The presidency has shrugged off a boycott by organised business and healthcare professionals and formalised its second health compact, signalling its intention to press ahead with National Health Insurance (NHI).
The compact follows the second presidential health summit in 2023 and was intended to be a consensus document signed by the parties that participated in the high-level meeting.
But last week, Business Unity SA (Busa), the SA Medical Association (Sama) and the SA Health Professionals Collaboration (SAHPC) said they would not agree to it, as they did not support the compact’s position on NHI. The NHI Act, which enacts universal health coverage reforms, was signed into law by President Cyril Ramaphosa in early May, two weeks before the general election.
Without acknowledging the absence of key stakeholders, acting president Paul Mashatile said on Thursday that the private sector had a crucial role to play in strengthening SA’s health system.
“Our experience in Covid-19 showed how we can deepen public-private partnerships. With greater collaboration, the resources and capabilities of both the public and private sector can be brought to bear to serve those who need healthcare the most,” he said at a signing ceremony in Pretoria.
“With the [NHI] act now signed into law, it is even more urgent that we work together,” he said.
Signatories to the compact include the Independent Community Pharmacy Association, the SA Medical Association Trade Union (Samatu), the Democratic Nurses of SA (Denosa) trade union, the SA National Aids Council, trade union federation Cosatu, Campaigning for Cancer, the SA Medical Research Council, the SA Pharmacy Council, and the Defend the NHI campaign.
Busa said the compact had been unilaterally amended by the government to include an explicit pledge of support for the NHI Act. Unlike the first compact signed in 2019, it is woven with references to NHI and expresses direct support for the act, which Busa, Sama and the SAHPC have indicated they will challenge in court. Busa has said consistently it supports universal health coverage, but not in the way set out in the act. It is opposed to the provisions for creating a government-controlled fund that will be sole purchaser of health services with medical schemes frozen out. It says its input was ignored throughout the legislative process. “Busa has always supported a collaborative, workable NHI rather than the current single-fund model which is both unaffordable and unimplementable,” it said.
The Health Funders Association (HFA), an industry body for medical schemes, voiced opposition to the compact this week, citing section 33, which says medical schemes will not be allowed to offer cover for healthcare services provided by NHI, and section 2a, which says the NHI fund will be sole purchaser of healthcare services, said HFA chair Craig Comrie.
Samatu general secretary Cedric Sihlangu said this week that the trade union backed NHI, as it was the only vehicle to achieve any form of meaningful progress towards universal health coverage. “The current health system is not working. We would support [measures] that bring even a glimpse of hope to everyone,” he said. “We are fully behind the compact, but more importantly the implementation of NHI” said Sihlangu. Appealing to the business sector to participate in a system that would service and support everyone, he said: “The current system is too lopsided in favour of the ‘haves’.”
Denosa, SA’s biggest nursing union, said its members backed NHI fully, believing it would ensure better working conditions, higher pay and more resources for treating patients. “Our members are aware of the potential loss of medical scheme subsidies and are willing to sacrifice [them] as long as it [NHI] addresses the challenges they face,” said Denosa deputy general secretary Khaya Sodidi.
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