Ramaphosa snubbed over the NHI

Update: the signing of the compact has been postponed until next Thursday, 22 August 2024.

Business Unity South Africa (BUSA) says it will not sign President Cyril Ramaphosa’s ‘health compact’ this week over disagreements about the National Health Insurance (NHI) scheme.

Ramaphosa will preside over the signing of the second Presidential Health Compact at the Union Buildings in Pretoria on Thursday (15 August 2024).

The second compact follows the 2023 Presidential Health Summit, which built on the inaugural summit of 2018 and brought 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”.

According to the presidency, the stakeholders involved in the Presidential Health Compact are integral to supporting the Department of Health in improving the health system.

It initially consisted of nine pillars, with a tenth pillar added during last year’s summit.

These include:

• 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.

Despite the successful coming together of stakeholders for the previous compact, the president’s latest attempt to present a united front for healthcare in South Africa will be met with resistance.

In particular, BUSA—as a key representative of private businesses in the healthcare industry, among others—said it would not be signing the compact.

It said it could not support a policy that explicitly endorses the NHI Act in its current form. BUSA has written to the President to express this concern.

“The draft of the Compact 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 as to the appropriateness of the NHI Act, let alone its feasibility as a legislative instrument to underpin universal health coverage,” said Cas Coovadia, BUSA CEO.

BUSA signed the 2018 Presidential Health Summit Compact, which was headlined: ‘Strengthening the South African health system towards an integrated and unified health system’.

“This objective was supported by business, particularly the focus on immediate opportunities for health improvement, including strengthening supply chain management, health infrastructure planning, accountability, augmenting health system resources, and the principle of collaboration in healthcare delivery,” the group said.

However, the original compact made minimal references to NHI and only in the context of longer-term planning.

The latest compact makes extensive mention of the NHI and presents it as core to the policy.

BUSA said there has been no consultation on the updated wording of the compact that fundamentally transforms it from health system strengthening to a focus on NHI implementation.

“Add to this the context of legal challenges around the NHI Act, and the government’s recent public statements indicating an openness to engagement on the NHI, (it) makes it all the more bewildering that the Health Compact document has been unilaterally amended and altered in its essence,” the group said.

“Our concern is that this is at the expense of immediate opportunities to expand and improve healthcare access. While everybody supports universal health coverage, there are ways to achieve it other than implementing an unaffordable, unworkable and unconstitutional NHI, which is essentially a funding model that is impractical, inequitable, and not feasible in the South African context.

“Furthermore, 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,” said Coovadia.

BUSA said the NHI Act needs to be amended to ensure that the country is able to deliver healthcare reform and advance universal health coverage without damaging the economy and the existing skills, innovation, resources and experience that reside in the private healthcare sector.

The group has long pushed against the NHI and the president’s decision to sign the scheme into law despite objections from private healthcare groups, businesses, legal experts, unions and the government itself.

Concerns raised about the scheme have been ignored, and questions around funding, coverage, implementation and administration have also been left unanswered.

Ramaphosa has alluded to further engagements, but new health minister Aaron Motsoaledia has been adamant that the rollout will proceed regardless, and that any “misunderstandings” would be clarified in a national roadshow.

Read: Big trouble for the NHI