R5 billion wasted on failed NHI pilots could have improved health system 

Issued by Siviwe Gwarube MP – DA Shadow Minister of Health
15 Oct 2019 in News

The Democratic Alliance (DA) can reveal the exact breakdown of the R5.1 billion that has been spent since 2012/13 on the 10 failed National Health Insurance (NHI) pilot projects. This breakdown has been revealed through parliamentary questions published on Monday.

The breakdown of the R5 billion wasted public money is crucial because there are lessons which should be learnt from this process that the Health Minister, Dr Zweli Mkhize, is simply ignoring in the National Health Insurance Process.

Previously, the Public Health Strengthening (Genesis) Report lamented the NHI pilot projects, saying there was “inadequate planning, a lack of resources, inconsistent communication, a lack of coordination where necessary and insufficient mechanisms to monitor progress and thereby ensure course correction”.

Furthermore, last week the Financial and Fiscal Commission (FFC) revealed some shocking statistics on the NHI Conditional Grants in the provinces. The FFC found that there was massive under- expenditure of the grants because there has been no capacity building for district offices to be able to rollout the various programmes.

FFC further noted that for conditional grants to be successful, districts and provinces need to be given at least 3 years lead time. This was never done for the NHI grants. Provinces and districts were simply given money and targets and no capacitation was afforded to them. That is why over R5 billion was wasted and more money continues to be lost to this NHI programme.

They have highlighted that the continuous spending of public money in provinces of these grants is tantamount to servicing a black hole. This will no doubt be exacerbated by the premature and ill-advised implementation of the NHI Fund.

At an average cost of R1.5 million to train a doctor over six years, the money spent on NHI projects could have trained 3 400 doctors and filled hundreds of nursing vacancies. With only 4003 doctors employed in the public sector, this would have brought much-needed relief across the country.

Just during the 2017/18 financial year alone, the Department spent R1.5 billion on NHI projects, with very little to show for it.

Name of the Grant Grant Deliverables (R 000′) 2017/18 (R 000′) 2016/17 (R 000′) 2015/16 (R 000′) 2014/15 (R 000′) 2013/14 (R 000′) 2012/13
National Health Insurance Equipment for PHC facilities and outreach teams, training of staff in SCM, impact assessment of pilot interventions 99 665 63 491 63 605 71 614 78 019
Ideal Clinics Evaluate clinics against ideal clinic criteria and support facilities to reach ideal clinic status 26 590 9 792
Human Papillomavirus Vaccine Two dose vaccination 199 534 189 992 158 719 189 489
Health Professionals Contracting Contracting health professionals and  CCMDD 549 035 361 580 279 780 R82,261 9 457
Health Facility Revitalisation Nursing Education Institutions, maintainance, repair and refurbishment 657 099 686 496 612 623 292 345 373 483
Information Systems Health Patient Registration System, PHC Stock Visibility System and Hospital Stock Visibility System. 83 807


What is clear is that the ANC government seeks to proceed with the implementation of the disastrous NHI Bill despite the fact that the pilots have failed, the lessons from those failed pilots have yet to be taken on board and the continued waste of public money on the implementation of the NHI programme without the requisite training for districts and provinces.

This commitment to an ideological win despite the evidence before the Minister is reckless and a gross display of disregard for public money in a finically stretched industry.

This is why the DA continues to wage a fight against the NHI Bill. This Bill will not achieve universal healthcare or improve the lives of South Africans. The health industry requires a system overhaul instead of this piecemeal, hole plugging, strategy being used. That DA supports the country’s efforts to attain Universal Health Care. That is why we have been proposing the Sizani Universal Healthcare Plan which is a credible alternative to the NHI.