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Controversial Health Bill approved
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2003-11-19

The controversial National Health Bill has been approved by the National Council of Provinces, completing its passage through Parliament despite objections from opposition parties. The Democratic Alliance and New National Party opposed the measure, mainly because of the certificate of need (CoN) provisions, arguing these are unconstitutional. The bill was approved in the National Assembly in September, and will now go to President Thabo Mbeki for his signature. In terms of the legislation, health practitioners will have to obtain a CoN to provide health services, or to establish or operate a health establishment or agency, such as a clinic, hospital or surgery. The CoN is granted to a person, and lapses when the individual dies or leaves the practice for whatever reason. The health department's director-general will issue certificates of need -- valid for a maximum of 10 years -- on the basis of a host of criteria. Many other countries, including the United Kingdom, the United States, Canada and Australia, had systems of licensure of health professionals. The bill allowed for regulatory distinctions to be made between health professionals with established practices or existing health establishments, and those setting up new practices or establishments after the bill became law, Dr Manto Tshabalala-Msimang said. The CoN was also not intended to be an instant remedy to the problem of inequitable distribution of health professionals and establishments. The emphasis would be on implementing it progressively to achieve the right of access to health care services. (Source: Business Day 19 November 2003) Link \//\ To view the National Health Bill (B32 of 2003) ftp://ftp.hst.org.za/pubs/govdocs/bills/nathealthbill.pdf or go to http://www.polity.org

The controversial National Health Bill has been approved by the National Council of Provinces, completing its passage through Parliament despite objections from opposition parties.

The Democratic Alliance and New National Party opposed the measure, mainly because of the certificate of need (CoN) provisions, arguing these are unconstitutional. 

The bill was approved in the National Assembly in September, and will now go to President Thabo Mbeki for his signature. 

In terms of the legislation, health practitioners will have to obtain a CoN to provide health services, or to establish or operate a health establishment or agency, such as a clinic, hospital or surgery. 

The CoN is granted to a person, and lapses when the individual dies or leaves the practice for whatever reason. 

The health department's director-general will issue certificates of need -- valid for a maximum of 10 years -- on the basis of a host of criteria. 

During the debate in the NCOP, the DA's Embre Gouws said the bill struck at the heart of the right of medical practitioners to choose their profession freely, as set out in the Constitution. 

It also violated the free market principle of supply and demand, she said. 

Dr Phillippus Nel of the New National Party also criticised the CoN provisions, saying they would not solve the problem of spreading health services more widely, and would have the opposite effect. 

It would also increase the brain drain of young doctors, which was confirmed in no uncertain terms by young doctors represented by the SA Registrars Association (SARA) recently. 

The NNP appealed to Health Minister Dr Manto Tshabalala-Msimang to reconsider the whole concept of the CoN, the merits of which had been widely contested, Nel said. 

However, Tshabalala-Msimang said the CoN provisions are the tools by which we intend to address the inequitable distribution of health services over time. 

The provision is certainly not unique nor particularly new in the South African context. 

Many other countries, including the United Kingdom, the United States, Canada and Australia, had systems of licensure of health professionals. 

The bill allowed for regulatory distinctions to be made between health professionals with established practices or existing health establishments, and those setting up new practices or establishments after the bill became law, she said. 

It is not our intention, after the act comes into effect, to immediately order existing medical practices and health establishments to close down and to relocate to a place of the state's choosing. 

The CoN was also not intended to be an instant remedy to the problem of inequitable distribution of health professionals and establishments. 

The emphasis would be on implementing it progressively to achieve the right of access to health care services. 

Let is not be naive. We recognise that it will take time to achieve this objective, Tshabalala-Msimang said. (Source: Business Day 19 November 2003)

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