Thread by @TaniaAjam

1. #NHI would be an important milestone for progressive realisation of socioeconomic rights in #SouthAfrica. The financing concerns raised by the #DavisTaxCommittee in 2017 have however not been addressed. @judith_february @thabileoka

taxcom.org.za/docs/20171113%…

2. Since 2017, the fiscal situation has deteriorated to the extent that cutting civil servant salaries - the holiest of holy cows in #SouthAfrica - has entered the public debate. National Treasury is saying the cupboard is bare, but the Department of Health thinks otherwise.

3. The hole in our fiscus due to corruption and mismanagement at #ESKOM and other SOEs will continue to hit us 2026 and afterwards. We have chosen to use our limited fiscal space to fund free Higher Education not health. There are always tradeoffs, and that one has been made.

4. While implementation design is a process, not an event, absence of feasible funding plans will sabotage the most laudable ideal. The we'll-make-it-up-as-we-go-along never works. Expressing funding concerns is not gratuitous resistance.

5. The only way #NHI will be financially viable is with economic growth above the 3% projection the White Paper used. A poorly consulted and implemented #NHI will depress growth still further AND undermine health system reform objectives.

6. As concerning is the failure of the pilot sites. If change was not accomplished at micro level, what are the chances of success with a system wide change? What will be done differently after the pilots to be more effective? What are responses to the pilot site failures?

7. Huge constitutional issues must be addressed. #NHI takes health functions away from Provincial Governments, leaving them as glorified education providers as public transport and housing functions are devolved to Municipalities increasingly.

8. If Provinces are going to be hollowed out by a series of incremental decisions stripping them of constitutional powers, why not scrap them altogether and save money. I have no doubt that litigation will ensue, which is never great for timely implementation.