Dear Portfolio Committee on Health,

I have been listening and reading with interest to all the announcements concerning the NHI Bill 2019 and I feel compelled to write to you on this matter. Government's communication campaign has clearly sought to saturate the media with a briefing by politicians of the ruling party and allies almost every day.

However, its hard to escape a sense of unease about something that is being foisted on all of us because its an idea to which the ruling party is committed - come what may. I am proud that this is one the few countries on the continent that gives women the right to terminate pregnancy. It was a political risk in a new democracy but it is backed by good science and a right to quality of care. At the same time, we have had disasters in health which set us back decades, you know very well what happened in the early response the HIV epidemic and parliament kept silent. I feel the same about the way in which government is handling the NHI in a context where money is tighter than ever, corruption is rife and the public sector has a very poor track record after 25 years of democracy.

These are my concerns, which I think your committee and parliament need to address frankly and honestly - not with promises that have no basis in evidence.

1. I want to start by saying that I would be first person to sign up for a well managed and effective public health service if it provides decent quality of care to me and any other user, regardless of income or health status. I have worked in both health and education so I know what to expect in the public sector.

2. We don't need more press statements and PR from government. Give all of us the information we need and the opportunity to debate the issues with health professionals and providers from all persuasions, public and private. You bring the Elders to tell us about Universal Health Care - does Graca Machel use public health care anywhere? Please don't insult us. I mean real debate where we can figure out what it will cost in taxes, what services will be covered, what will not be covered, how long should I expect to wait for cancer treatment? How do I know my contributions are well spent and how is corruption prevented?

3. Give us examples in comparable settings where NHI has worked (or not) and what it takes to make it work - not just rhetoric and promises, but evidence. This is not postwar UK. This is a messed up country in the 21st century with many other challenges to deal with.

4. Government have said nothing about how the NHI will change the relationship between provinces and national government, be honest, spell it out. Provincial governments are a sinkhole with strong vested interests. How will this change under the NHI?

5. NHI wants access to the subsidies we pay (i.e. public money) to public servants who currently buy private health care. In case you don't know it, its one of the main motivations for getting a public sector job. Great idea, take it away and put it into NHI and I want to see the reaction from public sector workers including parliamentarians, nurses, teachers and judges.

6. For those of us who don't live off the public purse, we must have a right to choose where to access health care with no constraints. If the service is available in the public sector and I am entitled to (and have paid for it), we want it and not by sitting on a bench for days or waiting for months until someone decides to do the procurement or when a doctor finally becomes available.

7. Where is the commitment to NHI from your fellow politicians? To my knowledge I haven't heard a single parliamentarian say, 'yes, take away my private health insurance, I will gladly rely on the public sector from today'. Every person in our political class makes very good use of private health care. I challenge the Committee to make that happen and I challenge you to get every public sector trade union to say the same. Then I might be a bit more convinced about the level of commitment to NHI. If its good for them, its good for us!

8. More money is not the issue in the health system. We currently have a public system which costs us R220bn annually which is a national shame and used only by those who cannot afford private care. Any factory worker who wants her family to be decently cared for will use her 'medical aid' if she is eligible. Why should we believe that more money will solve the problems of mismanagement, corruption, inefficiency, low quality of care, low morale and shocking failures in service delivery? We spent (i.e. public money) R4bn to test the NHI - and the results are pitiful - is this the basis on which to build a new system?

I fear this is one more example of how we do things in SA - when we can't simply get things to work we rely on making grandiose policy and regulation. Then we all lament 'we have great policy but implementation is a challenge' - for how long are we going to carry on this way? Make the public sector work first so we can all see whats possible!

We resent having to pay taxes (which support the public sector) and pay again for private health insurance. All of us do but its the reality in SA. Now you expect us all to pay for the NHI and simply hope for the best based on promises. But you cannot expect us to pay more for a public sector which simply absorbs more public money with no accountability and gives us more of the same.

Best regards,

Dhianaraj Chetty