The President’s office has disregarded a boycott by organised business and healthcare professionals. It has finalised its second health compact, demonstrating its determination to move forward with the National Health Insurance (NHI). Despite the absence of support from Business Unity SA (Busa), the SA Medical Association (Sama), and the SA Health Professionals Collaboration (SAHPC), the compact was signed as a consensus document by the parties that took part in the Presidential Health Summit.
The NHI Act, which enacts reforms for universal health coverage, was signed into law by President Cyril Ramaphosa in early May, two weeks before the general election. Acting president Paul Mashatile, without acknowledging the absent key stakeholders, emphasised the crucial role of the private sector in strengthening South Africa’s health system.
The Health Compact’s nine pillars include the development of human resources, improving access to medicine and vaccines, upgrading infrastructure, private sector engagement, quality healthcare, public sector financial management improvements, governance and leadership, community engagements, information systems, and pandemic preparedness.
The introduction of the human resource training grant during the Covid-19 pandemic enabled the department to create more than 73,000 new posts. The private sector supported health workforce development through the Public Health Enhancement Fund, which trained 100 doctors and 75 master’s and doctoral graduates.
The development of local manufacturing capabilities has been prioritised to expand access to medicines, and there has been ongoing expansion of health infrastructure. However, healthcare funding has faced challenges due to budget cuts, a constrained fiscal environment, inefficiencies, mismanagement, and corruption in resource allocation.
Minister Aaron Motsoaledi expressed concern that BUSA and others in the healthcare industry had refused to sign, but he remained hopeful that they would eventually find common ground. Signatories to the compact include the Independent Community Pharmacy Association, the SA Medical Association Trade Union (Samatu), the Democratic Nurses of SA (Denosa) trade union, the SA National Aids Council, the trade union federation Cosatu, Campaigning for Cancer, the SA Medical Research Council, the SA Pharmacy Council, and the Defend the NHI campaign.
Business Unity SA (Busa) has consistently expressed support for universal health coverage but opposes the provisions for creating a government-controlled fund in the NHI Act. The Health Funders Association (HFA), an industry body for medical schemes, also voiced opposition to the compact, citing sections of the act related to the role of medical schemes in providing healthcare services.
Despite the opposition, the trade union Samatu and SA’s biggest nursing union, Denosa, expressed their full backing for the NHI, believing it is the only vehicle to achieve meaningful progress towards universal health coverage.