Ramaphosa to sign new NHI health compact – without doctors and businesses on board

President Cyril Ramaphosa will proceed with signing the second Presidential Health Compact this week despite a boycott by businesses and thousands of healthcare professionals.

The presidency announced that Ramaphosa will sign the compact on Thursday, 22 August 2024, following a week-long postponement.

The Presidential Health Compact is an initiative launched by Ramaphosa in 2019, which established a “framework of cooperation” between critical sectors in South Africa to significantly influence good health outcomes.

The 2024 compact is the second iteration of the framework, and it specifically focuses on supporting health systems and strengthening and preparing them for the implementation of the National Health Insurance (NHI).

It’s the explicit focus on the NHI that has drawn the most criticism from key stakeholders in the healthcare sector, including business representatives and healthcare professional organisations.

While these sectors support the goal of universal healthcare, they have been vocal in their opposition to the NHI in its current format as a means to achieving this, citing a string of growing concerns, including, but not limited to, funding, coverage, implementation and administration.

Ahead of the initial signing date (15 August), three major groups pulled out of the initiative and refused to take part:

• Business Unity South Africa (BUSA), representing various private business interests in the healthcare sector;
• The South African Health Professionals Collaboration (SAHPC), representing 25,000 healthcare professionals;
• The South African Medical Association (SAMA), representing 12,000 medical practitioners.

BUSA CEO Cas Coovadia said 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, the group 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.

For the SAHPC, the compact is “nothing more than an attempt to lock in support for the NHI Act”, which it does not believe will be a viable or workable model for universal health coverage.

“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,” it said.

SAMA said it had serious concerns about the NHI as an avenue for the government to achieve its healthcare goals and called for the scheme to be re-evaluated.

“While we share the government’s commitment to universal healthcare, we believe that the NHI, in its current form, 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,” it said.

The groups called for further engagement with the presidency over the compact and its wording, specifically removing the sole focus on the NHI and reflecting a broader spectrum of potential solutions for South Africa’s healthcare future.

However, the presidency appears to be set to sign the compact regardless of the boycott.

This week, it published the list of the signatories, which includes representatives from government, business, civil society, labour and academia.

Only one business representative is listed, however, and it excludes BUSA, SAMA and the SAHPC.

The signatories to the health compact are:

Read: Doctors turn their back on Ramaphosa over the NHI