In a State of the Nation (SONA) address that has been described as “high on dreams, low on detail”, President Cyril Ramaphosa has again failed to give any concrete indications on government’s plans to fix the crumbling public health system and implement NHI despite highlighting health as one of the seven priorities of the new administration.

Acknowledging that urgent work that needs to be done to improve the quality of the health system, the president briefly referred to both the long-awaited Presidential Health Summit Compact (PHSC) and the elusive NHI scheme, repeating his mantra that both will be finalised soon.

Work on the Compact started in October last year, following the historic Presidential Health Summit attended by around 600 stakeholders from both the public and private sectors, including government representatives, academics, healthcare professionals, labour and community organisations, legislators and health economists. Although the Compact, which is expected to be a blueprint for the implementation of the proposed solutions by the nine Summit commissions, was due to be signed in December, it was delayed because members of the high-level commissions requested more time. In February, a report on the outcome of the deliberations at the Summit was released, acknowledging the urgency to address and prioritise key areas such as the filling of critical vacant posts and the allocation of financial resources to improve services for the attainment of universal health coverage (UHC) in South Africa. However, five months later the Compact to be signed by all stakeholders is still outstanding with the President again promising that it will be finalised soon.

As in his first SONA in February, the President repeated government’s commitment to the implementation of NHI without giving any further details on the plan that has been in the making for a decade.

“We are far advanced in revising the NHI detailed plan of implementation, including accelerating quality of care initiatives in public facilities, building human resource capacity, establishment of the NHI Fund structure, and costing the administration of the NHI Fund,” the president said, immediately proceeding to voice his concerns about the country’s failure to stem the rate of new HIV infections, particularly among young women.

According to President Ramaphosa, government will intensify its work to implement the 90-90-90 strategy to end HIV as a public health threat, which includes increasing the number of people on treatment by at least another two million by December 2020.