President Cyril Ramaphosa has postponed the signing of the Second Presidential Health Compact, initially scheduled for August 15, 2024, to August 22. This delay comes in response to significant opposition from business leaders regarding the National Health Insurance (NHI) Act.
The postponement has been announced without a specific reason from the Presidency, but it coincides with mounting resistance to the recently enacted NHI Bill, which became law on May 15, just ahead of the national elections.
Business Unity South Africa (BUSA) has voiced its strong disapproval of the Second Presidential Health Compact, which it claims endorses the NHI Act in its current form. According to BUSA, the revised compact heavily emphasizes NHI implementation, diverging significantly from the original 2018 Presidential Health Summit Compact. The 2018 document focused on immediate healthcare improvements, such as enhancing health infrastructure, improving supply chain management, and fostering accountability.
In contrast, BUSA argues that the current compact’s focus on the NHI Act neglects urgent opportunities for healthcare expansion and improvement. BUSA’s chief executive, Cas Coovadia, criticized the compact for endorsing a policy that, in their view, is impractical and financially unfeasible. Coovadia expressed concern that signing the compact without thorough consultations and discussions about the NHI could lead to negative consequences for South Africa’s healthcare system and economy.
BUSA advocates for amendments to the NHI Act to ensure that it aligns better with South Africa’s economic and healthcare realities. They believe that leveraging existing private sector resources could help design a more effective and sustainable system for universal health coverage.
The controversy surrounding the NHI Act has sparked widespread opposition from various sectors. Potential legal challenges are being prepared by multiple organizations, including the Health Funders Association, the South African Medical Association, and the Democratic Alliance. In July, Trade Union Solidarity achieved a partial victory in court when the North Gauteng Court ruled that certain sections of the NHI Act were unconstitutional.
As the President’s signing of the Health Compact is rescheduled, the government faces mounting pressure to address the concerns of business leaders and other stakeholders. The outcome of these discussions and legal battles will significantly impact the future trajectory of South Africa’s healthcare reforms and the NHI’s implementation.
