Deputy President Paul Mashatile signed the Presidential health compact last week despite the boycott by various medical and business organisations, and without acknowledging the absence of key stakeholders.
Absent from the signing ceremony at the Union Buildings were Business Unity South Africa (Busa), the South African Medical Association (SAMA), and the South African Health Professionals Collaboration (SAHPC).
SAMA spokesperson Dr Mvuyisi Mzukwa told News24 it was not unexpected that the government had gone ahead and signed despite their concerns.
Mzukwa said the government was trying to get them to support the National Health Insurance Bill through the health compact, but the two were different issues, he added.
“We support, and we’ve been part of, the Presidential health compact because it talks about objectives; we support (objectives) regarding health systems strengthening, revitalising the infrastructure and equitable distribution of resources.
“But when you keep referencing the NHI and forcing us indirectly to support the NHI, it’s when then we decided to say no, because we must separate the two. The compact and NHI are two different things. We wanted to support the compact on its own and not the NHI. Because in its current form, we don’t agree with it.”
Signing the compact without considering stakeholders’ refusal to sign it meant challenges in healthcare systems would continue, he observed.
“We are still going to see fragmentations…we will continue to see challenges within the system because not everybody is embracing what comes up with it… everything that is disastrous, they tend to do it publicly,” he said.
Echoing his sentiments, SAHPC spokesperson Caroline Corbett said the organisation was committed to advocating for tangible and affordable health reform, and access to quality healthcare for all South Africans.
“For this reason, we continue to be frustrated by the unilateral approach the government is taking on this.
“The original draft of the compact referenced NHI as a part of future developments in healthcare over the long term, but this was then amended without stakeholder consultation to reflect a new draft that really just positioned all signatories as giving their full support to NHI in its current format, as opposed to a compact that focused on true health reform and engagement.”
Corbett said that major stakeholders refusing to sign the health compact should be of concern to the government.
“This should again raise significant concern for them… without addressing the persistent concerns raised by SAHPC, including SAMA, they continue to delay the implementation and determination of sustainable and affordable solutions to the healthcare crisis in the country.”
Busa told Daily Maverick it had consistently supported the goals of the compact since its inception, and remained committed to these projects and objectives.
“These goals were based on the need for the public and private healthcare sectors to work collaboratively to improve the overall health system, focusing on urgent projects related to health infrastructure, human resource planning, management capacity building, medico-legal risk management, and health IT system interoperability, among others,” it said.
But the current version had been unilaterally amended by the government, transforming its original intent and objectives into an explicit pledge of support for the NHI Act.
“These changes were made without consultation. While reference was made to NHI in the previous version of the compact, it was only mentioned in the context of longer-term developments. Busa has always supported a collaborative, workable NHI rather than the current single-fund model, which is both unaffordable and unimplementable.
“We have consistently expressed this position at Health Summit discussions, and in our submissions on the NHI White Paper and the NHI Bill, offering constructive recommendations and proposals to achieve the policy objectives without risking the country’s finances or negatively impacting taxpayers. These have all been ignored.”
At the signing ceremony, while reaffirming South Africa’s commitment to achieving the UN Sustainable Development Goals of ensuring healthy lives and promoting the well-being of all – a “bold commitment to achieve universal health coverage” and to “provide access to affordable medicines and vaccines for all” – Mashatile conceded numerous challenges within the public healthcare system that prevented the government from providing decent quality healthcare.
The compact’s nine pillars are: development of human resources; improving access to medicine, vaccines and health products; upgrading infrastructure; private sector engagement; quality healthcare; public sector financial management improvements; governance and leadership; community engagements; information systems and pandemic preparedness.
The signing, Mashatile said, “is an opportunity to reflect on progress since the signing of the first compact”.
The introduction of the HR training grant during the pandemic had enabled the department to create more than 73 000 new posts, while the private sector continued to support the health workforce development, through the Public Health Enhancement Fund which had trained 100 doctors and 75 master’s and doctoral graduates.
“Access to medicines, medical devices and equipment has been expanded. New technology is being used to improve supply chain mechanisms, streamline regulatory processes and reduce backlogs,” he said.
There was also ongoing expansion of infrastructure, and by November 2023 there were 149 new primary health facilities, with 30 new hospitals either opened or under construction.
“We are implementing the National Quality Improvement Plan to ensure that more public and private facilities meet the Office of Health Standards Compliance requirements. This is in line with the requirements of the NHI.”
Healthcare funding faced challenges due to budget cuts and a constrained fiscal environment, compounded by, among other things, inefficiencies, mismanagement and corruption in resource allocation, he acknowledged.
“But budgeting is steadily improving to ensure a more equitable allocation of resources. Less money is being lost to litigation, thanks to the hard work of the health sector anti-corruption forum.”
In what seemed like an olive branch offering, he added that the private sector had a crucial role in strengthening the health system, reports Business Day.
“Our experiences with Covid-19 showed how we could depend on public-private partnerships. With greater collaboration, the resources and capabilities of both the public and private sectors can be brought to bear to serve those who need healthcare the most. With the NHI Act now signed into law, it is even more urgent that we work together,” he said.
Doctors speak out
But private sector doctors share the same sentiments as the medical organisations that oppose the compact.
Dr Grant Lindsay, who is against the implementation of NHI in its current form, said: “It is a travesty that they are pushing forward with this. I think this compact will come to nought. It’s just smoke and mirrors.”
Limpopo doctor Matthew Cooke said that not having stakeholders on board was a serious problem.
“(The health compact) is said to be a framework for co-operation. I think it’s difficult to label it that if the key stakeholders have not agreed to co-operate. How can you go and sign something like this that is supposed to set the groundwork for co-operation between various stakeholders if you don’t have everyone on board?”
Cooke said that the signing of the compact, despite the lack of buy-in from major stakeholders, made it clear the government was looking more for compliance than co-operation by “just forcing it down our throats”.
Among the signatories to the compact were the Independent Community Pharmacy Association, the SA Medical Association Trade Union (Samatu), the Democratic Nurses of SA (Denosa) trade union, the SA National Aids Council, Cosatu, Campaigning for Cancer, the SA Medical Research Council, the SA Pharmacy Council, and the Defend the NHI campaign.
BD PressReader – Presidency shrugs off health compact boycott (Open access)
See more from MedicalBrief archives:
Stand-off over President’s health compact
Organised business slams NHI emphasis in health compact
Ticking boxes instead of actually doing something to save SA’s ailing health system