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NHI is Mkhize’s biggest challenge

The private healthcare industry and civil society will be looking to new health minister Zweli Mkhize to provide clarity on where the government is going with its long-awaited National Health Insurance (NHI) policy, which made little progress under his predecessor Aaron Motsoaledi. All eyes on him: New health minister Zweli Mkhize has a huge NHI challenge on his hands; how to implement this in a crumbling public health system. He will also need a buy-in from the private health sector and cooperation from the provinces.

Driving through the reforms necessary to breathe life into the government’s ambitions to introduce universal health coverage on the back of an ailing public health system will be Mkhize’s biggest challenge. Given Mkhize’s experience working with business, and his reputation for being a pragmatist rather than an ideologue, hopes are high in the private healthcare industry that the days of a minister of health openly hostile to the sector are over.

Mkhize, 63, is a medical doctor with experience in public health and finance. He is widely regarded as a good listener who gets things done, characteristics critics say Motsoaledi lacked. Despite his passion for his portfolio, Motsoaledi presided over a series of catastrophic service breakdowns in public health during his 10-year tenure. He made little progress in getting the NHI past the policy stage. The cabinet is still to approve the first piece of legislation required to bring into effect the reforms spelt out in the NHI white paper published in June 2017. Mkhize has risen steadily through the ranks of the ANC since returning from exile in 1991. He was KwaZulu-Natal’s MEC for health from 1994 to 2004, before becoming provincial finance minister and then premier. In 2012 he took up the position of ANC treasurer-general and emerged as a potential presidential candidate in the contest to succeed former president Jacob Zuma in 2017. That political weight will be put to the test when he starts dealing with provincial health departments and MECs, who are given extensive powers by the constitution and do not take kindly to orders from the minister and his department.

Motsoaledi complained that he was held accountable for service delivery failures in the provinces that he was powerless to address. Whatever Mkhize manages to achieve with the provinces will cast a spotlight on Motsoaledi’s claim that his hands were tied. Mkhize, who has a reputation for being no pushover, faces an even more challenging task with provincial health departments when it comes to implementing NHI, as it envisages a purchaser-provider split that will effectively diminish their powers. Services for patients will be purchased by an NHI fund, which will bypass provincial health departments and contract with accredited public and private-sector providers.

Observers will closely watch the path the new health minister navigates with the NHI “war room” in the presidency, headed up by Olive Shisana.

The key question is whether he will allow the war room to retain the initiative and delegate to him the role of implementer, or whether he will find a way to bring that capacity into the department with him at the helm.

31 May 2019 Business Day TAMAR KAHN: