Picture: iStock
The signing of the Presidential Health Compact in Pretoria on Thursday was a disappointing affair instead of a hopeful event signalling unified action joined by all relevant constituents committed to proper healthcare reform.
The Progressive Health Forum, a national health advocacy network of progressive health workers, professionals, experts and activists concerned with the condition and responsiveness of the healthcare delivery system, says regrettably not hopeful at all.
Business Unity South Africa (Busa), the South African Medical Association (SAMA) 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 because they were expected to sign a document that refers to National Health Insurance (NHI) 25 times.
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.
ALSO READ: Unilateral changes to Health Compact contradict Ramaphosa’s spirit of collaboration
The Progressive Health Forum says the signing ceremony was attended by a selected group of healthcare ‘stakeholders’, some of unknown provenance but in sum falling so far short of relevant health sector and related constituency representatives, that it betrays the unfortunate but unavoidable conclusion that they were bit actors in a piece of populist political theatre.
“The ‘Health Compact’ was an outcome of the first Presidential Health Summit that the forum proposed to the president in 2017. That 2018 summit and the ensuing compact was devised, controlled and run by government exclusively, with a mere pretence at consultation being the norm and all of it in a thinly disguised pursuit of ramming through the NHI policy.”
The forum says the updated compact is nothing more than “an unapologetic attempt to shoehorn every constituent into unquestioning support for the NHI, in the teeth of the vehement opposition by the most important professional and civilian health sector stakeholders and national economic actors”.
“It is a disgraceful political sleight of hand, offending core constitutional tenets and demonstrating utter contempt for all but government’s preferred coterie of credulous and opportunistic supporters.”
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The forum says it is perhaps more familiar with this political chicanery than those who are less close to the appalling mismanagement of public health services, on which the vast majority population is totally reliant. “The chagrin of those who felt that their collaborative partnership with government will be reciprocated by meaningful engagement is now turning to palpable outrage and anger.
“The unvarnished wording and cadet school pledge of the compact, in the grand scheme of things, is marketing puffery, part of the cynical communication strategy that equates NHI with the liberation struggle, as billboards everywhere blare, another demeaning reference equating current political and bureaucratic interests with a transcendent fight for freedom.”
It fools no one, the forum says, certainly not the massed ranks of sceptical healthcare professionals who taste its bitter management every day.
“The damage that this government continues to visit on public health services through abject neglect, misgovernance and industrial scale corruption, perpetuates the indignity of every one of the 90% of the population who use it to access care, while politicians and officials, with their taxpayer subsidised contributions to medical schemes, enjoy unfettered access to private healthcare.”
After fifteen years of policy tinkering and failing to produce a convincing package of healthcare reforms, asking South Africans to wait another fifteen years for NHI is a hypocrisy too far, the forum says.
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After the signing presided over by Deputy President Paul Mashatile as the president had an eye infection and could not attend, Busa said in a statement it consistently supported the goals of the Presidential Health Compact since its inception in 2018.
These goals were based on the need for the public and private healthcare sectors to work together to improve the overall health system, focusing on urgent projects related to health infrastructure, human resource planning, management capacity building, medico-legal risk management and health IT system interoperability.
Busa says it remains committed to these projects and objectives but did not sign the current new version of the Presidential Health Compact because government unilaterally amended it, transforming its original intent and objectives into an explicit pledge of support for the NHI Act. “These changes to the Health Compact were made without consultation.”
While reference was made to NHI in the previous version of the Compact, Busa says it was only mentioned in the context of longer-term developments. “Busa always supported a collaborative, workable NHI rather than the current single-fund model which is both unaffordable and unimplementable.
“We consistently expressed this position at Health Summit discussions and in our submissions on the NHI White Paper and the NHI Bill, offering constructive recommendations and proposals to achieve the policy objectives without risking the country’s finances or negatively impacting taxpayers. These have all been ignored.”
Only twelve representatives attended the event to sign the Presidential Health Compact and most were from government departments.
ALSO READ: NHI: Here’s the Health Compact that businesses and doctors refused to sign
Dr Aaron Motsoaledi, minister of health, said at the signing he will meet with the business sector about NHI, but it is an engagement that must be organised by the president. He said the lack of cooperation was concerning, according to Netwerk24.
“I am worried if any South African refuses to support the Health Compact. I still hope that we will find each other. I told the business sector before that we cannot fight every time we meet. There cannot be tension all the time.”
Motsoaledi said Busa sent its response to the president and therefore he asked him to organise a meeting.
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