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FFC warns NHI implementation at risk amid vacancies, procurement failures and stalled IT system

NHI

Banele Ginindza|Published

"The NHI programme has a high vacancy rate in terms of warm bodies to actually do the implementation, also challenges with the procurement. It means that the capacity risks for implementing NHI are becoming more and more astute and more visible," said FCC chairperson, Dr Nombeko Mbava.

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Banele Ginindza

The Financial and Fiscal Commission (FFC) has cautioned that the rollout of the National Health Insurance (NHI) scheme is in serious jeopardy as persistent vacancies, procurement challenges, and poor coordination continue to cripple implementation efforts.

Briefing Parliament’s Portfolio Committee on Health, the FFC said the Department of Health has failed to act on its long-standing recommendations — including the urgent need to establish a single electronic health information system with live patient records — a cornerstone of the NHI’s success.

FFC chairperson Dr Nombeko Mbava told MPs that the NHI’s performance has worsened over the past two years, with a sharp decline in spending efficiency.

"We are seeing that the NHI programme itself has been a decline in terms of performance. In 2023, ony 94% of funds were spent. This has dropped now. In 2024, only 86% of funds were spent," Mbava said.

"So a total amount of R186.8 million was not spent. That amount also includes project funds for the IT system. It is not being implemented because of procurement system challenges and lack of warm bodies."

The Commission also flagged a worrying regression in the audit outcomes of several health entities, including the National Health Laboratory Service (NHLS), the Department of Health, and the Mine Workers Compensation Fund.

"There is stagnation with other entities including the Council of Medical Aid Scheme. The NHI programme has a high vacancy rate in terms of warm bodies to actually do the implementation, also challenges with the procurement. It means that the capacity risks for implementing NHI are becoming more and more astute and more visible," Mbava said.

FFC head of research Chen Wei Tseng said there were “serious misalignments” in how the NHI is being managed, with confusion over its fundamental purpose.

"Why is the target for NHI still about medicine delivery? Why is this medical scheme, the national health insurance, when we speak of insurance it's about risk? How does one prevent risk, account for the probability of risk? In this case, the moment the NHI somehow became a service for medicine. This does not make sense and it is a concern," Tsenge said.

He said the FCC had, over the years, observed that in the health sector the vacancy rates were not aligned to the professional requirements, with in some occasions, accountants being put as project managers and a medical doctor being expected to efficiently oversee Information Technology systems.

The recommendations the FCC said it has made over several years to the health department included, among others, that with human services and vacancy management, the national department and provincial administrations develop and implement a multi-year workforce planning strategy.

It said this would help fund vacancies and need for workers.

The FCC also called on the Minister of Health to instruct the boards of NHLS, Mine and Workers Compensation Fund to develop and implement audit turnaround plans.

"The FCC reiterates its call to government to prioritise building a single electronic health information service with live patient records as recommended in previous submissions. It should be ring fenced for direct implementable activities with clear reporting against milestones," it said.

The FCC said the Minister of Health must prioritize maintaining and improving the quality of healthcare in the public health care system through the repriotisation of the resources and funds for efficiency as the FCC has recommended in division of revenue for 2025/26.

"The FCC further recommends the Minister and other health departments to strengthen accountability mechanisms in public hospitals and provide guidelines to improve management practices," it said.

"On medical legal claims, the FCC recommends a reporting system to improve collection and analysis of legal claim data, including causes, clinical failures and settlement values."

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