The department's deputy director-general for health regulation and compliance, Anban Pillay, said the hourly rate for doctors contracting with the pilot district clinics was R355. Doctors were expected to sign up for a minimum of four hours a week. Motsoaledi said conditions in many public sector clinics were far from ideal and that, too, was a deterrent for doctors used to working in well-equipped and maintained practices. Angelique Coetzee, GM of the South African Medical Association (Sama), said the government had failed to consider the economics of private doctor practices. A doctor who worked in a government clinic for several hours would likely have to pay for a locum to see to their patients, and continue to pay overheads and staff salaries.

The going rate for a locum in Pretoria was R350 an hour and a general practitioner typically saw four patients an hour, at upwards of R250 a consultation. Marmol Stoltz, who heads Sama's committee on doctors in private practice, said the doctors were going to lose out if they left their practices. She added that there had not been proper consultation with doctors. Coetzee said money was not the only factor deterring doctors: the average age of doctors was 58 and not all of them wanted to go back to working in clinics and being ordered about. MPs were told that the slow pace at which doctors had been contracted had contributed to the slow pace of expenditure of the NHI component of the national health grant. Earlier this month, the Treasury said R1.2bn had been set aside for the NHI grant over the medium-term expenditure framework to begin contracting with doctors, develop new reimbursement mechanisms for central hospitals, and improve their revenue management. The funds are structured as an indirect grant managed by the Department of Health. Another R222m has been allocated to the provinces as an NHI conditional grant, primarily intended for purchasing equipment and goods and services. 

Tamar Kahn: Business Day, 6 March 2014