Strategies and active responses are needed to reverse the collapse of the health system, rights group Treatment Action Campaign (TAC) said this week. (Waldo Swiegers/Bloomberg via Getty Images)
The government has signed the second iteration of the presidential health compact, which aims to ensure better health outcomes in South Africa, despite a boycott by the business sector and many health professionals.
The health industry skipped the signing at Union Buildings on Thursday because it said the contentious National Health Insurance (NHI), signed into law by President Cyril Ramaphosa earlier this year, was the central theme in the compact.
Business Unity South Africa (Busa) said it had not signed the new version of the compact because the government had “unilaterally” amended and transformed “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,” Busa said in a statement.
Ramaphosa launched the health compact in 2019 as the collaborative effort of multiple stakeholders to overhaul the health sector in its entirety, the idea being that the broken system could not be fixed by the government alone.
The first iteration of the compact, which expired earlier this year, consisted of nine pillars, but a 10th pillar has been added for the newly signed second version.
The pillars are: development of 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.
“While reference was made to NHI in the previous version of the compact, it was only mentioned in the context of longer term developments. Busa has always supported a collaborative, workable NHI rather than the current single-fund model which is both unaffordable and unimplementable,” Busa said.
The business lobby group said it remained committed to supporting the projects and actions identified under the original version of the health compact, and building a strengthened and integrated health system that works for all South Africans.
“It’s disappointing that the initiative has been altered to endorse an NHI framework that many stakeholders, including ourselves, do not support because it is unworkable,” it added.
The Democratic Alliance (DA) — the former official opposition party which is now in a government of national unity — said the second health compact seems to circumvent the good faith of the first by making the NHI Act, the very vehicle many stakeholders staunchly opposed, as the foundation of the agreement.
“This is nothing more than a ploy to coerce support for the NHI Act and silence opposition to a piece of legislation that will lead to the decimation of the health sector,” the DA said in a statement.
The presidency published a list of the signatories to the compact, which did not include Busa and the South African Health Professionals Collaboration (SAHPC), a lobby group of health professionals.
Signatories include Ramaphosa, the minister of health, the Independent Community Pharmacy Association, labour federation Cosatu, the South African Medical Research Council and Traditional Knowledge Systems and Allied Health.
Busa chief executive Cas Coovadia told the Mail & Guardian that he had, after the first postponement of the signing of the compact, written to the director general in the presidency asking for further discussions but had not received a response.
SAHPC spokesperson Simon Strachan said the group of nine medical, dental and allied healthcare practitioners’ associations was not invited to the signing of the health compact.
“To be clear, we are not signing this because it is not a reflection of the discussions that were had. The fact that it includes the NHI just makes it more distasteful. Using every avenue to garner support for the NHI is distasteful,” Strachan said.