Unilateral changes to Health Compact contradict Ramaphosa’s spirit of collaboration

The unilateral changes to the Presidential Health Compact contradict government’s need to work together with all stakeholders at a time when true collaborative engagement is needed to ensure South Africa’s healthcare system is equipped to provide for the needs of all South Africans equitably.

Craig Comrie, chairperson of the Health Funders Association (HFA), says the backlash against the Second Presidential Health Compact is rooted in a broader concern that the unilateral change to the wording of the document contradicts President Cyril Ramaphosa’s previously endorsed spirit of collaboration.

“The Health Compact presented the opportunity for patriotic South African entities to work together with government on initiatives around accountability, infrastructure enhancement and human resource development, among others, to strengthen the healthcare system and the previous version which was focused on these initiatives was wholeheartedly supported by private and public entities.”

Business Unity South Africa (Busa), the South African Medical Association 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 are still expected to sign the same document that refers to National Health Insurance (NHI) 25 times.

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Collaboration is a two-way process

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.

Private stakeholders, including the HFA, have long advocated for a healthcare system that leverages the strengths of the public as well as the private sectors. This was the principle the Presidential Health Compact that was initially established on in 2018.

Comrie says authentic collaborative engagement is very important, but collaboration is a two-way process. “As the HFA, we feel a responsibility to all healthcare stakeholders – first and foremost to the citizens who rely on the healthcare system – to advocate for a genuine consultative process on the urgent concerns surrounding NHI legislation.”

The HFA has also highlighted that the NHI Act does not adequately address the practical issues of quality, sustainability and constitutionality, which are all vital in ensuring a robust, sustainable healthcare system.

Therefore, Comrie says, the unilateral changes to the Presidential Health Compact to make it an endorsement of the NHI Act were inappropriate and deviate from the original intention.

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

Time for deeper engagements

“As an organisation representing several major healthcare funders and millions of South African healthcare consumers, we have repeatedly called for deeper engagements to ensure that the voices of all stakeholders, including healthcare professionals who are the lifeblood of South Africa’s healthcare system, are heard and considered,” says Comrie.

“We made practical, feasible and constructive recommendations on an approach that can rapidly expand access to health coverage consistent with the NHI policy objectives. Any further effort at consultations must also deal with the need to preserve and advance South Africans’ constitutional right to access quality healthcare.”

The HFA and its members’ extensive experience in health funding and the many submissions presented over the past decade highlight necessary considerations that to date do not appear to have been taken into consideration in the legislation, Comrie points out.

“We remain optimistic that deeper engagements will follow before the die is cast for South Africa’s future health system, as this is an opportunity to harness our collective strengths.”