements signed between private healthcare and the public sector are the backdrop to concerns around NHI.  

News24 reported that some doctors are concerned that the agreements will be used when the NHI becomes a reality, and that the terms will remain permanent.

This means that, whichever per diem fee is agreed to now, during the pandemic, would remain in place as the NHI fee for specialists. 

An agreement on the terms of the partnership is yet to be finalised. 

Life after Covid-19

Ramaphosa has previously said that, whether people liked it or not, the NHI had to be implemented. 

On Sunday, he gave the clearest indication yet that the NHI would become a reality, referring to it as the silver lining of the Covid-19 pandemic. 

"We're going through the process now of putting in the pillar of the NHI, and we want to see Covid-19 leaving a legacy of an NHI we can be proud of into the future," Ramaphosa said. 

He said that 52% of Covid-19 patients who had recovered had gone through the country’s healthcare system.

Ramaphosa said this was an indication that the country’s healthcare system could live up to the challenge of what's to come after the pandemic. 

"Without regard to your status in life, how much your earn, where you live, people have been admitted to our health facilities and given treatment," he said. 

The president said he was of the opinion that, apart from setting up field hospitals, facilities in existing hospitals should be expanded, so "we can benefit from this post Covid-19".