After the Constitutional Court ruled against controversial provisions that would have allowed the government to determine where medical professionals could work, the Department of Health says it is now looking at alternatives.<\/p>\n
National Health Department spokesperson Foster Mohale said the Department was looking at schemes in Canada and Denmark, where structured licences were issued to health facilities, and health practitioners had to apply to work at these hospitals.<\/p>\n
The purpose of the certificate of need \u2013 the ruling the Constitutional Court shot down \u2013 was to equalise the availability of medical practitioners, including specialists, between the private and the public sector and also between urban and rural areas.<\/p>\n
At the moment, the Department of Health has a limited ability to purchase some services from private doctors using conditional grants when those services are not available in the public sector.<\/p>\n
But Mohale said a more proactive approach would be to follow the structured strategy used by Denmark or Canada, where licences were determined by the health department, and practitioners applied to work at those licensed establishments.<\/p>\n
On Monday, after two decades of legal battles, the Constitutional Court declared as unconstitutional provisions that would have given the government control over where medical practitioners and nurses could work, and ordered their removal from legislation.<\/p>\n
While the Department of Health\u2019s lawyers labelled the certificate of need scheme \u201ca central pillar in the implementation of the National Health Insurance Act\u201d in court, spokesperson Foster Mohale said the department wished to point out that no part of the National Health Insurance Act had been declared unconstitutional.<\/p>\n
The application was brought by the Solidarity trade union, the Alliance of South African Independent Practitioners Association, the South African Private Practitioners Forum, several doctors and the Hospital Association of South Africa.<\/p>\n
They asked the court to confirm an earlier ruling by Judge Anthony Millar in 2024 that the provisions surrounding the \u201ccertificate of need\u201d were unconstitutional.<\/p>\n
\u2018A call for better health reform\u2019<\/p>\n
Doctors from the Universal Healthcare Access Coalition (UHAC) said the ruling by the Constitutional Court should be viewed as \u201ca call for better health reform, not as a defence of the status quo\u201d. <\/p>\n
They welcomed the Constitutional Court judgment.<\/p>\n
UHAC is a coalition of health professional bodies, health worker associations, patient advocacy groups and aligned constituencies working to actualise access, equity and uniform quality through integration of all health assets.<\/p>\n
\u201cThe judgment does not reject health reform. It confirms that reform must be lawful, rational, evidence-based and institutionally workable. South Africa urgently needs universal access to quality healthcare. <\/p>\n
\u201cThe deep inequalities between public and private healthcare, between provinces, and between urban and rural areas remain unacceptable. But these inequalities cannot be solved through broad, poorly defined and highly centralised powers without clear safeguards or a coherent implementation framework,\u201d UHAC\u2019s statement says.<\/p>\n
The statement added that the judgment by the Constitutional Court also raised a concern that they too were very worried about \u2013 how the NHI reinforced excessive government centralisation, unclear powers and weak safeguards.<\/p>\n
\u201cThese qualities do not create access. They create uncertainty, delay, risk and weakened capability,\u201d the UHAC statement said.<\/p>\n
\u201cSouth Africa needs a practical pathway that strengthens public health services, regulates private participation properly, defines clear entitlements, improves purchasing and pricing and builds accountable institutions capable of delivering universal access,\u201d the doctors said.<\/p>\n