Doctors turn their back on Ramaphosa over the NHI
Following business group BUSA’s decision to boycott the 2024 presidential health compact signing, thousands of doctors and other health practitioners are also turning their back on the document.
The presidency announced this week that the president Cyril Ramaphosa would be signing the compact, which represents an accord of strategic intent among the stakeholders that sign it.
The new compact—the second since 2018—was written up following the 2023 Presidential Health Summit.
The summits bring 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.
However, the 2024 compact has taken a very explicit stance of having the National Health Insurance scheme underpin the strategy—which stakeholders are rejecting.
The South African Health Professionals Collaboration (SAHPC)—a national group of nine medical, dental, and allied healthcare practitioners’ associations representing more than 25,000 dedicated private and public sector healthcare workers—said it will not sign the compact, blaming the NHI.
The group said that the compact is ‘nothing more than an attempt to lock in support for the NHI Act”.
While the SAHPC acknowledged that health reforms are necessary to address the challenges in the country’s healthcare system, it believes the way that the Health Compact has been written is fundamentally biased towards solidifying support for the NHI Act as the sole solution to achieving universal health coverage.
“The compact heavily focuses on the NHI, presenting it as the only viable option for the country, which we don’t accept,” said Simon Strachan, a spokesperson for the SAHPC.
“Health professionals, including general practitioners, specialists, dentists, and allied workers, are the cornerstone of health provision in this country. Our primary concern is, and always will be, the well-being of patients.
“We do not believe the NHI is a viable or workable model for universal health coverage. Our numerous proposals and concerns have not been acknowledged.”
Strachan said that instead of trying to get dissenting stakeholders to sign an agreement, an urgent formal engagement with the President on the NHI and ways of achieving universal health coverage is needed.
The boycott from healthcare workers follows businesses’ rejection of the compact on the same grounds.
BUSA CEO Cas Coovadia said on Wednesday that businesses do not support the NHI in its current form and have made that explicitly clear throughout the various government processes leading up to Ramaphosa hastily signing it into law ahead of the 2024 elections.
He said that these inputs were ignored, and questions around funding, coverage, implementation and administration have also been left unanswered.
In addition, BUSA said 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.
“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.
The compact was to be signed on Thursday (15 August), but it has now been postponed to next Thursday (22 August). The presidency provided no reasoning for the postponement.
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