Teething problems at provincial health departments, including a lack of co-ordination, poor planning and uncertainty in districts, remain stumbling blocks to the effective testing of how the National Health Insurance (NHI) will work at pilot sites.

The dire state of affairs was detailed in a Financial and Fiscal Commission presentation to Parliament’s portfolio committee on health and the standing committee on appropriations.

In 2015, Health Minister Aaron Motsoaledi introduced the NHI white paper. In February, the government announced that it would set up an NHI fund even though the white paper is considered a work in progress.

The commission’s Elliot Hadebe told MPs that challenges persisted at the NHI pilot sites when it came to “vertical and horizontal co-ordinated planning” between national government, provincial health departments and districts.

“Co-ordination problems were evident [at] … NHI pilots and [in the implementation of] grants. Provinces were unaware of what to use the grants for.”

Hadebe said the NHI grants had to be accompanied by capacity building.

Alex van der Heever, chairman of social security systems administration and management studies at the University of Witwatersrand, said the NHI grant spending challenges were a microcosm of the larger problems which affected larger grants, such as the national  tertiary services grant and the health professions training and development grant.