Nicholas Crisp, a leading protagonist of the government’s controversial National Health Insurance (NHI), is stepping down. But he’s not likely to go away.
Crisp was appointed head of the NHI well before the bill was passed by parliament in 2023. The act was signed without specifying an implementation date and has since been challenged in at least six court cases.
“I’ll be leaving any day now,” Crisp tells the FM. “The cabinet voted to allow me to stay an extra two years — to age 67 — and that comes after September.” He says he will support his successor in a consultancy capacity but will no longer be a government employee.
Crisp, who is also acting director-general of health, is retiring along with 27 senior officials, three of whom are suspended and face criminal charges. There are about 70 senior positions in the department.
The three are director-general Sandile Buthelezi, deputy director-general Malixole Mahlathi and CFO Phaswa Mamogale. They face charges of fraud and theft related to the allegedly irregular appointment of two service providers at the department.
In March they appeared at the Pretoria specialised commercial crimes court. The theft charges relate to money allegedly diverted from the Global Fund to Fight Aids, Tuberculosis & Malaria.
On losing so many senior staff in such a short time, Crisp says: “We’re not panicking. We should see this as an opportunity. We have been in the process of succession planning for some time. This is an unfortunate sideshow, if you like. In a way these things are good. They highlight alleged compliance failures and force us to tighten up what we’re doing.”
He says it also improves audit outcomes. “It’s a bit rough on those accused and now suspended, but they were all due to go anyway. The only one not due to retire is Mamogale because he’s still young.”
Health minister Aaron Motsoaledi denies having a hand in initiating the charges against the three. “No, no. The Hawks came to me. Dr Buthelezi called me … to say the Hawks were charging him. It was a complete surprise to me.”
Crisp says an internal investigation of the three officials will be completed soon.
“The timing will depend on how the hearing unfolds,” he says. “We hope they don’t change lawyers or fail to attend, as sometimes happens with these things. We want to make a case, get their side of the story, and get an outcome as soon as possible. This is totally independent of the Hawks’ charges.”
The criminal justice system will do its own thing. It has nothing to do with us
— Nicholas Crisp
He says the outcome of the hearing will decide whether the officials return to work, return under certain conditions or do not return at all. “They could also be demoted for 12 months or moved to an area where they don’t deal with money. These are all options.”
The findings will be presented to Crisp or to whoever is appointed to the post of director-general.
“We take steps in the capacity in which we’re appointed. It’s not about what Nicholas Crisp thinks. And the criminal justice system will do its own thing. It has nothing to do with us,” he says.
Crisp admits losing three top officials “obviously comes as a blow”. He says the department is “managing to hold the fort for now”.
Meanwhile, the department’s programme director of the Global Fund, Yolisa Tsibolane, has raised a red flag about South Africa’s slow response to a gradual reduction in support from the fund.
“We need a sustainability and transition plan now, not later,” she says.
South Africa is in the second year of the fund’s seventh three-year grant cycle, known as GC7, which runs until March 2028. After that, two further funding cycles remain before support is expected to reduce dramatically.
The implications are substantial. The fund finances a wide range of activities, including laboratory testing, mobile digital chest X-ray units, human resources and operational costs in some of the country’s highest-burden TB districts.
According to Tsibolane, future support is likely to focus increasingly on technical assistance, innovation, training and health system strengthening rather than day-to-day operational expenses.
The department is one of four principal recipients of Global Fund support in South Africa, alongside civil society organisations. Within the department, the national TB programme is the largest beneficiary.
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