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JEREMY MAGGS: With the National Health Insurance [NHI] Act officially enacted but encountering significant legal scrutiny, there are growing fears that we may be embarking on reform without consensus, clarity, or the necessary financial backing. Concurrently, more individuals are falling through the cracks of a system hindered by inequality, insufficient investment, and political instability.

What steps can we take moving forward? What genuine inclusive reform should look like? How can we forge collaborations that yield tangible results beyond mere discussions? Central to this conversation is Dr. Katlego Mothudi, managing director of the Board of Healthcare Funders. Dr. Mothudi, welcome. Are you concerned that we are careening towards unproductive reform?

KATLEGO MOTHUDI: Absolutely, Jeremy. First and foremost, we should have acted sooner. Right now, we find ourselves on the defensive. The indicators for health outcomes are not in our favor. Recent data from the World Health Organization [WHO] indicates that few countries striving for universal health coverage will hit the 2030 target.

We should be amplifying our efforts, but in a constructive way.

The challenge lies in our failure to engage in the right discussions. We are not heeding the right advice, despite addressing many of the points you mentioned to some degree.

However, as the NHI Act shows, a significant amount of feedback was unfortunately overlooked.

JEREMY MAGGS: Do you feel we’ve reached a pivotal moment where a constructive shift is no longer possible?

KATLEGO MOTHUDI: No, I believe change remains achievable. The legislative process is certainly facing hurdles at present. The current iteration of the bill may not be ideal, but we have alternative routes available. We recently saw how the courts intervened regarding the VAT hike, resulting in a corrective action.

It’s not too late for us to engage in these discussions. There’s still an opportunity to consider feedback from all stakeholders, though too often, we end up talking at cross purposes.

Perhaps certain ideologies are preventing us from addressing the necessary technical aspects, but we can still spark critical conversations to refine our approach.

JEREMY MAGGS: You stress the importance of decision-making. Are you still in dialogue with the government, and do you sense any willingness to listen despite the ideological barriers you’ve pointed out?

KATLEGO MOTHUDI: There was an attempt to initiate dialogue a few months back, but those initiatives have since stalled. Several organizations provided the requested feedback to the president [Cyril Ramaphosa], yet we’ve learned that these inputs have not been acted upon by the Ministry of Health.

This absence of dialogue explains why organizations that once avoided legal action have now resorted to it. We are lacking meaningful engagement of any kind.

JEREMY MAGGS: Have you or your organization lost confidence in the health minister [Aaron Motsoaledi]?

KATLEGO MOTHUDI: Since his reappointment, we haven’t had significant interaction, and he seems to have stepped into a complicated landscape. We recognize that the government is navigating a reshaped framework, yet they still appear out of sync.

I believe we can engage in productive dialogues, but we let ideologies obstruct essential actions. As one former president pointed out, people aren’t fed by rhetoric; they require concrete results.

It’s vital to discard discussions that impede our progress and concentrate on what needs to be done. A roadmap is available; countries have embarked on this journey before. We’ve learned from their mistakes and failures.

We can extract insights from those experiences, and we possess enough expertise within this country—whether from the public or private sectors—to develop a viable solution.

JEREMY MAGGS: But, I imagine, changing entrenched ideologies poses significant challenges, which could always impede progress.

KATLEGO MOTHUDI: Absolutely, it is a challenge. We fully endorse the WHO’s recommendations for building strong healthcare infrastructures, one of which involves effective leadership and governance. That’s where we need to start. We must ensure robust leadership, sound governance structures, and that advisors possess the necessary expertise.

JEREMY MAGGS: As a final question, you’ve referenced this earlier: the high court has mandated the president to reveal the decision-making documentation related to the enactment of the NHI. What do you expect these records to show?

KATLEGO MOTHUDI: We hope the records will demonstrate that there was significant input that the president should have considered before signing the bill. Many submissions from our organizations were against proceeding with it, and we are aware that most of this feedback has been neglected.

Our aim is to illustrate that the bill, and the process leading to its approval, was flawed and warrants reconsideration.

By indicating irrationality in the decision-making process, we highlight that the leadership failed to fulfill its obligations and strayed from its constitutional duties.

JEREMY MAGGS: Thank you very much, Dr. Katlego Mothudi, for sharing your perspectives. Strong statements from the managing director of the Board of Healthcare Funders.

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