Ramaphosa’s message to NHI boycotters in South Africa
President Cyril Ramaphosa says that businesses and organisations who did not sign the latest NHI-focused presidential health compact should work towards the government’s plans anyway, with the hopes that open dialogue will eventually help everyone ‘find each other’.
Responding to questions in a written parliamentary Q&A this past week, the president was asked whether any steps had been taken to address the concerns raised by various stakeholders regarding the second presidential health compact.
The compact was signed by the presidency in August – however, key stakeholders, primarily the private sector, healthcare professionals and business organisations, boycotted the event and refused to sign.
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).
However, it’s the explicit focus on the NHI that drew backlash from the very stakeholders the compact aims to draw in, with business group BUSA, and healthcare professional bodies, SAMA and the SAHPC, pulling out of signing the document.
The groups criticised the compact for focusing on the NHI – which remains contested and faces potential years of legal challenges – and effectively trying to force the groups opposing the laws to sign on and support the scheme.
Ramaphosa, however, said that those who boycotted the signing of the compact should support it anyway.
“We believe there is good reason for these stakeholders to be involved in the work needed to achieve the aims that are contained in the compact,” he said.
“Through the compact, we aim to invest in a capable, compassionate, fit-for-purpose workforce in the health sector. We aim to strengthen local manufacturing of health products and ensure health infrastructure meets the necessary quality standards that our people require in the health system.”
Ramaphosa said the compact seeks to use the private sector’s capabilities to enable the NHI and has noble goals and intentions that everyone should support.
“It seeks to maintain the gains that have been made in the National Quality Improvement Plan to ensure users experience the same quality of care whether in a state or in a private facility.
“The compact also aims to ensure adequate community engagement and inclusivity in the health sector so as to ensure that some people do not feel excluded where they experience inferior health care services.
“Importantly, the compact aims to ensure that the National Health Insurance is implemented affordably, deriving value for money and also eliminating corruption.
“These are the objectives which all stakeholders can support and work towards,” he said.
“We therefore encourage all role players to be involved in pursuing all these noble objectives so that we can ensure that we have a health care system that will serve all the people of our country.”
Speaking on the conflict over the NHI, the president said that he hopes the disparate views on the scheme will find some common ground.
“Through continuous engagement, which is what I am calling for also on the NHI, stakeholders should be able to find each other and to find solutions to some of the problems that still exist.
The president’s tone on the NHI and its critics stands in stark contrast to the health department’s approach since the seventh administration as the Government of National Unity (GNU) was established.
Contrary to calls for engagement, the department has spent the past few months shooting down criticism of the NHI and branding opposing groups and media platforms as anti-poor propagandists using fear-mongering and ‘apartheid tactics’ to scare people off the scheme.
Ramaphosa recently told Parliament he had a “fairly lengthy discussion” with Health Minister Aaron Motsoaledi after his recent comments on the NHI and aggressive responses in Parliament about the matter.
The government has since initiated engagements with business groups, asking for proposals and solutions to the impasse – not just criticism. The business groups have welcomed the move and are hopeful of further progress.
“By working together on the fundamental issues on which we agree, we will be able to make a significant contribution to improving the quality of health care for all South Africans. We will be able to do this through engagement, not boycotting, but also talking to each other on a continuous basis,” Ramaphosa said.
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