Business Unity South Africa (Busa) has objected to the emphasis placed on NHI in the second presidential health compact due to be signed today, saying it cannot pledge support for a policy it opposes, and which it believes is unaffordable and unworkable.
Business Day reports that a draft document circulated last week explicitly supports NHI and its enabling legislation, which Busa says will damage SA’s health system and investor confidence.
“The draft … does not take into account what we have said, and promotes the NHI in its current form at a time when we are still in discussion and engagement about our displeasure (with it). It was never our intention that the NHI should be part of the health compact,” Busa CEO Cas Coovadia said on Tuesday.
“The intention was to collaborate on looking at how we can improve the public health sector. There are serious differences between us and government on whether NHI in its current form is an appropriate legislative instrument. If you want a compact everyone will sign, then have a compact on which everyone agrees.”
The compact follows the second presidential health summit held last year where a wide range of stakeholders discussed ways to improve the health system. The first presidential health summit in 2018 was also followed by a compact, which contained only a handful of references to NHI and was signed by business.
The draft health compact for the second summit, which Business Day has seen, contains 12 articles each linked to NHI.
Article 1 says the government and other stakeholders commit themselves to achieving universal health coverage through NHI, for which a legislative framework has been created.
Article 12 says the government and all other stakeholders commit to jointly implementing NHI-related health systems and service improvement plans.
Stakeholders expected to sign the compact include the President, Health Minister Aaron Motsoaledi and representatives of business, civil society, labour, healthcare professionals, healthcare users, statutory health councils, academic and research organisations and public health entities, as well as traditional and allied health practitioners.
Busa wrote to the presidency at the weekend to express its concern, and while receipt of the letter was acknowledged, it had not received a response, said Coovadia.
Presidential spokesperson Vincent Magwenya said the presidency would prefer to engage with business directly rather than via the media.
Busa had previously given extensive input to the NHI scheme, which was largely ignored, before petitioning the President to not assent to the Bill, which it said was simply unaffordable.
Scaring South Africans
However, Motsoaledi has been scathing about projected and much-publicised costs to fund NHI, slamming Momentum Health Solutions’ estimate of more than R1.3trn as “mathematical hooliganism” designed to scare South Africans into rejecting the new system.
Addressing the media last week after the ANC’s three-day policy lekgotla, Motsoaledi had suggested he was opening the door to fresh consultation on the controversial plan for achieving universal health coverage even as the government moves to implement it.
“We are going to implement section 57 immediately to make sure we get going with transitional mechanisms. But simultaneously we are intending to run massive roadshows, workshops, and meet all the role-players and relevant stakeholders to understand their concerns,” the minister had said.
He added that in “the war that is raging about NHI” no one says they are against universal health coverage. “They will all say they support universal health coverage and then put a big ‘but’. And after that ‘but’ they will say, in the form in which it is in NHI (…)
“So, our job is going to find out exactly in what form do you want it. We need to start dialoguing. South Africa is known for dialogue.”
Motsoaledi contrasted this envisaged dialogue with Momentum’s dissemination of its estimate that it will cost more than R1.3trn per annum to provide every South African with healthcare of the same quality as is provided by the private healthcare system, made public during a webinar on 30 July, reports Moonstone.
“I found this unfortunate and in bad taste… disturbing. It doesn’t build a nation…all it does is to create fear and uncertainty, for people to live in fear. It’s a scarecrow, to scare them off,” the Minister said.
The report he was referring to quoted Damian McHugh, chief marketing officer for Momentum Health Solutions, as saying that even if one assumed a lower total NHI cost of about R900bn a year, it was significantly higher than the combined expenditure of the public and private healthcare systems, estimated at slightly more than R500bn a year. This figure was arrived at by adding the estimated R230bn spent by the private healthcare sector to the R271.9bn allocated to public healthcare in the 2024/25 Budget.
“It is unacceptable, and … scaring people like that is tantamount to mathematical hooliganism (…); which an advanced country like ours should not be doing,” said Motsoaledi.
He compared Momentum’s NHI cost estimate to the Minister of Human Settlements’ announcing that all South Africans must be housed and have decent shelter, and someone estimating how much that would cost by finding the selling price of the most expensive house in an exclusive suburb and multiplying the price by 61m people.
He said Momentum assumed, incorrectly, that NHI means the state must pay “whatever amount” for every South African to receive healthcare.
According to Motsoaledi, it costs R1 800 to have a child circumcised by a general practitioner in a township. But if the parents take the child to a private hospital, they will pay between R15 000 and R18 000 because the procedure will be performed by specialists, a urologist and an anaesthetist, as well as an assistant to the urologist. Specialists charge higher fees because they require 15 years’ training.
He said Momentum’s calculation was based on the NHI following this type of system, which makes healthcare “unnecessarily expensive”.
“We won’t follow that, obviously, but Momentum is assuming we will do that.”
Motsoaledi said Momentum also incorrectly assumed that once NHI is introduced, public healthcare facilities will be rendered “irrelevant” because everyone will go to a private facility.
Roadshow ‘a bit rich’
The roadshow plan has been disparaged by Busa, the DA and Solidarity, who called it a charm offensive and not serious engagement.
Busa's Coovadia said while the organisation was willing to engage with the government on NHI, it did not consider a roadshow the right way to do it.
“A roadshow is not engagement: engagement is sitting down and looking at what the issues are, whether we can reach agreement on those and how we can move forward.”
The DA called the roadshow a talk shop aimed at charming or strong-arming stakeholders into supporting NHI.
“Both the National Assembly and the National Council of Provinces held public participation processes. None of the inputs was ever seriously engaged with, and all were simply ignored,” said the party’s health spokesperson Michele Clark.
Solidarity economics researcher Theuns du Buisson expressed doubt about the roadshow, saying the trade union’s input on NHI had been largely ignored.
“It’s a bit rich to say there will now be a new consultation process,” he said.
Meanwhile, reports eNCA, the Health Department says the roadshows are the Health Minister’s own personal initiative, with Deputy Director-General for NHI Nicholas Crisp adding that Motsoaledi also has obligations in his capacity as an ANC member – but remaining mum on whether the department was footing the bill.
Business Day PressReader article – Organised business sticks to guns on NHI (Open access)
BusinessLIVE article – Aaron Motsoaledi’s NHI roadshow raises eyebrows (Restricted access)
See more from MedicalBrief archives:
Minister opens up NHI discussions with roadshow
Government dodges issue of NHI funding model – DA
Motsoaledi to increase push for NHI
NHI will be the equaliser between rich and poor — Motsoaledi