Business opposes government’s NHI plan

Business Unity South Africa (BUSA) announced it will not be signing the President’s Health Compact, as it cannot support a policy that explicitly endorses the National Health Insurance (NHI) Act in its current form.  

In a press statement released today, BUSA – the apex business organisation representing South African businesses – said that it has written to the President to express its concern.

This comes after President Cyril Ramaphosa announced earlier this week that he will be presiding over the signing of the second Presidential Health Compact on Thursday, 15 August 2024.

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”. 

According to the statement, the stakeholders involved in the Presidential Health Compact are integral to supporting the Department of Health in improving the country’s health system.

The Presidential Health Compact initially consisted of nine pillars, with the tenth pillar added during last year’s summit. 

These include developing 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.

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.” 

BUSA is concerned that this is at the expense of immediate opportunities to expand and improve healthcare access. 

Coovadia explained that while everybody supports universal health coverage, there are ways to achieve it other than implementing an unaffordable, unworkable and unconstitutional NHI.

He described the NHI as a funding model that is impractical, inequitable, and not feasible in the South African context. 

“Furthermore, 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, still need to take place,” Coovadia said.

BUSA believes the NHI Act needs to be amended to ensure that the country is able to 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,” the organisation said.