Business Unity South Africa (BUSA) and the South African Medical Association (SAMA) say they will not sign the second Presidential Health Compact because the document explicitly endorses the National Health Insurance (NHI) Act.
BUSA is the country’s largest federation of business organisations in terms of its members’ contribution to GDP and employment. SAMA is a voluntary association for medical practitioners who work in the public and private sectors.
The second health compact was scheduled to be signed at the Union Buildings in Pretoria today. But the Presidency issued a statement yesterday saying the signing ceremony has been postponed to next Thursday, 22 August. It said the postponement was because of “unforeseen circumstances”.
BUSA’s chief executive, Cas Coovadia (pictured), said yesterday the organisation welcomed the postponement and would be engaging with the Presidency on the matter. “We are not aware of the reason for the postponement.”
In a statement released earlier yesterday, Coovadia said 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.”
BUSA wrote to the Presidency at the weekend to express its concerns.
The second compact follows the 2023 Presidential Health Summit, which built on the inaugural summit in 2018. Last year’s summit brought together the government, business, labour, civil society, health professionals, trade unions, statutory councils, and researchers to develop solutions to challenges in the national healthcare system.
The first compact also included references to NHI. Coovadia said these references were minimal and only in the context of longer-term planning.
BUSA said there has not been any consultation on the updated wording, which transforms the compact from aiming to strengthen the health system to a focus on implementing NHI.
Business Day reported it has seen a copy of the draft second compact, which, it said, contains 12 articles each linked to NHI.
According to the publication, Article 1 states the government and other stakeholders commit to achieving universal health coverage through NHI, and Article 12 states the government and all other stakeholders commit to implementing NHI-related health systems and service improvement plans.
BUSA said the legal challenges to the NHI Act and the government’s recent public statements indicating an openness to engagement on NHI make it “all the more bewildering” that the health compact document has been unilaterally amended and altered in its essence.
“Our concern is that this is at the expense of immediate opportunities to expand and improve healthcare access,” Coovadia said.
He said it would be putting the cart before the horse to sign and agree to the compact when structured, formal discussions, and engagement with the government on NHI must still take place.
BUSA said the NHI Act should be amended to ensure that the country can deliver healthcare reform and advance universal health coverage without damaging the economy and the skills, resources, and experience in the private healthcare sector.
SAMA calls for revision of NHI framework
In a statement yesterday, SAMA said although it fully supports the overarching goals in the health compact, it has “serious concerns” about the current NHI model as the primary vehicle for achieving them.
“While we share the government’s commitment to UHC [universal health coverage], 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.
“SAMA urges for a re-evaluation of the NHI framework, advocating for a more flexible, inclusive, and sustainable approach that considers the diverse needs of South Africa’s population and healthcare providers.
“We recommend that references to NHI in the Presidential Health Compact be reconsidered to allow for alternative models of achieving UHC, which may include hybrid approaches or reforms that build on the strengths of both the public and private sectors.”
SAMA said it was particularly concerned that the current NHI model could strain healthcare resources, exacerbate existing inefficiencies, and limit patient choice. Instead, it advocates for a health reform model that ensures access to quality care for all citizens without compromising the standards of care, financial sustainability, or the autonomy of healthcare providers.
SAMA called for an “open and inclusive dialogue” on the best way to achieve UHC.
“We 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,” it said.
The NHI Act was signed into law in May, but none of its provisions has yet been promulgated.
