South Africa’s president Cyril Ramaphosa has signed a new law which aims to provide universal healthcare, two weeks before a general election and despite pushback from the opposition and business groups.
“The National Health Insurance (NHI) is a commitment to eradicate the stark inequalities that have long determined… who receives adequate healthcare and who suffers from neglect,” Ramaphosa said at a televised signing ceremony in Pretoria.
The fund established under the law will provide healthcare for all at rates to be determined by the government, in one of the world’s most unequal nations.
However, it could take years to put the system into practice around the country.
South African MPs approved the controversial new law in June last year after years of debate and consultation.
“The provision of healthcare in this country is currently fragmented, it is unsuitable and it is wholly unacceptable,” Ramaphosa said.
The president slammed the opposition which has been critical of the new law and insisted that South Africa was acting in line with a global commitment.
“Those who are trying to hold us back… are completely out of line,” he said.
South Africa inherited 14 health systems from the apartheid era.
A merged system has limped along post-1994 to spark a parallel industry of private but pricey quality care, which the state argues is unfair and unsustainable.
In 2022, only eight million of South Africa’s 62 million people had access to private medical care, with the rest entirely dependent on the government, according to government figures.
The fund would redress the burdened public healthcare system and private sector’s unaffordability, the president said.
But opposition parties have condemned the move by the ruling African National Congress (ANC), which risks losing its outright majority in May 29 general elections for the first time since South Africa became a democracy 30 years ago.
They say it risks collapsing the health system and have raised suspicions about the timing of the ratification.
The ANC is “willing to sacrifice the country’s entire healthcare system to remain in power for another term,” said the Freedom Front Plus (FF Plus), a small right-wing and predominantly white Afrikaner party.
The second largest opposition party, the Democratic Alliance which has consistently faulted the law, was to hold a news conference outside the Union Buildings where the signing was taking place.
The government has also said the NHI will provide better health outcomes, prevent avoidable deaths and ease poverty.
“The rising cost of healthcare makes families poorer,” Ramaphosa said.
The NHI “will free up resources in poor families for other essential needs and through this, we will be able to reduce poverty.”
