Health professional groups are standing firm against signing the Presidential health compact in Pretoria today, saying they are being expected to sign a document that refers to the National Health Insurance (NHI) 25 times.
Business Unity SA Business, the South African Medical Association (SAMA) and the SA Health Professionals Collaboration, said yesterday they will still not sign the health compact, saying their concerns about the NHI have not been addressed.
The second compact follows the 2023 Presidential Health Summit which built on the inaugural summit of 2018 bringing together government, business, labour, civil society, health professionals, unions, service users, statutory councils, academia and researchers to develop sustainable and inclusive solutions to challenges in the national health system.
Stakeholders were supposed to sign it last week, but BUSA, SAMA and the SAHPC, all refused to sign it in its current form.
All three were invited to the signing at the Union Buildings, but the second draft of the compact they received is still the same as the one they received last week.
The Citizen reports that the Presidency also did not contact any of the three bodies to discuss their concerns regarding the document.
Cas Coovadia, CEO of BUSA, said his views are unchanged from last week, when he said the current version of the compact does not incorporate the views of the business organisation.
“The draft that was shared with BUSA promotes the NHI in its current form as the foundation underpinning healthcare reform. BUSA does not agree with this, given the serious differences between us and government about the appropriateness of the NHI Act, let alone its feasibility as a legislative instrument to underpin universal health coverage.”
Dr Mzulungile Nodikida, CEO of SAMA, also still has the same concerns as last week, when he said SAMA fully supports the overarching goals in the compact, which emphasises strengthening the health system, enhancing health infrastructure and the equitable distribution of healthcare resources.
“However, SAMA has serious concerns about the current NHI model as the primary vehicle for achieving these goals.
“In its current form, it may not adequately address the complexities of our health system and could inadvertently lead to unintended consequences that compromise both the public and private healthcare sectors.”
Echoing SAMA, Simon Strachan, a spokesperson for the SAHPC, said this week that the organisation also still feels the same.
Among the associations that SAHPC represents are South African Private Practitioners Forum (SAPPF), Federation of South African Surgeons (FoSAS), South African Dental Association (SADA), South African Society of Anaesthesiologists (SASA), Unity Forum of Family Practitioners (UFFP), South African Orthopaedic Association (SAOA), South African Society of Obstetricians and Gynaecologists (SASOG) and the Radiological Society of South Africa (RSSA).
Coovadia also pointed out that the references to NHI in the original compact were minimal and only in the context of longer-term planning.
“There has been no consultation on the updated wording that fundamentally transforms the compact from health system strengthening to a focus on NHI implementation.
“The context of legal challenges around the NHI Act and government’s recent public statements indicating an openness to engagement on the NHI make it all the more bewildering that the document was unilaterally amended and altered in its essence.”
While the first media invitation on the Presidency’s website last Monday contained no reference to the NHI, the invitation for today clearly stated that the second compact “has a monitoring and evaluation component where roles and responsibilities are assigned to a broad range of stakeholders to support health systems strengthening and preparation for the implementation of the NHI”.
The new invitation also did not include the names of BUSA, SAMA and the SAHPC.
It indicated that the signatories were the President, Ministers of Health and Science & Innovation, Independent Community Pharmacy Association (ICPA), South African National Aids Council (SANAC), South African Medical Association Trade Union, Democratic Nurses of South Africa, Cosatu, Campaigning for Cancer, South African Medical Research Council (SAMRC), South African Pharmacy Council (SAPC), National Unitary Professional Association for African Traditional Health Practitioners of South Africa (NUPAATHPSA) and Traditional Knowledge Systems and Allied Health.
Long-term planning
News24 reports that business had originally endorsed the 2018 compact – which made minimal mention of NHI and only in the context of long-term planning – long before the NHI Act, which would create a single pool of healthcare funding, was signed into law.
The stakeholders are integral to supporting the National Department of Health in improving the health system, but they flatly reject the 2024 compact, which has used the NHI scheme to underpin the strategy, reports BusinessTech.
The draft compact circulated last week states that the government and other stakeholders commit themselves to achieving universal health coverage through NHI and that they commit to jointly implementing NHI-related systems and service improvement plans.
Coovadia said inputs from businesses had been ignored, and questions around funding, coverage, implementation and administration had also been left unanswered.
In addition, there has been no consultation on the new compact’s updated wording, which transforms it from a health-system-strengthening focus to a focus on implementing the NHI, he said.
“Furthermore,” he told Daily Maverick, “it is putting the cart before the horse to sign and agree to a compact when structured, formal discussions and engagement with government on the NHI, as a key pillar of universal health coverage, still need to take place.”
SAMA also has serious concerns, and “urges a re-evaluation of the NHI framework…a more flexible, inclusive, and sustainable approach that considers the diverse needs of SA’s population and healthcare providers”, reports BusinessLIVE.
“In (the) light of our concerns, SAMA calls for an open and inclusive dialogue on the best path forward, and urge that future references to the NHI in the presidential health compact be revised to reflect a broader spectrum of potential solutions and that stakeholder engagement remains a cornerstone of this ongoing reform process.”
Business Tech article – Doctors turn their back on Ramaphosa over the NHI (Restricted access)
Business Day article – NHI row – Health Summit postponed (Restricted access)
Daily Maverick article – Health compact signing postponed after business objections (Open access)
See more from MedicalBrief archives:
Organised business slams NHI emphasis in health compact
Minister opens up NHI discussions with roadshow
Motsoaledi to increase push for NHI