Acting president Paul Mashatile has signed the second presidential health compact in President Cyril Ramaphosa’s stead—paying lip service to the private sector’s role in healthcare provision in South Africa as businesses and healthcare professionals boycotted the event.
Ramaphosa appointed Mashatile as acting president based on medical advice that he allow an eye infection to clear. As such, it was Mashatile who signed the compact on behalf of Ramaphosa.
The Presidential Health Compact is an initiative launched by Ramaphosa in 2019, which established a “framework of cooperation” between critical sectors in South Africa to significantly influence good health outcomes.
The 2024 compact is the second iteration of the framework, and it specifically focuses on supporting health systems and strengthening and preparing them for the implementation of the National Health Insurance (NHI).
However, it is this explicit focus on the NHI that has drawn backlash from the very stakeholders the compact aims to draw in, with business group BUSA, and healthcare professional bodies, SAMA and the SAHPC, pulling out of signing the document.
Despite the boycotts, Mashatile talked up the importance of the private sector in healthcare in South Africa, encouraging cooperation. However, he did not steer away from the NHI as the central theme to the government’s plans.
“The private sector has a crucial role to play in strengthening health systems. Our experience with Covid-19 showed how we could deepen public-private partnerships,” he said.
“With greater collaboration, the resources and capabilities of both the public and private sectors can be brought to bear to serve those who need health care most.”
Mashatile said that, with the NHI Act now signed into law, “it is even more urgent that we work together”.
“As we implement the NHI, we will build on lessons learned to streamline standards and ensure quality of care, whether it is rendered at a public or private facility.
“We need diverse expertise as we work towards strengthening health systems and building their resilience into the future We need to share resources to ensure that programmes are implemented.”
The continued push for the NHI comes despite abject rejection from the private sector of the scheme in its current form, with concerns frequently raised about funding, coverage, implementation and administration, which have gone unanswered.
The boycott of the signing by key groups also reflected this rejection, where the organisations cited a lack of consultation over the wording of the compact and its focus on the NHI, saying that the document was “nothing more than an attempt to lock in support for the NHI Act”, while challenges are mounting.
Democratic Alliance MP tracking health, Michele Clarke, said that the boycott—and the fact that the only showing from the business sector was the Independent Community Pharmacy Association—was evidence of the opposition to the NHI, and risked breaking goodwill between business and the government.
“The fact that the Health Compact was signed despite widespread concerns and without proper engagement from the President about these concerns mimics the public participation charade in Parliament before the NHI Act was signed.
“The second Health Compact undermines the goodwill and collaboration between the government and various stakeholders, including health professionals, the business community, and labour unions, that the first Compact engendered to improve South Africa’s health sector,” she said.
Trade union Solidarity, which has been an aggressive opponent to the NHI and one of the main drivers of litigation against the scheme, said that the boycotts rendered the compact “worthless”.
Theuns du Buisson, economic researcher at the Solidarity Research Institute (SRI), said the presidency “might just as well have concluded a treaty with itself”.
“As was the case with the signing into law of the NHI Bill shortly before the election, the government is now also steamrolling this compact through without heeding the serious consequences it may hold for all of us, and for the economy,” he said.
Speaking to News24, health minister Aaron Motsoaledi said he was concerned about the boycott but was hopeful that the disparate parties could “find each other” and “create good things”.
Read: Ramaphosa to sign new NHI health compact – without doctors and businesses on board
