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Doing panga surgery with the National Health Act

Legislators are like tik addicts. They’re convinced that after just one more hit they’ll find Nirvana.

But the law, especially when cack-handedly drafted, is an imperfect instrument for changing society. It’s like using a panga for plastic surgery: the results are likely to please neither practitioner nor patient.

Filled as it is with a righteous zeal to correct the wrongs of the past, the African National Congress has since 1994 unleashed a slew of social engineering legislation. Unfortunately, some of it has been so poorly drafted that it has fallen at the first hurdle when challenged in the courts.

And some laws, despite the ANC’s admirable intentions, have been so poorly conceived that they have had perverse consequences, outcomes predicted by many commentators but ignored by a governing alliance. After all, this is a government less driven by delivering modest, incremental improvements than it is by a grand, utopian vision engendered by Marxist ideological fervour.

For example, the various bits of legislation intended to fortify the often shamefully flouted rights of black labour tenants on white farms achieved the exact opposite of what was planned. The idea was to stabilise an agricultural sector where worker and family live at the place of employment and had the right to supplement their mostly low wages with some subsistence farming on the side.

Instead, landowners alert to the land restitution intentions lurking unstated but obvious in the legislation picked up the pace of mechanisation, retrenching hundreds of thousands of workers, and then evicting them en famille from the farms. Alternatively, they simply offered the remaining workers financial inducements to relocate – an urban erf with a house; a cash settlement – that fuelled the sugar-coated movement of vast numbers of people to the cities.

While some farmers do still have staff living on their farms, the government’s recently stated intention to give these farmworkers as much as 50% of such farms, the exact share dependent on the worker’s length of service, will put a stop to worker tenancies. It’s a bizarre bit of populism, akin, if government is to be conceptually consistent, to giving long-serving domestic workers in the cities a proportionate share of their employer’s suburban homes. To figure out that such legislation will trigger retrenchments and unemployment doesn’t take a brain surgeon.

Which is fortunate, since brain surgeons are about to become an even rarer species in South Africa than they are already. With last month’s promulgation of those sections of the National Health Act that allows the state to decide where medical professionals establish their practice, we can expect another negative result of the law of unintended consequences – the accelerated emigration of top-flight medical experts.

What would you do – as a lawyer, or an accountant, or an engineer – if the government suddenly abrogated to itself the right to decide where you could open a practice, or indeed whether you should be allowed to continue operating where you have been sited forever? Because that’s exactly what the NHA sections just signed into law by President Jacob Zuma – although drafted as far back as 2003 – does to the medical profession.

Whether a general practitioner, a specialist, a physiotherapist, an occupational therapist, or a dietician, the constitutional right to work will be subject to “certificate of need”, issued by the state in accordance with the Act’s objective of ensuring “an equitable distribution and rationalisation … to correct inequities based on racial, gender, economic and geographic factors”. No matter how laudable this objective, the reality is that this ambitious experiment in social engineering will be carried out by an anonymous collection of semi-literate, incompetent and corruptible bureaucrats – the very same ones who can’t ensure that government clinics pay their staff on time and can’t keep hospital dispensaries stocked with staple drugs.

A doctor friend, who always shunned private practice for health department work before joining a not-for-profit, made the point to me that many doctors would by preference work in the public service, if it they could have satisfying careers in well-run, effective medical institutions. “The reality is unfortunately that the state treats doctors like crap,” he says. “I’ve travelled to isolated clinics where they don’t even provide tea-making ingredients, so one has to remember to take one’s own. And then it’s in any case likely that the bloody kettle will be broken.”

The example cited is on the face of it petty, but it is emblematic of a greater malaise. Instead of taking a proctologist’s approach to the problem, if only Health Minister Dr Aaron Motsoaledi could remedy public sector health, he wouldn’t have to worry about the personal, rational decisions of private practitioners.

Follow WSM on Twitter @TheJaundicedEye


  • This Jaundiced Eye column appears in Weekend Argus, The Citizen, and Independent on Saturday. WSM is also a book reviewer for the Sunday Times and Business Day. Follow @TheJaundicedEye.


  1. michael michael 9 June 2014

    The medical practitioners will be able to work where ever they like, they must just pay the bribe to the corrupt bureaucrat. It is the way business is done in Africa.

  2. Martin Warburg Martin Warburg 9 June 2014

    I like your “panga” analogy. It is absolutely spot on.
    The trouble is that it applies not only to medicine and agriculture, but the economy, education and just about everything the ANC government touches. The one thing they do very well is butcher opportunities!

  3. Joseph Coates Joseph Coates 9 June 2014

    Like the comparison between endangered animal species and the extermination of our specialized medical practitioners opting for better working conditions( if you so want to call it that) venturing to other first world countries to carry out their committed passion for medicine.
    Heaven help us, should nationalized health service which is lying dormant in the corridors of our government run hospitals- become operative . With current lack of staff in our hospitals and shortage of medical supplies, the patients may become endangered species.

  4. Martin Young Martin Young 9 June 2014

    Spot on!

    My advice to young doctors and all other affected professions with ambition in this country is to go overseas. Leave!

    Your obligations to your families outweigh any obligation others might place on you towards the rest of the country.

    The government is recommending a medicine it itself is not prepared to take.

  5. RubinB RubinB 9 June 2014

    If National Health is to be shoved down our throats, then God help us!
    I have had insight into Nat Health in both the UK and Germany, and I would rather not get sick there. There the doctor works for the Government and does not care much about the patient.
    A relative of mine in the UK, after a year of this, got herself a private medical aid fund and now goes to a doctor and a dentist of her choice (both South African!) At least they are interested in the patient. (He is after all the one who pays them!)
    I know Germans and Swiss people who come here for serious medical treatment, not because it is cheaper (with the travel included it is probably not); they come here because the medical staff treat them like human beings. I have been told that by several.
    Conversely I have seen how people are treated in local State hospitals. There you are just a number; your time is of no concern to the staff. Exactly like in the UK.
    It would be interesting to hear from other bloggers, if they have had similar experiences.

  6. Leon Leon 9 June 2014

    I saw this coming. That’s why I am not in South Africa any more.

  7. nguni nguni 9 June 2014

    Well, let’s hope this is like the NHS and is still 20 years from actually happening. I think it’s unconstitutional anyway, no better than the forced evictions under apartheid. One suspects reality will be more like michael described. If not, then this NHA law will be the end of private medicine in SA.
    BTW are there any other African countries that offer a national health service? Or the dole, or free housing for that matter? Why are we trying to emulate the 1st world with a 3rd world tax base?

  8. Zeph Zeph 10 June 2014

    It is time for self medication; I must go stock up with brandy!
    Although one must laud government for its intentions they do not think things through.

  9. Impedimenta Impedimenta 11 June 2014

    Sadly true. I see “cack-handle” policy drafting in my fields too. So much energy is needed to rewrite unworkable policy. Where does government get their ‘expert advisers? Why doesn’t each draft policy also come with an impact statement: outlining how it will be implemented and the economic and cost ramifications?

  10. Baz Baz 12 June 2014

    Those poor buggers that don’t have medical aids and in times of serious cases of
    minor operations.Their penalty is our badly run government hospitals that oblige in giving treatment after long periods of waiting for appointments and availability.
    National health would be a solution for them at a marginal monthly cost; thus putting pressure once more on our tax payers and pushing inflation cost through the ceiling
    which has already sky-rocketed out of all proportion.

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