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It’s not often that 360 doctors of varying disciplines, anxiously awaiting the birth of a much-feted infant, agree on the diagnosis and urgent treatment of its severely ailing mother. That’s what happened at the South African Medical Association’s (SAMA’s) prenatal ‘check-up’ of the impending National Health Insurance (NHI), at Emperor’s Palace in Gauteng early this October. Everyone, from NHI midwives Dr Aaron Motsoaledi (national health minister) and Dr Olive Shisana (its chief nurse), to individuals like social security economist Alex van den Heever (who at best fears a failure to thrive), believes the diagnosis of the health care system upon which an effective NHI will depend is blindingly obvious. They also agreed on a 10-point treatment plan for the ailing matriarch (one aspect of which is the NHI, aimed at providing vital health equity and access for all). That left only one real question: Does ‘Mama Nzantsi’ have the human and financial capital, let alone the management capacity, to carry, birth and then nurture this NHI child to maturity?

NHI consensus: fix the existing system or risk failure