By Phenyo Selinda
Pretoria – On Thursday, President Cyril Ramaphosa will preside over the signing of the second Presidential Health Compact at the Union Buildings in Pretoria. This event marks a significant step in the government’s ongoing efforts to reform and strengthen South Africa’s healthcare system, with a particular focus on preparing for the implementation of the National Health Insurance (NHI).
The Presidential Health Compact, initially introduced by President Ramaphosa in 2019, is a framework designed to foster cooperation between various sectors, including government, business, labour, civil society, and health professionals. The Compact aims to improve health outcomes by assigning roles and responsibilities to stakeholders in the health system, ensuring that these efforts are monitored and evaluated consistently.
This second iteration of the Health Compact follows the 2023 Presidential Health Summit, which built on the inaugural summit held in 2018. The summit brought together a wide range of stakeholders to address challenges in South Africa’s healthcare system, particularly those that have hindered the equitable delivery of health services across the country.
Expanded Scope and Key Pillars
While the initial Health Compact focused on nine pillars—such as human resources development, access to medicine, infrastructure upgrades, and governance improvements—a tenth pillar was added during the 2023 summit. This new pillar emphasizes pandemic preparedness, a critical addition in the wake of the COVID-19 pandemic, highlighting the need for a resilient healthcare system that can withstand future health crises.
Among the signatories to this Compact are key government figures, including the President and the Ministers of Health and Science and Innovation. They are joined by representatives from civil society, labour unions, statutory councils, and traditional health practitioners. However, this Compact has not been without its controversies.
Ongoing NHI Disputes
The focus on the NHI within this Compact has sparked considerable debate and dissent among some of the most critical stakeholders in the healthcare sector. Notably, major groups such as Business Unity South Africa (BUSA), the South African Health Professionals Collaboration (SAHPC), and the South African Medical Association (SAMA) have expressed significant concerns. These groups have opposed the NHI in its current format, citing issues related to funding, implementation, and the overall feasibility of the proposed model.
BUSA, representing private business interests, has outright refused to support the Compact, arguing that their concerns have been ignored in the final document. They, along with healthcare professionals, have raised alarms about the potential negative impact the NHI could have on both the public and private healthcare sectors.
Despite this opposition, the presidency is proceeding with the signing, signaling its commitment to the NHI as a cornerstone of South Africa’s health policy going forward. However, the absence of these key stakeholders from the signing process raises questions about the inclusivity and future implementation of the NHI
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