NHI: Here’s the Health Compact that businesses and doctors refused to sign

The Presidential Health Compact that Business Unity South African and the South African Medical Association refused to sign with the president and other stakeholders at the Union buildings this afternoon contained an undertaking that “government and all other stakeholders will jointly implement the National Health Insurance-related health systems and service improvement plans”.

The signing of the Health Compact was postponed from Wednesday to Thursday 22 August.

Presidential spokesperson Vincent Ngwenya told Netwerk24 that it was only postponed due to changes in the president’s diary and not because of organisations refusing to sign the Health Compact.

CEO of Business Unity South Africa (Busa) Cas Coovadia welcomed the postponement on Wednesday. Coovadia said that the current version does not incorporate the views that it put on the table in April this year. It also reportedly includes significant references to the National Health Insurance (NHI) Act.

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SA Medical Association will not sign the current version

Dr Mzulungile Nodikida, CEO of the South African Medical Association (SAMA), says 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 National Health Insurance (NHI) model as the primary vehicle for achieving these goals.

“While we share the 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. It could inadvertently lead to unintended consequences that compromise both the public and private healthcare sectors.”

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This is what the Health Compact says about NHI

In a draft copy of the Presidential Health Pact seen by The Citizen, the delegates who will sign the document recognise that:

• “South Africa has chosen National Health Insurance (NHI) as its pathway to universal health coverage. The National Health Insurance Act, No. 20 of 2023, has been signed into law, ushering in the required legal framework for South Africa to achieve universal health coverage through NHI implementation.
• National Health Insurance is more dynamic than just a financing model for the health system. It is also a paradigm for the transformation of health service delivery and management to improve equitable access, quality, and effectiveness of health services, anchored on the Primary Health Care philosophy.
• Regardless of their different interests and roles, the government and all stakeholders have a common interest in enabling the implementation of National Health Insurance through health systems strengthening efforts and other policy reforms in both the public and private sectors.”

ALSO READ: NHI Act will not ensure universal healthcare soon

Supporting NHI for universal health coverage

In addition, the Health Compact states that the delegates support “the President of the Republic of South Africa’s call for the acceleration of the journey towards universal health coverage through National Health Insurance, with National Health Insurance being a lodestar for this voyage, and the President’s enablement of this vision through the enactment of the NHI Act, No 20 of 2023 in May 2024, and his call that government and all other stakeholders whose work or investment has an impact on quality and quantity of health care should work together as government and social partners”.

The Health Compact goes on to state in Article 1, that “government and all other stakeholders commit themselves to achieving universal health coverage in South Africa, enabled through the development and implementation of National Health Insurance, for which a legislative framework has been created.

“Every citizen must have access to high-quality health services whenever and wherever they need them without facing financial hardship”.

According to Article 2, “government and all its partners and stakeholders are fully cognisant that the successful implementation of National Health Insurance requires healthcare providers equipped with the requisite skills, competencies and caring attitudes to access citizens’ health care”.

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Most of the Health Compact articles reference NHI

Article 3, which addresses medicine availability, also references NHI, saying that access to products for all is non-negotiable with the national health insurance dispensation.

Article 4, which deals with health infrastructure, states that major resources are still required to ensure that the country’s infrastructure can support NHI and that government and “all other stakeholders commit to an NHI dispensation where the public and private sectors would fully cooperate to eliminate the inequitable two-tiered health system and jointly create one health system”.

In addition, Article 5, which deals with private sector participation, states that “government and all other stakeholders recognise that private sector participation in improving access, coverage and quality of health services is an essential building block for implementing the NHI”.

Most of the 16 articles of the Presidential Health Compact contain references to the NHI, but the part of Article 12 that states that “government and all other stakeholders will jointly implement the National Health Insurance-related health systems and service improvement plans” is perhaps the part that upsets the other stakeholders the most.

ALSO READ: SA health system favours the rich, says Motsoaledi on NHI

SAMA wants references to NHI in Health Compact to be reconsidered

Nodikida says SAMA reaffirms its unwavering commitment to advancing Universal Health Coverage (UHC) and strengthening the South African health system.

“As participants in the recent Presidential Health Summit and the formulation of the 2024-2029 Presidential Health Compact, we recognise the critical need to ensure equitable access to quality healthcare for all South Africans.”

He says SAMA fully supports the overarching goals in the Presidential Health Compact, which emphasises health system strengthening, the enhancement of health infrastructure and the equitable distribution of healthcare resources but is concerned about the current NHI model.

“SAMA urges 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.”

Nodikida pointed out that SAMA is particularly concerned that the current NHI model could strain healthcare resources, exacerbate existing inefficiencies and limit patient choice.

“Instead, SAMA 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.”