President Cyril Ramaphosa signing into law the National Health Insurance (NHI) Bill in May 2024 to achieve universal coverage for health services. Picture: GCIS.
The government has postponed the signing of the Second Presidential Health Compact by a week as it irons out issues with the private sector players following serious push-back by big business against the National Health Insurance (NHI) scheme.
The National Health Insurance Bill was signed into law on 15 May, 2024, marking an important milestone on the journey by the country to realise Universal Health Coverage without anyone incurring financial hardships as enshrined in the Constitution.
Business unity South Africa (Busa) yesterday said it would not be signing the President’s Health Compact as it cannot support a policy that explicitly endorses the NHI Act in its current form.
The signing ceremony of the Health Compact was scheduled for today at the Union Buildings but The Presidency yesterday said it has been postponed until next Thursday.
Busa said it has written to President Cyril Ramaphosa to express its concern.
Cas Coovadia, Busa CEO, said they believe the NHI Act needed to be amended to ensure that the country was able to deliver healthcare reform and advance universal health coverage without damaging the economy and the existing skills, innovation, resources and experience that reside in the private healthcare sector.
Coovadia said the country should be leveraging these resources to help design and support a system that was fit for purpose and that was able to benefit future generations.
“The draft of the Compact that was shared with Busa promotes the NHI in its current form as the foundation underpinning healthcare reform,” Coovadia said.
“Busa does not agree with this given the serious differences between us and the government as to the appropriateness of the NHI Act, let alone its feasibility as a legislative instrument to underpin universal health coverage.”
The second compact follows the 2023 Presidential Health Summit which built on the inaugural summit of 2018 and brought 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.
The Presidential Health Summit Compact in 2018 was an objective supported by business, particularly the focus on immediate opportunities for health improvement, including strengthening supply chain management, health infrastructure planning, accountability, augmenting health system resources, as well as the principle of collaboration in healthcare delivery.
It initially consisted of nine pillars with a 10th pillar added during last year’s summit.
The references to NHI in the original Compact were minimal and only in the context of longer term planning.
Coovadia said there has been no consultation on the updated wording that fundamentally transforms the Compact from health system strengthening to a focus on NHI implementation.
He also said that the government’s recent public statements indicating an openness to engagement on the NHI made it all the more bewildering that the Health Compact document had 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. While everybody supports universal health coverage, there are ways to achieve it other than implementing an unaffordable, unworkable and unconstitutional NHI, which is essentially a funding model that is impractical, inequitable, and not feasible in the South African context,” Coovadia said.
“Furthermore, it is putting the cart before the horse to sign and agree to a Compact when structured, formal discussions and engagement with government on the NHI, as a key pillar of universal health coverage, still need to take place.”
Meanwhile, health minister Dr Aaron Motsoaledi this week engaged stakeholders in Limpopo on the NHI Act as part of ongoing countrywide stakeholder engagement programme to understand the concerns and recommendations from various sectors of society on how this health sector reform can be effectively implemented for the benefit of all citizens.
This is in spite of fact that the government suffered a serious setback last month after the High Court ruled that the Certificate of Need (CON) under the National Health Act of 2003 was unconstitutional and amounted to “nothing more than the arbitrary deprivation of property and impairment of the right to freely practice a trade, occupation or profession”.
The CON’s aim was to dictate where private doctors could practice, what type of facilities they could operate, and to criminalise operating without a certificate, and could also be withdrawn if providers did not “share” their resources with the State in public-private partnerships.
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