Busa rejects NHI-focused Health Compact, criticises lack of consultation

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Busa is the largest federation of business organisations in the country, based on its members' contributions to GDP and employment. Its stance has consequently led to the Presidency postponing the signing of the Compact.

The second Compact follows the 2023 Presidential Health Summit, which built on the 2018 inaugural summit that united various stakeholders to create sustainable and inclusive solutions for national health system challenges.

“The draft of the Compact that was shared with Busa promotes the NHI in its current form as the foundation underpinning healthcare reform. Busa does not agree with this given the serious differences between us and government as to the appropriateness of the NHI Act, let alone its feasibility as a legislative instrument to underpin universal health coverage,” says Cas Coovadia, Busa chief executive officer.

From support to dispute

The references to NHI in the original Compact going back to 2018 were minimal and only in the context of longer term planning. Headlined: Strengthening the South African health system towards an integrated and unified health system, Business supported the focus on immediate opportunities for health improvement, including strengthening supply-chain management, health-infrastructure planning, accountability, augmenting health-system resources, as well as the principle of collaboration in healthcare delivery.

There has been no consultation on the updated wording that fundamentally transforms the Compact from health-system strengthening to a focus on NHI implementation, Coovadia said.

Add to this the context of legal challenges around the NHI 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, he said.

Unilateral policy shift

“Our concern is that this is at the expense of immediate opportunities to expand and improve healthcare access. While everybody supports universal health coverage, there are ways to achieve it other than implementing an unaffordable, unworkable and unconstitutional NHI, which is essentially a funding model that is impractical, inequitable, and not feasible in the South African context.

"Furthermore, it is putting the cart before the horse to sign and agree to a Compact when structured, formal discussions and engagement with government on the NHI, as a key pillar of universal health coverage, still need to take place,” said Coovadia.

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He said Busa believes the NHI Act needs to be amended to ensure that 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.

"The country should be leveraging these resources to help design and support a system that is fit for purpose and that is able to benefit future generations," he noted.

Joining Busa in its objections is the South African Medical Association (Sama) which also refused to sign the second Presidential Health Compact because the document explicitly endorses the NHI Act.

The signing of the new Health Compact is now earmarked for Thursday, August 22, 2024.