IMATU is of the view that the proposed National Health Insurance (hereinafter referred to as “the NHI”) is not an insurance scheme, but is rather an alternative method for providing public health care to citizens of the Republic. The NHI should not be seen as a reform of health care or an alternative funding mechanism. Any reform must focus on improving the current public health system and the provision of public health care to citizens.

IMATU is of the view that there is a need for a two tier health system, which is in existence in countries which have a similar developmental status as South Africa. The mere fact that members of a medical scheme have greater options to choose from is immaterial, as the medical scheme contributions are paid by the individual member (often with employer contributions). The relevant benefit option is determined by the needs of the relevant member. This means that the disposable income of a family is therefore increased or reduced by the choice made in respect of the relevant benefit option. 

It is wrong to conclude or assume that medical scheme members have a choice of service providers, as compared to the remainder of the population who do not have a medical scheme cover. The reality is that members of medical schemes pay for this benefit.  In many instances, principal members of medical schemes consider medical aid membership a necessity. The fact that consumers consider medical aid benefits as a necessity results therein that that they have less disposable income available to spend on other goods and services.

 Medical schemes are the main contributors to private health care. This does not detract from the principle that medical scheme members pay for the service that they receive (over and above the cover provided by the medical scheme). This is done through co-payments and other out-of-pocket expenses.

 The mere fact that the public health sector lacks resources, both in human capital resources and financial resources, is not an issue which will be corrected by the introduction of a NHI system. These issues must be addressed at a policy level by National Government. The optimum level of staffing in all health departments (national, provincial and local) is a national issue, which needs to be critically addressed. Vacant positions within the public health sector must be filled as a matter of urgency.

 IMATU does not agree with the notion that NHI will provide for medical cover for the whole population. In other countries (which have a GDP similar to that of the Republic), NHI has resulted in considerable co-payments and other out of pocket expenses for members covered by NHI. It is therefore wrong to assume that NHI will provide comprehensive medical care for all citizens of the Republic. The reality in the present day South Africa is that members of medical schemes prefer private health care through co-payments or direct out-of-pocket expenses, due to lack of confidence in the public health care system.

An improvement in the overall health care system will only be achieved if the standard and quality of health care in public health care institutions is drastically improved. The devolution of primarily health to the lowest level, and third tier of government, is one of the key elements in improving overall health care services.

2.      Problem Statement

 IMATU acknowledges that various reform initiatives have been introduced since the advent of the democratic South Africa. These initiatives have proved unsuccessful, due to a lack of political will and/or executive intervention.

 IMATU is of the view that the Republic will never be in a position to move away from a two tier health care system. Other countries, which have comparable GDP’s to the Republic, successfully utilise a two tier health care system. Their health outcomes are, however, significantly better than those of the Republic, as public health care is provided for far more effectively in terms of capital expenditure.

 The institutional collapse in public health care should be addressed before the concept of NHI can be meaningfully considered. The human resources requirements for all health departments should be addressed as a matter of urgency. The reasons for the ineffective application of available funding of public health care institutions should be determined before the concept of NHI can be meaningfully engaged upon.

IMATU is of the opinion that the overall image of public health care should improve by providing a quality public health care service, which citizens will have the confidence to rely on and use.

IMATU agrees with the statement that private health care has its own and unique challenges, especially in areas of affordability and spiralling costs.  IMATU is, however, adamant that the problems in public health care should be addressed separately from those in private health care. IMATU is thus of the view that it is disingenuous to suggest that the problems in both private and public health care can be addressed simultaneously.

3.      The Burden of Disease

The concept of the quadruple burden of diseases, identified in the Lancet Report, is wider than merely health related issues.  It contains elements of a socio-economic nature, law and order elements, lack of morals and ethics (violence against women and children) in our society, and lifestyle elements (education), regarding non-communicable diseases.

 4.      The Quality of the Health Care System

 The deep-rooted problems in the provision of public health care should, in the first instance, be addressed in order to achieve an improvement in the overall health outcomes of the Republic. 

 The NDOH has been pro-active in identifying these problems, which consist of various factors, and which will require various interventions within the public health care system.

 5.      Health Care Expenditure in South Africa

 The 4.1% of GDP spent on private health care, which caters for 16% of the population, should not be seen as disproportionate to that of the percentage of citizens utilising public health care. The fact that citizens are members of medical schemes is an individual choice of such member, who pays for this benefit. Membership of a medical scheme reduces the net income of such members, and in turn this leads to lower disposable income. The notion that members of medical schemes are in a better position in receiving health care, is therefore wrong. 

It is furthermore apparent that the institutional collapses of public health care facilities have led to a scenario where citizens have no confidence in the public health care system.  Citizens perceive private health care as a necessity and will use their available income to receive private health care. This also applies to persons who do not belong to medical schemes but who are willing to make the necessary out-of-pocket payments to afford private health care, due to a lack of faith in the public health care system.

 6.      Distribution of Financial Resources and Human Resources

 The lack of human resources within the public health sector is exacerbated by the fact that vacant positions in the whole of the public sector, are not filled. The NDOH should develop an organisational structure that accurately determines the number of health care professionals needed, as measured against the number of patients. Addressing the shortcomings in the human resources environment will go a long way to improve the overall health outcomes in the Republic.

The fact that the amount per capita spent in the private health care environment is more than is spent in the public sector, is due to the fact that members of medical schemes pay for this benefit. These members are not in a better position when compared to citizens who receive free public health care services.

 7.      Medical Schemes Industry

IMATU acknowledges that deep-rooted problems exist in the medical scheme environment, and within private health care.

IMATU is, however, of the view that these problems should be addressed separately from the collapse in public health care. Any improvement in the overall health outcomes for the Republic should primarily take place through the transformation of public health care.

 8.      Out of Pocket Payments and Co-Payments

Citizens will continue to use private health care by incurring out of pocket expenses and/or through co-payments, because they have no confidence in the public health care system.

 9.      History on Proposals for Health Care Financial Reforms

 The policy document supplies a synopsis and history of previous health care reform initiatives. IMATU supports NDOH’s attempts to address the problems in public health care as a matter of urgency.

 10.    National Health Insurance

The term National Health Insurance or “NHI” is a misnomer and is incorrectly applied in the present context. What is proposed in the policy document is not an insurance product, but rather a model for the delivery of public health care.

NHI should not be an objective of public health care, but should rather be seen as a method whereby public health care is provided to all citizens.

11.    Principles of National Health Insurance

Appropriateness is identified as one of the key principles of NHI. It is furthermore stated that primary health care should best be provided at a local level. IMATU supports the concept that primary health care be provided at local level. This will ensure proper governance and accountability at local level. 

The above principle, however, seems to be contradicted by the stance of various provincial health departments, who insist that municipal clinics and the services they provide to local communities, be transferred to provincial health departments.

 12.    Objectives of NHI

One of the main objectives of NHI seems to be universal coverage wherein everyone has access to health care.  Already, though everyone in the Republic currently has access to public health care facilities.  The problem is not founded in the accessibility of the public health care system, but rather in the manner in which public health care services are provided to citizens. These problems should first be addressed, whereupon the concept of “universal coverage” will become academic.

13.    Socio-Economic Benefits of NHI

The notion that the public financing of health care will free up citizens to spend their disposable income on other goods and products are materially wrong. Citizens will continue to incur out of pocket expenses for private health care if public health care provision is not drastically improved.

14.    Economic Impact Modelling

The economic impact assessment seems to ignore the fact that the introduction of NHI will lead to an increase in taxation. This in turn will mean less disposable income for individuals, which in turn will mean that individuals will have less money available for other goods and services. The economic impact of NHI should therefore be further assessed before any meaningful assessment can be made regarding the economic impact of NHI.

15.    The Re-Engineering of Primary Health Care

IMATU supports the re-engineering of primary health care.  Primary health care institutions should operate, and fall under the jurisdiction of local authorities and not those of provincial or national health structures. 

In order to ensure proper governance and accountability the re-engineered primary health care system should be accountable for all its activities at a local level.

 16.    District Specialist Support Teams

The concept may lead to an improvement of the overall health outcomes in the Republic. It will, however, only be successful if the current problems in the human resources environment within the health sector are addressed.

17.    Municipal/Ward Based Primary Health Care Agents

IMATU supports the concept of at least ten primary health care agents per municipal ward. IMATU is, however, of the opinion that these structures must be accountable to local communities and municipal councils, to ensure proper governance and accountability.           

 18.    Delivery of Primary Health Care through Private Practitioners

If private practitioners should provide primary health care then the following problems could arise:

Long waiting lines of patients will not be addressed due to the capitation of the service to be provided;

 The private service provider may refer the patient to the district or central hospital system as there is little incentive for an early and proper diagnosis;

 The private service provider may also insist on an out of pocket expense and/or co-payments over and above the capitation fee provided for by the NHI.

 19.    The Office of Health Standards Compliance

The concept may lead to an improvement of the overall health outcomes in the Republic. IMATU is, however, of the view that this body will only succeed if there is adequate human resource capacity within the NDOH to properly staff the compliance office.

 20.    Payment Procedures under National Health Insurance

The capitation is a private sphere concept aimed at controlling costs in the private sector. It should therefore not apply to public health care institutions, who operate under budgetary constraints, and who are mandated to provide health care in terms of the Constitution. Capitation of fees of accredited private service providers will also lead to a two-tiered system in that private service providers will claim the capitation against the NHI, and insist on an out-of-pocket payments or co-payments for fees in excess of the capped amount for a particular service or procedure.

 21.    Health Care Coding System

The notion that the introduction of a coding system will lead to proper planning will only be sustainable if the human resources shortcomings are addressed in all departments of health and in all spheres of government.

 22.    District Health Authorities

IMATU does not support the notion that District Health Authorities should be able to contract with NHI. District Health Authorities are politicised structures, which are not governed and/or accountable to communities at a local level in respect of the functions which they have to perform. It will also open the door for corruption and other financial malpractices.

 23.    The Role of Co-Payments under NHI

It is IMATU’s submission that private health care providers will not charge fees in accordance with the NHI protocols and guidelines. They will therefore insist on co-payments or out-of-pocket payments in excess of the NHI protocols and guidelines. 

This will have a twofold effect on consumers, who will either have to fund this co-payment or out-of-pocket expense, or alternatively the patients will be compelled to use the public health care system only. 

Citizens will prefer the option of a co-payment or incurring out-of-pocket expenses, which will not address the inherent problems in private health care, namely the issues of spiralling and uncontrolled costs, and the over servicing of patients.

24.    How Much Will NHI Cost?

The policy document states that the Republic spends approximately 8,5% of GDP on health care. Other developmental States spend far less than 8,5% of GDP on health care. They, however, have significantly better health outcomes.  IMATU is of the view that interested parties should first look at the shortcomings in the current public health care system.  If these shortcomings are addressed through the necessary political willpower and executive interventions, the overall health outcomes will drastically improve in relation to the percentage of GDP spent on health care. IMATU is of the view that the solution to the current problems facing health care does not lie in the introduction of NHI. The question which must be answered, is why the current percentage of GDP spent on health care does not produce positive health outcomes. What interventions should be implemented to achieve a positive outcome? This is the real question to be answered.

25.    The Establishment of the National Health Insurance

The establishment of the NHI as a government-owned entity will create another bureaucratic institution. All central government institutions that collect and disburse funds are prone to financial mismanagement and irregularities. This immediately poses issues of oversight, governance and accountability. Parliamentary oversight is not an appropriate control mechanism, it is submitted.

 26.    The Role of Medical Schemes

IMATU is concerned that the introduction of NHI will effectively lead to the demise of all medical schemes in the local government environment.  Local government employers will not, as they currently do, contribute to both NHI as well as accredited medical schemes. Local government entities, as part of the broader public sector, will merely inform employees that they will only contribute to NHI due to the fact that they are compelled to do so in law. Local government employees who wish to belong to accredited medical schemes will be forced to pay the full contribution from their own earnings.  The employer subsidy will fall away as the employer will only contribute to NHI. Most of the IMATU’s members, belonging to medical schemes, will be forced to relinquish their medical scheme membership and rely solely on NHI. This scenario includes the predicament of thousands of municipal pensioners who receive post-retirement medical aid contributions from their former employers. The position of these pensioners is not dealt with in the policy document.

 The introduction of NHI is also seen as an additional form of taxation and a compulsory statutory deduction. This may have a detrimental effect on the South African economy as a whole, in that households will have less disposable income available for other goods and services.

 27.    The Registration of the Population

The financial implication of registering the population needs to be amplified in order to assess the impact of the registration on the proposed NHI scheme.

28.    Information Systems for NHI

The required Information Communication Technology Resources need to be pre-determined in order to assess whether they will contribute to a successful implementation of the NHI system for the Republic.

29.    Conclusion

IMATU is of the view that the proposals contained in the policy document contain no elements of NHI. The document is seen as an attempt to reform the provision of public health care through an additional funding mechanism. The problems in the provision of public health care should be addressed as matter of first priority before the concept of NHI can be meaningfully engaged upon.

“IMATU is ready for the challenges of the New Year and with these in mind, we welcome back to the workplace all members, shop stewards and staff of IMATU and everybody who is involved in the operations of our municipalities. The challenges are huge, but we are relying on our well-oiled operational system to address these opportunities to contribute positively to the administration of local government”, said IMATU’s National President, Stanley Khoza.

Late last year IMATU met with the newly appointed Minister of Co-Operative Governance and Traditional Affairs, Mr. Richard Baloyi and his management team.

• The future status of the Provinces and District Municipalities,
• the erosion of municipal services through privatization,
• the transfer of municipal services to the other organs of state,
• the transfer of primary health care practitioners,
• the future of the Metro Police,
• and inconsistency with fixed term contract appointments and the possible restructuring of electricity distribution were raised in the discussion.

Uncertainty amongst the municipal workforce about the government’s intentions regarding a single public service was also addressed. Minister Baloyi referred to the government’s discussion on the introduction of a Single Public Service. He assured the delegation that government had no intention to disband local government as a third tier of governance. He said that “the Single Public Service debate does not exist anymore…Public Service Management is the debate now”.

IMATU raised the trend of casualisation which occurs in all municipalities whereby temporary employees are employed by municipalities outside of the conditions of service applicable in the SALGBC, with the Minister.

Infrastructure failures in municipalities were also addressed, while emphasis was placed on the need for eradication of nepotism, fraud, corruption and other criminal activities in and around the municipal structures.

The Minister was also informed of the deteriorating relationship with the employers’ organisation, SALGA, and the effect that it has on collective bargaining in the industry. Specific mention was made of this year’s unsuccessful negotiations that took place under the jurisdiction of the South African Local Government Bargaining Council (SALGBC).

The Minister amicably addressed some of the matters that IMATU presented, ensuring his department’s commitment to partner with IMATU, and his intention to deal with the concerns and problems in a consultative manner.

He referred to the “regrettable and sorry state of affairs” regarding service delivery in the country and asked that partners such as IMATU should not lament on “run down services”, but instead assist the department with determining who or what is responsible for the deterioration.

‘’Run down services are not the same as services that are poorly delivered”, he said.

“Immediate intervention in instances where service levels have deteriorated, can repair the systems”, he said.

IMATU was applauded for its “Start Working” campaign which was launched earlier in the Eastern Cape.

“Count on us to become your partner with this National initiative”, Mr. Baloyi said.

“I am sure that our meeting with the Minister will reap fruit. Let us all make local government work effectively in 2012, it is now up to us”, said IMATU’s President.

The Festive Season is a time of birth, wonder, sharing, and resting at home with our loved ones.

As we prepare for this busy and joyous holiday season, it is time to reflect on the year that has passed.

We have, in our work environment, as well as in our personal capacities, experienced much in 2011.

As we approach the Festive Season, we take this opportunity of thanking all of you who form the IMATU family: Office Bearers, members and staff, for journeying with us during 2011.

On behalf of the Administration, we extend to you and your families, the warmest Season’s Greetings.

May you have a very happy holiday season, and a New Year filled with peace, joy, productivity and prosperity.

IMATU National Office

Pretoria

IMATU’s  President addressed the SALGBC’s gala dinner on 8 December 2011 in Ekurhuleni.

“Honourable Minister, our partners in the SALGBC and other distinguished guests.

As IMATU we are proud to be a founding member of and party to the SALGBC. We are also extremely proud of the role we have played in the shaping of the human resources and labour relations landscape within the municipal sector due to the role we played in the bargaining council.

We are here to celebrate the successes of the last ten years but we also have to look into the future and identify areas of concern, which affect us all as parties to the bargaining council.

When national government envisaged a new municipal dispensation for the country, critics were keen to point out that a system where municipalities and employees bargain collectively for the whole sector, was not possible.

This was indeed a concern as there were many industrial councils functioning under the 1956 Labour Relations Act, which dealt with bargaining arrangements in their own areas of jurisdiction. And, of course, there were at least three employer bodies who represented the interests of municipalities at that time.

The conditions of service and benefit arrangements were by no means uniform in the different municipalities.

It was therefore a daunting task to finalise the establishment agreement and to agree on a constitution for the SALGBC. Tonight is indeed an opportune moment to celebrate the role of those involved who laid the foundations and finalised the then constitution and establishment agreement. In this regard, IMATU wishes to thank Messrs Dave Rogers, Klasie Claassens and Theo Crouse for the role they played in this process. 

The biggest challenge remained the standardisation of the conditions of service for employees in the sector. Negotiations started in all earnest in 2001 and were concluded in 2003 when a collective agreement was concluded. This achievement must be seen against the background of the reduction of more than 800 municipalities to 284 as it was then.

The parties to the SALGBC were also able, on three occasions, to reach wage agreements applicable to the sector. The multi-year wage agreements went a long way to establish employment security and allowed the parties to focus on other collective bargaining topics.

The parties then agreed to standardise the various collective agreements in the sector into a consolidated document, “the Main Collective Agreement”. This was indeed an achievement to bring together the various agreements into one collective agreement. This agreement is of course up for re-negotiation next year and we hope that negotiations will be concluded speedily.      

The financial affairs of the council are well managed and the office of the General Secretary and all his support staff should be congratulated for their hard work in this regard.

Tonight is also an opportune moment for the parties to reflect on where we see ourselves in the next decade, and to identify the problems and challenges facing us.

IMATU is extremely concerned that the parties to the SALGBC have not managed to achieve uniformity in all municipalities on the implementation of the wage curve and job evaluation outcomes. This remains a challenge as it impacts on the uniformity in wage scales and the ensuring that municipal employees receive equal pay for equal work.

IMATU believes that all municipal services should be universally assessable, affordable and of a superior quality in order to improve the lives of all South Africans. The implementation of the outcomes of the Local Government Sector Summit, which was held in 2005, would have gone a long way to improving the lives of our citizens, but none of the outcomes have been debated or implemented. Perhaps the parties to the council should do introspection and resuscitate the work done at the Summit as a starting point for engagement on quality and affordable services.

IMATU is also deeply concerned regarding the lack of engagement in the SALGBC on the future of municipal services. A working group has been established to deal with municipal services, which working group has achieved no outcomes mainly due to SALGAs inability or lack of commitment to participate in the working group. This has to be rectified as a matter of urgency as municipal services remain the reason for our existence.

In conclusion we wish to extend our gratitude to the General Secretary, his dedicated staff in the national office and in the divisions. Thank you for always going about your business in a professional manner.

We wish God Speed to the SALGBC and all parties to the council in making the following decade an even greater success story as the last one.”

Members and non- members of IMATU have had the privilege of meeting our President, Stanley Khoza.

Stanley was born on 18 December 1956 in Chesterville and he grew up in Kwa Mashu, (two townships within the erstwhile Durban boundaries) in the province of Kwa Zulu Natal. 

Stanley is a devoted sportsman who has represented South Africa on more than one occasion in the discipline of karate-dojo.  He balances his employment responsibilities and trade union activities with karate development.

In 1982 he formed the Amandla Esizwe karate-dojo in Kwa Mashu, which now has 15 branches within the eThekwini Metro Region. He has produced 95 black belt karatekas from previously disadvantage communities. He aims to use karate in sharing his life skills knowledge and experience with his students.  Stanley’s wish is to provide an opportunity for the youth from all communities to meet in a spirit of unity and peace and to learn the values of self-control and upliftment through the discipline of karate – dojo.

The redressing of the imbalances of the past, which are still in existence and being actively involved with social development in his community, are some of the priorities high on his list.

A devoted trade unionist, he was elected into leadership positions at the formation of IMATU.  During 1990, he was elected as a shop steward of the Durban Municipal Employees Society (DMES) which was one of the founding unions which formed IMATU.  He joined the Durban City Council in 1983, now known as the eThekwini Metropolitan Municipal Council.

From 1999 to 2007 he served as the Vice Chairperson of IMATU (eThekwini Region) and an IMATU NEC Member.  From 2002 to 2007 he served as IMATU Vice President: Labour Relations.  The period from 2007 to 2010 saw him occupying the position of IMATU Deputy President. From 2007 to date, he is the Chairperson of IMATU eThekwini Region.  In October 2010 he was elected as IMATU’s National President.

He also served in the SALGBC as Executive Committee member in 2002, Bargaining Committee Member and National Moderation Committee Member.

During 2008 he was elected to serve as FEDUSA NEC member and MANCOM member and FEDUSA KZN Provincial Chairperson.

His goal is to take IMATU to new heights and ensure IMATU becomes the majority trade union within the local government sector.

We are indeed privileged to have a leader of his capacity in our midst.

“This is good news, especially after the Public Protector has found prima facie evidence of maladministration and abuse of public funds against Co-operative Governance Minister Sicelo Shiceka.  We believe that the President has acted suitably in responding to the reports of the Public Protector regarding the misdemeanours”, said IMATU’s General Secretary Johan Koen.

IMATU also reacted to Home Affairs Minister Nkosazana Dlamini Zuma’s speech at the second annual Good Governance Conference, recently held in Pretoria.

Minister Dlamini Zuma said that accountability, transparency, consistency and good leadership were some of the essential elements required for good governance.

“Yes, what the Minister says is true and the statement has a ring to it that tends to be repeated by public officials regularly. The problem lies with the delivery of the elements she quoted”, he said.

“The Minister referred to accountability and said that public representatives and government were accountable to the electorate to ensure that the electoral mandates were delivered on. This remains lip-service to the communities who expect top-class service delivery from the government and especially local government, “said Koen.

“The industry of local government demands accountability, transparency, consistency and good leadership and we expect the government to deal with these leaders if they do not perform as expected,” Koen said.

“We congratulate Minister Richard Baloyi who becomes the new Minister of Co-operative Governance and Traditional Affairs and we look forward to an upright working relationship with him”, said Koen.