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Business Unity South Africa (Busa) has welcomed the announcement from the Presidency that the signing of the Presidential Health Compact has been postponed to next week after it was initially planned to happen tomorrow.
Cas Coovadia, CEO of Busa welcomed the postponement saying the organisation indicated that the current version does not incorporate the views that it put on the table in April this year and that it also includes significant references to the National Health Insurance (NHI) Act.
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.
It consists of ten pillars, that include the development of human resources, improving access to medicine, vaccines and health products, upgrading infrastructure, private sector engagement, quality healthcare, public sector financial management improvements, governance and leadership, community engagements, information systems and pandemic preparedness.
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In a statement issued on Wednesday morning, Coovadia said that Busa would not sign the Compact on Thursday because it cannot support a policy that explicitly endorses the NHI Act in its current form. He added that Busa wrote to the President to express its concern.
“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.”
The headline of the 2018 Presidential Health Summit Compact was ‘Strengthening the South African health system towards an integrated and unified health system’. Coovadia says this was an objective business supported, particularly the focus on immediate opportunities for health improvement, including strengthening supply chain management, health infrastructure planning, accountability and augmenting health system resources, as well as the principle of collaboration in healthcare delivery.
He points 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.
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“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.”
Coovadia says Busa is concerned 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.”
In addition, he says, 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, must still take place.
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“Busa believes the NHI Act must be amended to ensure that the country can 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. The country should be leveraging these resources to help design and support a system that is fit for purpose and that is able to benefit future generations.”
Coovadia says Busa certainly did not expect the Compact to contain any reference to NHI. “These issues must be addressed and we will now engage with the Presidency to see if we can negotiate for a Compact that all stakeholders agree with to create a collaborative effort to address the efficiency of the health care system.”
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