The state is obliged under the Constitution to make policy decisions that respect, protect, promote, and fulfil the rights in the Bill of Rights. The objectives of the NHI are to:
- provide access to quality health services for all South Africans regardless of their employment status
- achieve equity and social solidarity through the creation of a universal fund
- control key financial resources through the procurement of healthcare services on behalf of the nation
- improve the public health infrastructure and resources
The proposed NHI system will give effect to the right of access to healthcare in section 27 of the Constitution. In fulfilling this obligation, the state will go to whatever lengths necessary to ensure that that happens as seen in the recent challenge by the Opposition to Urban Tolling Alliance (OUTA) to the introduction of the e-tolling system. This case went all the way to the Constitutional Court.
The court’s attitude was that courts do not determine the kind of funding to be used for infrastructural funding or who should bear the brunt of that cost – this is a political policy-making process that falls within the preserve of executive government, through public participation, consultation and appropriate channels. The court rejected the argument that there was no public participation.
Post this judgement, the public and the media have been severely criticised for not playing an active role and participation in preventing unpopular policy decisions that affect them.
The state is certain to allow extensive public comment on the NHI system.