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The Presidential Health Compact signed in Pretoria last Thursday is worth nothing because major stakeholders from the business and medical sectors withdrew their support and refused to sign it due to unilateral changes to the wording to include support for the implementation of the NHI Act.
The health compact is President Cyril Ramaphosa’s initiative and was supposed to outline a framework for various sectors of society including government, business, labour, health professionals and academics to tackle the most pressing health challenges in South Africa.
The first health compact was signed in October 2018.
The second Health Compact follows the 2023 Presidential Health Summit which built on the inaugural summit of 2018.
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These organisations refused to sign Health Compact:
Business Unity South Africa (Busa), the South African Medical Association (SAMA) and the South African Health Professionals Collaboration (SAHPC), that represents about 25 000 doctors, all refused to sign the Health Compact in its current form, because they were expected to sign a document that refers to National Health Insurance (NHI) 25 times.
The Progressive Health Forum, a national health advocacy network of health workers, professionals, experts and activists concerned with the condition and responsiveness of the healthcare delivery system, also refused to sign.
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The Forum said the signing ceremony was attended by a selected group of healthcare ‘stakeholders’ that fell so far short of relevant health sector representatives that it betrays the unfortunate but unavoidable conclusion that they were bit actors in a piece of populist political theatre.
Professor Alex van den Heever, chair of Social Security Systems Administration and Management Studies at the University of the Witwatersrand, told Health-e News that the notable absence of these organisations contradicts the purpose of the Health Compact pledge.
He said it is not clear if the Health Compact can be regarded as a compact when major stakeholders withdrew, as it requires consensus across diverse interest groups and not just those who are affiliated to a single political party.
“The purpose of the health compact is to establish a wide social consensus on a particular issue or set of issues. Many social issues are affected by divided interests. A social compact attempts to bridge these interests and find common ground,” he said.
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According to Van den Heever, reaching social consensus typically requires intensive engagement and problem solving among all the stakeholders.
“Abdication by key social partners indicates a failure to establish a social compact. While government is free to publish any documents it wants, regardless of how ill-conceived or shallow, calling this document a compact stretches credulity and is plainly contrary to the rational purpose of a social compact.”
Busisiwe Mavuso, CEO of Business Unity South Africa (BLSA), also criticised the signing of the Health Compact. “We achieve much when government and the private sector work together in a productive way that draws on the strengths of each party.
“That is why the idea of ‘compacts’ can be helpful in painting a vision and achieving consensus. However, the ‘Health Compact’ that was signed by the deputy president is a mockery of that idea. A compact that excludes key organised business is not a reflection of any deep consensus and not the way for the country to make progress.”
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She says Busa, the apex business body, as well as key organisations in the health sector have publicly expressed dismay that the compact was unilaterally redrafted by government to put the NHI scheme at its centre.
“Busa and BLSA are on record for our clear view that the NHI as currently conceived is unworkable and a huge risk to the economy. We cannot compact with government, unless it is in line with the many constructive proposals from business on how the NHI could be made workable without extensive damage to the economy.”
Mavuso says it is an act of bad faith that government would go ahead and sign a compact that is nothing of the sort.
Meanwhile, the chairperson of the Portfolio Committee on Health, Dr Sibongiseni Dhlomo, has welcomed the signing of the Presidential Health Compact. “Today marks a significant milestone in our collective journey towards improving the health and well-being of our nation with the signing of the compact.”
ALSO READ: 25 000 healthcare professionals will also not sign President’s Health Compact
He said in a statement that the compact assigns roles and responsibilities to a broad range of stakeholders to support the strengthening and preparation of health systems for the implementation of the NHI. Members of the committee of the sixth parliament participated in the deliberation for the second Presidential Health Compact.
“In recent years, we have witnessed the impact of various health crises, which have underscored the urgent need for a cohesive and collaborative approach to health governance. The compact brings together government entities, healthcare providers, civil society and the private sector, fostering a spirit of partnership and shared responsibility. It aims to streamline efforts, allocate resources more effectively, and implement innovative solutions that will ultimately lead to better health outcomes for all.”
According to the Presidency, the signatories were the president (deputy-president Paul Mashatile represented the president), the ministers of health and science and innovation, the Independent Community Pharmacy Association, South African National AIDS Council, South African Medical Association Trade Union, Democratic Nurses of South Africa. Congress of South African Trade Unions, Campaigning for Cancer, South African Medical Research Council, South African Pharmacy Council, National Unitary Professional Association for African Traditional Health Practitioners of South Africa and Traditional Knowledge Systems and Allied Health.
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