Second Presidential Health Summit: SA needs another Health Compact

He was addressing the second Presidential Health Summit that is currently being held at the Birchwood Hotel in Boksburg. The two-day summit brings together key stakeholders from various constituencies within the health sector to review the implementation of interventions agreed to during the first summit held in 2018. The latest summit is a bid to revive what was called “the roadmap for South Africa’s path to universal healthcare” and the pledge of “one country, one health system" and assess the country’s readiness to implement NHI.

It also aims to assess the performance of the health system against the Presidential Health Compact that was signed by President Cyril Ramaphosa and all social partners in 2019, committing social partners to a five-year program to improve healthcare services in the country. At the time, Ramaphosa called it “a turning point for the healthcare sector”. However, since then, not much has happened to take forward the undertakings and promises of the Compact, with the health system spiralling into further decay and disarray as Covid-19, understaffing, bad management, and corruption took their toll on service delivery.

Ramaphosa is addressing the delegates at the summit today, (5 May).

It also aims to assess the performance of the health system against the Presidential Health Compact that was signed by President Cyril Ramaphosa and all social partners in 2019, committing social partners to a five-year program to improve healthcare services in the country. At the time, Ramaphosa called it a “a turning point for the healthcare sector”. However, since then not much has happened to take forward the undertakings and promises of the Compact with the health system spiraling into further decay and disarray as Covid-19, understaffing, bad management and corruption took their toll on service delivery.

Ramaphosa is addressing the delegates at the summit today (5 May).

According to the Health Minister, the state cannot address all the health challenges on its own and needs the support of other stakeholders, including the labour, private sector, civil society organisations, users and communities.

“A health compact can help to establish a shared vision and goals for the health system and provide a framework for collaboration among stakeholders. It can facilitate the development of policies and strategies that are evidence-based, inclusive, and transparent, and ensure that resources are used efficiently and effectively. The compact can also help to promote accountability, by establishing clear roles and responsibilities for each stakeholder, and monitoring and evaluating progress towards the agreed-upon goals.

“Furthermore, a health compact can help to mobilise resources for the health system, by engaging with the private sector and other stakeholders on innovative financing mechanisms, such as public-private partnerships. It can also help to ensure that resources are allocated equitably, and that vulnerable and marginalized populations have access to quality health services,” Dr Phaahla said.

Conceding that the health system is facing numerous challenges including the shortage of health workers, inadequate funding, poor leadership and accountability, and limited access to health facilities with South Africa having one of the highest mortality rates globally, the minister blamed many of the problems on the country’s two-tiered private-public healthcare system.

“The public sector caters to most of the population, while the private sector serves a smaller portion. However, the public sector is often understaffed, under-resourced, and overcrowded, leading to longer waiting times and inadequate care,” he repeated the health department’s well-known tune.

“The country’s public health sector is underfunded with a spending of R259.2 billion or 4.2% of the GDP to serve 85% of the population, while the private sector spends about the same amount of money for 15% of the population. This results in inadequate resources to provide quality care,” he added.

Calling the NHI a potential solution to address the healthcare financing challenges, he said it will aim to correct the current inequities that remain pervasive, so that South African policy and practice align with the aspirations of the Universal Health Coverage commitment within the United Nations Sustainable Development Goals.

Phaahla announced that a 10-year infrastructure plan had been costed in consultation with National Treasury. 

“Under Covid-19, funds were directed to put up several temporary structures, and some are being converted for regular long-term use. While there is an ongoing rollout of new placement, upgrades, and maintenance projects, more is needed.” 

He added the mode of delivery of infrastructure also needed urgent reform to increase speed and quality while reducing wastage and high cost.

According to Phaahla, the corruption with PPE during the pandemic exposed serious weaknesses in the department’s financial management and that incidences of poor financial management are still occurring, leading to non-delivery of essential goods and services.

He added that the formation and launch of the Health Sector Anti-corruption Forum in 2019 by President Ramaphosa was an excellent step in addressing epidemic corruption.

Phaahla says the primary goal of the second Presidential Health Summit is to find “viable solutions that would enable the healthcare system to be adequately prepared for the implementation of the NHI.”

To achieve this objective, the summit has set the following goals:

1. Review and evaluate the implementation of interventions agreed to in 2018 and measure with a score card the health system’s performance against the Health Compact.
2. Evaluate the functioning of the first compact’s six pillars and identify best practices, encouraging consistent, streamlined, standardised, and more robust participation. And add the Pillar on Pandemic Preparedness.
3. Discover alternate, sustainable interventions that ensure the implementation of mechanisms that have not been put in place to achieve the unmet targets.
4. Determine the readiness of the health system to implement the NHI, recognising the urgent measures required to recalibrate the system and hasten the NHI reforms; and
5. Analyse global experiences, shaping approaches to bring South Africa closer to NHI and establish resilient health systems that suit the South African context.