Certificate of need a useful instrument to apply to Cabinet – Business Day, 11 August 2014

ACCORDING to Business Day, longstanding proposals to require doctors and other providers of health services to obtain "certificates of need" from the government before they are allowed to practise have once again been put on hold. That is no reason, however, why we should not explore extending this concept.

ACCORDING to Business Day, longstanding proposals to require doctors and other providers of health services to obtain "certificates of need" from the government before they are allowed to practise have once again been put on hold. That is no reason, however, why we should not explore extending this concept.

Perhaps the health minister himself could be required to produce a certificate of need. Do we actually need him? Are his proposed interventions in the healthcare sector not likely to do more harm than good? Private healthcare would certainly be better off without all his ministrations, but public healthcare would probably also be better off. Our private healthcare groups would be free to buy up state hospitals that don’t work, or clinics that run out of HIV/AIDS drugs.

All that would be needed is for the Treasury to provide vouchers with which poor people could buy healthcare from private providers, who would compete for their custom. These vouchers would take the form of smartcards to be handed out on production of identity documents to licensed outlets with national networks — for example, 24-hour filling stations, cellphone shops, or fast food joints. They would be paid a fee per voucher handed out.

The patients would then go to the health provider of their choice and hand over their voucher. The doctor or clinic would present it to the Treasury, which would then transfer the funds into his bank account.

The certificate-of-need could be extended. Do we actually need 35 ministers and 35 deputies? Some wag suggested when they were appointed that the ministeriat was growing faster than the economy. We might be able to reverse this if each one had to produce a certificate of need showing what value they added to the country and its economy.

Do we actually need a minister of mineral resources? African National Congress secretary-general Gwede Mantashe has said that his party had a "dream" that South Africa would one day have a "mining champion".

Well, when his party came to power, we actually had a number of mining champions.

Fact is that if it weren’t for all the mining ministers we’ve had, we might have lots more mining champions. As with all economic decisions, there is a trade-off here. Fewer ministers, more champions. Perhaps Mr Mantashe could put this to President Jacob Zuma when the two discuss the next round of ministerial deployments.

A certificate of need would also enable us to evaluate the minister of trade and industry. Both activities have been going on since time immemorial, certainly long before anybody thought of having a minister to deal with them, let alone appointing one. Economic development has also been a natural outcome of human endeavour over the centuries.

So it is by no means obvious that our minister of economic development would be able to produce a credible certificate to the effect that we cannot do without him.

Do we need a labour minister? Arguably, there is a direct correlation between high unemployment and 20 years of legislative activism on the part of labour ministers.

What all ministers should do is provide hard data and arguments to prove that we actually need them. That would certainly cut the Cabinet down to size.

• Kane-Berman is a consultant at the South African Institute of Race Relations.

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