NHI row: health summit postponed

The second presidential health summit, scheduled for Thursday when the second presidential health compact was due to be signed, has been postponed to August 22 amid mounting concern about the compact’s endorsement of National Health Insurance (NHI).

An urgent notice from events management in the presidency said simply that the postponement was due to “unforeseen circumstances”.

Vincent Magwenya, spokesperson for President Cyril Ramaphosa, said the event was postponed “due to changes in the diary that had to be accommodated”. He said the postponement had nothing to do with opposition to NHI.

The postponement comes as the SA Medical Association (Sama) voiced concern about the compact because of its endorsement of NHI. Business Unity SA (Busa) has said it won’t sign the

compact for this reason as it cannot pledge support for a policy it opposes.

The draft compact circulated last week states that the government and other stakeholders commit themselves to achieving universal health coverage through NHI and that they commit to jointly implementing NHIrelated health systems and service improvement plans.

Stakeholders expected to sign the compact included the president, health minister Aaron Motsoaledi and representatives of business, civil society, labour, healthcare professionals, healthcare users, statutory health councils, academic and research organisations and public health entities, as well as traditional and allied health practitioners.

Sama said in a statement that it does not support NHI. “Sama fully supports the overarching goals set forth in the presidential health compact. However, Sama has serious concerns about the current NHI model as the primary vehicle for achieving these goals.

“While we share the government’s commitment to universal health coverage, we believe that the NHI, in its current form, may not adequately address the complexities of our health system and could inadvertently lead to unintended consequences that compromise both the public and private healthcare sectors.

“Sama urges for a re-evaluation of the NHI framework, advocating for a more flexible, inclusive, and sustainable approach that considers the diverse needs of SA’s population and healthcare providers.

“We recommend that references to NHI in the presidential health compact be reconsidered to allow for alternative models of achieving universal health coverage,” the statement reads.

“In [the] light of our concerns, Sama calls for an open and inclusive dialogue on the best path forward to achieve universal health coverage. We urge that future references to the NHI in the presidential health compact be revised to reflect a broader spectrum of potential solutions and that stakeholder engagement remains a cornerstone of this ongoing reform process.”

Busa said NHI was unaffordable, unworkable and would harm SA’s health system and investor confidence.

“The draft of the compact that was shared with Busa promotes the NHI in its current form as the foundation underpinning healthcare reform,” Busa CEO Cas Coovadia said in a statement on Wednesday. “Busa does not agree with this, given the serious differences between us and government as to the appropriateness of the [National Health Insurance] Act, let alone its feasibility as a legislative instrument to underpin universal health coverage.

“There has been no consultation on the updated wording that fundamentally transforms the compact (of 2018) from health system strengthening to a focus on NHI implementation. Add to this the context of legal challenges around the, [National Health Insurance] 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,” said Coovadia.

“The intention was to collaborate on looking at how we can improve the public health sector. There are serious differences between us and government on whether NHI in its current form is an appropriate legislative instrument. If you want a compact everyone will sign, then have a compact that everyone agrees on,” said Coovadia.

The act, signed by the president on May 15 but not yet promulgated, faces legal challenges from trade union Solidarity and the Board of Healthcare Funders, representing medical schemes and administrators.