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Summit: A fixit plan by December and a pledge on private healthcare

President Cyril Ramaphosa

President Cyril Ramaphosa that there would be a plan by December to tackle SA's public health crisis, speaking at a two-day health summit to 600 stakeholder delegates. Deputy President David Mabuza said the proposed National Health Insurance ‘does not negate the existence of private health schemes for those who desire (them)’.

South Africa’s Presidency has acknowledged the crisis gripping the public health system, and concluded a two-day summit at the weekend with a commitment to devise a plan for fixing the sector’s ills by early December. According to a Business Day report President Cyril Ramaphosa is taking the lead on health, driving a process aimed at improving the quality of services and speed up implementation of National Health Insurance (NHI).

Only 8.87m South Africans, or 15.61% of the population, could afford private healthcare via medical scheme cover in 2017, according to the Council for Medical Schemes, leaving the rest of the population dependent on public health services that have virtually collapsed in many parts of the country.

The report says the presidential health summit highlights the importance Ramaphosa is attaching to healthcare ahead of 2019’s election, and follows a summit on NHI he convened in August. The latest summit drew more than 600 delegates from across the healthcare spectrum, including senior executives from South Africa’s private hospital groups, pharmaceutical companies and the medical scheme industry, as well as unionists, activists, healthcare professionals, MPs, government officials and academics. It concluded with a commitment to devise a presidential health summit compact that will be signed by stakeholders by 10 December.

The Presidency will assume oversight of the compact to make sure its goals are met, said Ramaphosa’s adviser on social policy, Olive Shisana. “The president has made it very clear he is taking stewardship of NHI and quality. The departments themselves have to execute what the president is saying,” she said. “That is why we have a ‘war room’. We are building expertise for oversight, for translating policy into action. It is a new model for fast-tracking delivery.”

The report says Deputy President David Mabuza, who addressed the gathering on behalf of Ramaphosa, frankly acknowledged the problems facing healthcare. He signalled an inclusive approach, saying all sectors had to be involved to realise universal access to healthcare services. “In the short term, government will prioritise the filling of critical vacant posts to stabilise shortages in key areas of our health system. In the context of fiscal constraints, provinces will be expected to prioritise their financial resource allocations in a manner that ensures that the delivery of quality healthcare is not compromised,” he said.

Aspen Pharmacare’s head of strategic trade, Stavros Nicolaou, is quoted in the report as saying that the summit is a positive development as it elevates health as a social priority. “From business’s point of view, universal coverage is an imperative, but it needs to be achieved through an inclusive process, where consensus is achieved through all four National Economic Development and Labour Council (Nedlac) social partners. The balance (must be) struck between affordable access for our citizens and ongoing sustainable health businesses that are able to serve patients’ needs (and) contribute to our country’s much-needed economic growth and job creation aspirations,” he said.

The report says SA Medical Association chair Mzukisi Grootboom welcomed the Presidency’s acknowledgement of South Africa’s healthcare crisis, saying Health Minister Aaron Motsoaledi had previously been reluctant to do so.

Business Unity SA (Busa) CEO Tanya Cohen suggested the process for devising the compact be taken to Nedlac, as it has the appropriate skills and expertise. Shisana said Nedlac is not the right forum as it only includes representatives from business, labour and community organisations, and will not provide a voice for other important stakeholders such as academia and Chapter 9 institutions.


Speaking on behalf of the president, Mabuza has reiterated the South African government’s commitment to universal healthcare, known as the NHI. Bhekisisa reports that he, in his speech, made important comments regarding the role of the private sector in the NHI, which will be phased in from 2019, Mabuza explained.

"We need one health system of all our people… in which health services are provided by both the private and public services according to improved standards of care, and that does not negate the existence of private health schemes for those who desire (them).”

The report says Mabuza also launched the country’s latest wellness campaign, called Cheka Impilo. As part of the campaign, the country will seek to: put 2m more people on antiretrovirals; diagnose and treat 80,000 more people with TB; and identify and treat thousands more with diabetes, high blood pressure and cancer.


Business is ready to partner with the government to improve South Africa’s healthcare. Business Day reports that this is according to Busa's Tanya Cohen who told delegates: “As with land, mining and energy, we regard health and education as key policy areas that need to be tackled if we are going to improve our collective prospects.”

South Africa is at a crisis point, with the majority of South Africans unable to access decent healthcare, she said, citing the collapse of state oncology services in KwaZulu-Natal, medicine shortages, and Gauteng’s scandal when mentally ill patients were moved from Life Esidemeni’s care to unlicensed NGOs, which led to the deaths of 144.

Cohen said the private healthcare sector is highly regarded worldwide, but acknowledged it had challenges of its own. Busa is committed to ensuring the concerns identified in the final report of the Competition Commission’s health market inquiry are addressed. “The private sector is a key building block in ensuring our broader participation in the health sector, alongside that of other social partners,” Cohen said.

Deputy president of the National Health Education and Allied Workers Union (Nehawu) Mike Shingange said workers who belong to medical schemes confront the shortcomings of both the public and private sectors. “Many of us have medical aids that cannot take care of us all year, or all our dependents. We end up taking out of our pockets (for relatives) in the townships and in the rural areas. We represent both the employed, and the suffering people of our community,” he said.

Shingane urged government to speed up the development of the state-owned pharmaceutical company Ketlaphela, saying it would reduce South Africa’s reliance on imports.


Solutions proposed during the meeting will now form the basis for wider consultation ahead of a public plan to turn the health system. Bhekisisa reports that the strategy is slated to be released in less than two months – by 10 December. “We intend to develop a compact among all key stakeholders, including government, health providers, academics, health system users, labour, the private sector and civil society,” Mabuza explained.

“This compact will provide guidance and assist in the implementation of critical tasks, such as updating the quality improvement plans for all our health facilities…(and) the development of a human resource operational plan to allow us to correct the deficiencies in the system.”

Mabuza also reiterated Ramaphosa’s previous statements that the government would prioritise the filling of posts and that provinces had been told to safeguard service delivery amid tight budgets. These assurances come after at least three years of austerity budgets in many provinces, including some like the North West and Eastern Cape that have reported freezing posts.

He also promised that National Treasury will soon deliver a long-awaited proposal on the financing of the NHI Fund, but did not give a specific timeline. How the NHI will be funded, is perhaps the biggest question in South Africa’ move towards universal healthcare.

The report says the 2017 version of the NHI Bill projected the universal health scheme would cost R256bn by 2025 – a figure based on outdated statistics.

The Office of the Presidency is expected to establish a “war room” to help coordinate the shift to an NHI. While Treasury continues to review financing models, the Presidency is re-costing the health system to provide more realistic figures on the NHI’s true price tag, including calculating health costs based on district health profiles, Mabuza said.

“We admit that we have a crisis”, Minister of Science and Technology Mmamoloko Kubayi-Ngubane is quoted in the report as saying. “We must own the problems”.

[link url=""]Business Day report[/link]
[link url=""]Mabuza speech[/link]
[link url=""]Business Day report[/link]
[link url=""]Bhekisisa report[/link]

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