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At least one business organisation and two medical organisations will still not sign the Presidential Health Compact in Pretoria on Thursday because they are still expected to sign the same document that refers to National Health Insurance (NHI) 25 times.
The second compact follows the 2023 Presidential Health Summit which built on the inaugural summit of 2018 that 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.
Stakeholders were supposed to sign it last week, but Business Unity South Africa (Busa), the South African Medical Association and the South African Health Professionals Collaboration (SAHPC), which represents about 25 000 doctors, all refused to sign the Health Compact in its current form.
They have now been invited to the signing at the Union Buildings, but the draft of the Health Compact they received is still the same as the one they received last week.
This has prompted them to refuse to sign it.
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The presidency also did not contact any of the three organisations to discuss their concerns about how the document tries to entrench the NHI.
Cas Coovadia, CEO of Busa, says he feels the same as last week when he said the current version of the Health Compact does not incorporate its views.
“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 about the appropriateness of the NHI Act, let alone its feasibility as a legislative instrument to underpin universal health coverage.”
Dr Mzulungile Nodikida, CEO of SAMA, also still has the same concerns as last week, when he said SAMA fully supports the overarching goals in the Presidential Health Compact, which emphasises strengthening the health system, enhancing health infrastructure and the equitable distribution of healthcare resources.
“However, SAMA has serious concerns about the current NHI model as the primary vehicle for achieving these goals.
“While we share government’s commitment to universal health care, 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.”
ALSO READ: 25 000 healthcare professionals will also not sign President’s Health Compact
Simon Strachan, a spokesperson for the SAHPC, said last week that while the SAHPC acknowledges that health reforms are necessary to address the challenges in the country’s healthcare system, it believes the way that the Health Compact has been written is fundamentally biased towards solidifying support for the NHI Act as the sole solution to achieving universal health coverage
“The Health Compact focuses heavily on the NHI, presenting it as the only viable option for the country, which we do not accept. Health professionals, including general practitioners, specialists, dentists and allied workers, are the cornerstone of health provision in this country.
“Our primary concern is and always will be the well-being of patients. We do not believe that the NHI is a viable or workable model for achieving universal health coverage. Our numerous proposals and concerns have not been acknowledged.”
Strachan said this week that the organisation still feels the same.
The SAHPC represents the South African Private Practitioners Forum (SAPPF), South African Medical Association (SAMA), Federation of South African Surgeons (FoSAS), South African Dental Association (SADA), South African Society of Anaesthesiologists (SASA), Unity Forum of Family Practitioners (UFFP), South African Orthopaedic Association (SAOA), South African Society of Obstetricians and Gynaecologists (SASOG) and the Radiological Society of South Africa (RSSA).
ALSO READ: Health Compact signing postponed after complaints about reference to NHI
Coovadia also pointed out that the references to NHI in the original Compact were minimal and only in the context of longer-term planning.
“There has been no consultation on the updated wording that fundamentally transforms the Compact from health system strengthening to a focus on NHI implementation.
“The context of legal challenges around the NHI Act and government’s recent public statements indicating an openness to engagement on the NHI, makes it all the more bewildering that the Compact document was unilaterally amended and altered in its essence.”
While the first media invitation on the Presidency’s website last Monday contained no reference to the NHI, the invitation for this Thursday clearly states that the second Presidential Health Compact “has a monitoring and evaluation component where roles and responsibilities are assigned to a broad range of stakeholders to support health systems strengthening and preparation for the implementation of the NHI”.
The new invitation also does not include the names of Busa, SAMA and the SAHPC.
It indicates that the signatories are the president, ministers of health and science and innovation, Independent Community Pharmacy Association (ICPA), South African National AIDS Council (SANAC), South African Medical Association Trade Union, Democratic Nurses of South Africa, Cosatu, Campaigning for Cancer, South African Medical Research Council (SAMRC), South African Pharmacy Council (SAPC), National Unitary Professional Association for African Traditional Health Practitioners of South Africa (NUPAATHPSA) and Traditional Knowledge Systems and Allied Health.
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