NHI is coming – whether business likes it or not

Despite substantial opposition, the second Presidential Health Compact was signed on Thursday, 22 August, marking one step forward for National Health Insurance (NHI) in South Africa.

The Health Compact is Ramaphosa’s attempt to get the government, businesses, and healthcare professionals to support the implementation of NHI in its current form. 

The second compact follows the 2023 Presidential Health Summit, which built on the inaugural summit of 2018 and brought together several stakeholders. 

These include 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”. 

However, RMB economists said this event was marked by dissatisfaction from Business Unity South Africa (BUSA) and two medical organisations due to the endorsement of the NHI Act in its current form. 

BUSA and medical groups refused to sign, citing concerns about the NHI’s affordability and implementation, and the lack of consultation on the compact’s amendments. 

BUSA – the apex business organisation representing South African businesses – said that it has written to the President to express its concern.

BUSA said it had seen the draft of the Compact, which 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 the government as to the appropriateness of the NHI Act, let alone its feasibility as a legislative instrument to underpin universal health coverage,” said CEO Cas Coovadia.

The Presidential Health Summit Compact in 2018 was headlined: ‘Strengthening the South African health system towards an integrated and unified health system’.  

Coovadia said this objective was supported by business, particularly the focus on immediate opportunities for health improvement, including strengthening supply chain management, health infrastructure planning, accountability, augmenting health system resources, and the principle of collaboration in healthcare delivery.

“The references to NHI in the original Compact were minimal and only in the context of longer-term planning,” he explained.

“There has been no consultation on the updated wording that fundamentally transforms the Compact from health system strengthening to a focus on NHI implementation.”  

“Add to this 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 Health Compact document has been unilaterally amended and altered in its essence.” 

Despite these issues, RMB said BUSA remains committed to the original goals of the Health Compact, which include improving health infrastructure, human resource planning, and health IT systems. 

The South African Health Professionals Collaboration (SAHPC) also announced it will not sign the President’s compact. 

The organisation, representing over 25,000 private and public healthcare workers, said the compact is nothing more than an attempt to lock in support for the NHI Act. 

While the SAHPC acknowledges that health reforms are necessary to address the challenges in the country’s healthcare system, it does not believe that the NHI, in its current form, is the solution. 

“The SAHPC believes the way that the Health Compact has been written is fundamentally biased towards solidifying support for the NHI Act as the sole solution to achieving universal health coverage,” spokesperson Simon Strachan said.   

“The compact heavily focuses on the NHI, presenting it as the only viable option for the country, which we don’t accept.”

“Our primary concern is, and always will be, the well-being of patients. We do not believe the NHI is a viable or workable model for universal health coverage. Our numerous proposals and concerns have not been acknowledged.” 

The SAHPC called on the government to partner with the private sector in reforming South Africa’s healthcare system to improve outcomes for patients. 

Deputy President Paul Mashatile, who presided over the signing, reaffirmed South Africa’s commitment to the UN Sustainable Development Goals and highlighted progress in healthcare, such as the creation of new posts during the Covid-19 pandemic, improved access to medicines, and expanded health infrastructure. 

RMB explained that the compact’s nine pillars focus on human resources, access to medicine, infrastructure, private sector engagement, quality healthcare, financial management, governance, community engagement, and pandemic preparedness. 

The compact was signed by various government officials, health organisations, and trade unions, including the President, Health Minister, Minister of Science and Innovation, South African National Aids Council, South African Medical Association Trade Union, Democratic Nurses of South Africa, and the Congress of South African Trade Unions.