Blade Nzimande, Deputy President Paul Shipokosa Mashatile and Aaron Motsoaledi at the Signing Of The Second Presidential Health Compact at Union Buildings on August 22, 2024 in Pretoria, South Africa. The Presidential Health Compact is a framework of cooperation between critical sectors in South Africa that significantly influence good health outcomes. (Photo: Gallo Images / Frennie Shivambu) 
The signing of the second Presidential Health Compact on Thursday, presided over by Deputy President Paul Mashatile in his capacity as acting president, took place under a persistent cloud of dissatisfaction from South Africa’s largest business organisation and two medical organisations.
The ongoing bone of contention is the implementation of the National Health Insurance (NHI).
The signing had been postponed for a week after Business Unity South Africa (Busa) announced on 14 August it would not sign the accord because the latest version explicitly endorses the NHI Act in its current form, which business organisations and some political groups oppose.
Read more: Health compact signing postponed after business objections
The South African Medical Association and the South African Health Professionals Collaboration – comprising nine medical, dental and allied healthcare practitioners’ associations representing more than 25,000 dedicated private and public sector healthcare workers – too said they would not sign, saying their concerns about the NHI had not been addressed.
The second compact follows the 2023 Presidential Health Summit which built on the inaugural summit of 2018 and brought together the 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.
‘Remains committed’
Busa said on Thursday it had consistently supported the goals of the Presidential Health Compact since its inception in 2018, and remained committed to these projects and objectives.
“These goals were based on the need for the public and private healthcare sectors to work collaboratively to improve the overall health system, focusing on urgent projects related to health infrastructure, human resource planning, management capacity building, medico-legal risk management, and health IT system interoperability, among others,” it said.
However, Busa had not signed the current version because it had been unilaterally amended by the government, transforming 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. 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. We have consistently expressed this position at Health Summit discussions, and in our submissions on the NHI White Paper and the NHI Bill, offering constructive recommendations and proposals to achieve the policy objectives without risking the country’s finances or negatively impacting taxpayers. These have all been ignored.”
Busa remained committed to supporting the projects and actions identified in the original version of the compact, and to building a strengthened and integrated health system that worked for all South Africans, but it was “disappointing” that the initiative had been altered to endorse an NHI framework that many stakeholders, including Busa, did not support because it was unworkable.
“Busa maintains that structured, formal and urgent engagement with government is required, not only on the Health Compact, but also on the NHI Act, to ensure 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. This engagement should include the Presidency, National Treasury and the Department of Health.”
Challenges
Reaffirming South Africa’s commitment to achieving the United Nations Sustainable Development Goals of ensuring healthy lives and promoting the well-being of all – a “bold commitment to achieve universal health coverage” and to “provide access to affordable medicines and vaccines for all” – Mashatile said the public healthcare system has numerous challenges that prevent the government from providing decent-quality healthcare for all South Africans.
The Health Compact’s nine 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.
Thursday’s signing, Mashatile said, “is an opportunity to reflect on progress since the signing of the first compact”.
The introduction of the human resource training grant during the Covid-19 pandemic had enabled the department to create more than 73,000 new posts, while the private sector continued to support the health workforce development, through the Public Health Enhancement Fund which had trained 100 doctors and 75 master’s and doctoral graduates.
“Access to medicines, medical devices and equipment has been expanded. New technology is being used to improve supply chain mechanisms, streamline regulatory processes and reduce backlogs,” he said.
The development of local manufacturing capabilities was being prioritised to expand access to medicines. “We have been consistent that building a stronger local manufacturing industry is key to our country’s health security especially during pandemics.”
There was also ongoing expansion of health infrastructure, and by November 2023 there were 149 new primary health facilities, with 30 new hospitals either opened or under construction.
“We are implementing the National Quality Improvement Plan to ensure that more public and private facilities meet the Office of Health Standards Compliance requirements. This is in line with the requirements of the NHI.”
Healthcare funding faced challenges owing to budget cuts and a constrained fiscal environment, compounded by, among other things, inefficiencies, mismanagement and corruption in resource allocation.
“Budgeting in the health sector is steadily improving to ensure a more equitable allocation of resources. Less money is being lost to litigation thanks to the hard work of the health sector anti corruption forum.”
The private sector had a crucial role in strengthening the health system.
“Our experiences with Covid-19 showed how we could depend on public-private partnerships. With greater collaboration, resources and capabilities of both the public and private sectors can be brought to bear to serve those who need healthcare the most. With the NHI act now signed into law, it is even more urgent that we work together,” Mashatile said.
Signatories to the compact:
- President;
- Health minister;
- Minister of science and innovation;
- Independent Community Pharmacy Association;
- South African National Aids Council;
- South African Medical Association Trade Union;
- Democratic Nurses of South Africa;
- Congress of South African Trade Unions;
- Campaigning for Cancer;
- South African Medical Research Council;
- South African Pharmacy Council;
- National Unitary Professional Association for African Traditional Health Practitioners of South Africa; and Traditional Knowledge Systems and Allied Health. DM