Acting President Paul Mashatile Signs Controversial Second Health Compact Amid Opposition from Business and Labour

Acting President Paul Mashatile has signed the Second Presidential Health Compact, a critical step towards advancing South Africa’s National Healthcare Insurance (NHI) initiative. The signing, however, comes in the wake of significant opposition from key stakeholders, including business groups and labour unions.

The Health Compact, which was delayed by a week due to pushback, has sparked controversy primarily because of its endorsement of the NHI Act. President Cyril Ramaphosa, who is currently on sick leave recovering from an eye infection, delegated the signing responsibility to Mashatile.

In his address at the signing ceremony, Mashatile emphasized the importance of collaboration between the private sector, labour, and civil society in addressing the country’s healthcare inequalities. “The private sector has a crucial role to play in strengthening health systems in South Africa,” Mashatile stated. Reflecting on the COVID-19 pandemic, he highlighted how private-public partnerships could be leveraged to enhance the healthcare system.

“With greater collaboration, the resources and capabilities of both the public and private sectors can be brought to bear, to serve those who need healthcare the most,” he said. Mashatile also noted that the implementation of the NHI Act, now signed into law, requires urgent and collective action. “As we implement the NHI, we will build on lessons learned to streamline standards and ensure quality of care, whether it is rendered at a public or private facility,” he added.

Mashatile stressed the need for diverse expertise in strengthening health systems and called for shared resources to ensure effective implementation of healthcare programmes.

The Compact has been co-signed by several key figures, including Health Minister Aaron Motsoaledi, Minister of Science, Technology and Innovation Dr Blade Nzimande, and representatives from various labour and health organisations. However, the Compact’s endorsement of the NHI Act has led to resistance from several prominent organisations, including the South African Medical Association (SAMA), the SA Health Professionals Collaboration (SAHPC), and Business Unity SA (BUSA).

BUSA has been vocal in its opposition, with CEO Cas Coovadia stating that the organisation could not support a policy that endorses the NHI Act in its current form. “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,” Coovadia said.

Coovadia further criticised the timing of the Compact’s signing, arguing that it was premature to agree to such a compact without having structured and formal discussions on the NHI as a cornerstone of universal health coverage.