Business balks at signing presidential health compact, citing NHI

SA’s umbrella body for organised business has objected to the emphasis placed on National Health Insurance (NHI) in the second presidential health compact due to be signed on Thursday, saying it cannot pledge support for a policy it opposes.

A draft document circulated last week explicitly supports NHI and its enabling legislation, which Business Unity SA (Busa) says is unaffordable and unworkable, and will damage SA’s health system and investor confidence. The NHI Act was signed into law by President Cyril Ramaphosa on May 15 but has yet to be brought into effect.

“The draft we have before us does not take into account what we have said, and it is promoting the NHI in its current form at a time when we are still in discussion and engagement about our displeasure [with it]. It was never our intention that the NHI should be part of the health compact,” Busa CEO Cas Coovadia said on Tuesday.

“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 compact follows the second presidential health summit held last year, which brought together a wide range of stakeholders to discuss ways to improve the health system.

The first presidential health summit in 2018 was also followed by a compact, which contained only a handful of references to NHI and was signed by business. The draft health compact for the second summit, which Business Day has seen, contains 12 articles each linked to NHI.

Article 1 says the government and other stakeholders commit themselves to achieving universal health coverage through NHI, for which a legislative framework has been created. Article 12 says the government and all other stakeholders commit to jointly implementing NHI-related health systems and service improvement plans.

Stakeholders expected to sign the compact include 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.

Busa wrote to the presidency at the weekend to express its concern. Receipt of the letter was acknowledged, but Busa had not receive a response to the issues it raised, said Coovadia.

Presidential spokesperson Vincent Magwenya said the presidency would prefer to engage with business directly rather than via the media.

Busa made extensive input on the NHI bill, which it said was largely ignored, and then petitioned the president not to assent to the bill. It said previously it was considering its legal options. As the NHI act has not been promulgated it is not yet in force. It faces legal challenges, from trade union Solidarity and the Board of Healthcare Funders, representing medical schemes and administrators.

kahnt@businesslive.co.za