How is South Africa going to implement NHI when corruption is so rampant?
| Jurisdiction | South Africa |
| Date | 01 December 2022 |
| Published date | 01 December 2022 |
| Pages | 76-76 |
| DOI | 10.7196/SAJBL.2022.v15i3.741 |
December 2022, Vol. 15, No. 3 SAJBL 76
EDITORIAL
As 2022 came to a close, it became patently clear that the fight against
corruption in South Africa (SA) was no longer an uphill battle, but a
mammoth crusade. The reality that corruption had become endemic
and pervasive was overwhelming, tarnishing and even ruining the
festive period for most people in the country. Despite SA having
the third-largest economy in Africa and a strong history of activism,
because of corruption it has been rated the most unequal country
in the world.[1] Improper use of public resources for private ends has
become progressively rampant since the dawn of our democracy, is a
shameful reflection of the failure and betrayal of the ruling party, and
has resulted in a huge trust deficit developing between the state and its
citizens. Characterised by lack of transparency, weak accountability and
inefficiency, corruption is a typical outcome of poor governance.[2]
State capture, political corruption whereby the state’s decision-
making processes are significantly influenced by private interests, was
detailed explicitly by the Zondo Commission.[3] Between 2014 and 2017,
it had already been estimated that state capture cost the country up
to ZAR250 billion[4] and reduced the country’s GDP (gross domestic
product) growth rate by ~4% a year.[5]It has been stated that the damage
caused by state capture during the Zuma administration impacted the
country’s economy so negatively that it effectively undid the efforts of
theMandelaandMbekiadministrations in developing the economy.[6]
The effects of corruption have been catastrophic in all aspects of
life for all in the country, except, of course, for the corrupt. Population
health outcome is impacted negatively by this abuse of trust and
intentional violation of duty.[2] This is particularly severe for the poor
and disadvantaged. In SA, health facilities are exposed to corruption
by the architecture of their governance. Hospitals in the state sector,
most accounting bodies and regulators have chief executives who
are political appointees. And this has been the situation for close on
30 years, with political nepotism, cadre deployment and patronage
being the norm. For example, cliques are deployed bypoliticians so
that human resources, procurement and licensing for facilities can be
manipulated. With the current state of health services, it is evident that
the wrong people are chosen for these executive jobs in the public
sector. This patronage system with its illegal spending runs far too deep
and costs the country billions of rands yearly. Irregular expenditure,
i.e. contravening legal supply chain processes, is a strong indicator
of corruption. During 2020/2021, the Gauteng Department of Health
packed away ZAR3.8billion in irregular expenditure. This was more than
double the amount from the previous year. Rampant dishonesty prevails
because the corrupt are protected from the consequences of their
misconduct, and the honest, dedicated and committed are removed or
threatened with removal.[7]
The current picture of the public healthcare system is that it is hanging
by a very fine thread, and nearly ready to crash from its precarious
breaking point. The lived reality of 50million South Africans is that of
standing in queues from 4 am with no guarantee of seeing a healthcare
worker or even getting to the pharmacy before it closes. These long
waits are often futile as a consequence of stock-outs and the lack of
medical equipment because of unpaid bills and deliberate, unashamed
theft within the facilities, and with networks on the outside.[8] Given the
brazen corruption at the level of the power utility, Eskom has plunged
the country into darkness with prolonged periods of loadshedding.
Electricity and water outages are commonplace in our healthcare
facilities.
There is little to no assistance from officials whose lexicon is devoid
of care, caring and compassion. Corruption has flouted several
Constitutional rights of people living in SA, including the right to
healthcare. In the midst of this unbridled corruption, the very same
corrupt government ironically pushes forward with its plans for universal
health coverage (UHC) through the National Health Insurance (NHI).
The goals of UHC, such that everyone needing healthcare can access
quality services without financial hardship, and attain sustainable health
outcomes, are laudable. This is something we must strive for, as it is a
step in the right direction to attain justice in health for all. It is essential
for health systems to be strengthened so that primary healthcare
improves. But for this to be successful, government needs a reality check.
Corruption must stop undermining our quest for equity, quality and
responsiveness, and die the death it deserves. But will it? Is eradicating
corruption a pipedream? And if so, will our long-awaited NHI be a
pipedream too?
Ames Dhai
Editor-in-Chief
ames.dhai@wits.ac.za
1. Pillay K. South Africa – a snapshot of its journey against corruption. Transparency
International, 2022. https://www.transparency.org/en/projects/enforcement-of-
african-commitments-against-corruption/data/tea-cac-south-africa (accessed
20 January 2023).
2. Naher N, Hoque R, Hassan MS, Balabanova D, Adams AM, Ahmed SM. The
inuence of corruption and governance in the delivery of frontline health care
services in the public sector: A scoping review of current and future prospects
in low and middle-income countries of south and south-east Asia. BMC Public
Health 2020;20:880. https://doi.org/10.1186/s12889-020-08975-0
3. Phillip X. South Africa: 10 facts to know about the Zondo Commission reports.
The Africa Report, 27 May 2022. https://www.theafricareport.com/207302/
south-africa-10-facts-to-know-about-the-zondo-commission-reports/ (accessed
22 December 2022).
4. Citizen. R250bn lost to stae capture in the last three years, says Gordhan. The Citizen,
12 September 2017. https://www.citizen.co.za/news/south-africa/r250bn-lost-to-
state-capture-in-the-last-three-years-says-gordhan/ (accessed 21 December 2022).
5. News24. Damage from state capture ‘worse than suspected’ – SARB. News24, 6
June 2019. https://www.news24.com/Fin24/damage-from-state-capture-worse-
than-suspected-sarb-20190606 (accessed 24 January 2023).
6. Mahlaka R. Years of Zuma. Current and ex-Treasury ocials: State capture
nearly destroyed South Africa. Daily Maverick, 31 January 2022. https://www.
dailymaverick.co.za/article/2022-01-31-current-and-ex-treasury-ocials-state-
capture-nearly-destroyed-south-africa (accessed 10 December 2022).
7. Van den Heever A. How do you stop a hospital heist? Appoint a blunder-proof
board. Daily Maverick, 17 August 2022. https://www.dailymaverick.co.za/
article/2022-08-17-how-do-you-stop-a-hospital-heist-appoint-a-plunder-proof-
board/ (accessed 20 December 2022).
8. Daily Maverick. NHI in times of collapsing public healthcare, rampant corruption
and deep mistrust ingovernment? Daily Maverick, 1 June 2022. https://www.
dailymaverick.co.za/article/2022-06-01-nhi-in-times-of-collapsing-public-
healthcare-rampant-corruption-and-deep-mistrust-in-government/ (accessed
24 January 2023).
S Afr J Bioethics Law 2022;15(3):76. https://doi.org/10.7196/
SAJBL.2022.v15i3.741
This open-access article is distributed under
Creative Commons licence CC-BY-NC 4.0.
How is South Africa going to implement NHI when
corruption is so rampant?
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