The Road to Universal Health Coverage: South Africa’s National Health Insurance

Since democracy dawned, South Africa has been on a journey to fix the healthcare system to make it more equal, accessible, and affordable for all. Despite many efforts made by the government, there has been significant pushback from the private sector and some healthcare professionals highlight the concern that the healthcare system is too fragmented for such a bold change. The National Department of Health says South Africa’s two-tier system of paying for healthcare has failed to guarantee good quality healthcare for all.

Currently, the government funds the provision of healthcare services that the majority of the country relies on, while the minority use private healthcare services through medical aid schemes or out-of-pocket payments. This two-tier funding system locks many out of reach from health professionals and facilities in the private sector. NHI is believed to create a single healthcare funding pool for private and public healthcare providers.

The Right to Health

All South Africans hold the right to have access to health care services, this is a basic human right guaranteed by the Constitution. Achieving this requires fundamental changes to create a health system that can deliver just this. The current system is riddled with inefficiencies and fragmentation – resources and funds are either misused or overused resulting in substandard health outcomes. As a member of the United Nations, South Africa is committed to Universal Health Coverage, so that all people have equitable access to the full range of quality health services they need, without financial hardship.

What is the National Health Insurance (NHI)?

NHI is a health financing system that is designed to pool funds from which the government will purchase healthcare services from public and private providers. All eligible South African residents as defined in the NHI Act will be able to visit these providers whenever they require healthcare, without paying directly. It aims to provide equity and social solidarity through the pooling of risks and funds.

Like home or car insurance, all South Africans who can pay will contribute to the NHI fund. These funds will be made through taxes and special contributions – the details of which are still unclear. The NHI Fund, as envisaged, would manage a significant portion of the country’s Gross Domestic Product (GDP), and there are concerns about whether the system could be effectively and ethically administered.

The government has not specified the treatments that NHI-accredited private hospitals and General Practitioners (GPs) will have to provide, but it states that they will include emergency services, mental health services, palliative care, and rehabilitation services.

The NHI Journey

The idea of NHI is not new and not unique to South Africa. Many countries globally use similar models to provide affordable and accessible quality healthcare. South Africa’s NHI journey started in 2011 with the release of the NHI Green Paper for public comment. This was followed by pilot projects in 2012 which focused on health system strengthening. In 2015, the NHI White Paper was released which laid the foundation for NHI as the vehicle to achieve Universal Health Coverage with a single health system.

Recent Milestones and Future Phases

The NHI Bill was signed into law on May 15, 2024, by the President. This was a significant landmark in attaining universal and comprehensive quality health coverage for South Africans. The Ministry of Health has advised that between 2024 and 2028, the implementation of the NHI Act will be phased in gradually using a progressive and programmatic approach based on available financial resources.

Phase 1 (2023-2026): This phase commenced in 2023 and will continue for three years until 2026. It focuses on establishing the necessary infrastructure and governance structures, integrating the private and public sectors, and ensuring that both sectors become more effective and efficient.

Phase 2 (2026-2028): The second phase will start in 2026 and run for another three years until 2028. During this phase, reforms that began during Phase I would be expanded upon and further cemented to provide access to all South Africans without financial hardship.

The Road Ahead

The healthcare sector in South Africa requires its employees to be prepared and responsive to this transition. Upskilling and reskilling can prove beneficial to make this system successful. The right mix of management, digitization, and healthcare skills aligned with the dynamic healthcare industry can take South Africa to where it needs to be. The NHI represents a game-changing shift that needs ongoing work and contributions from every part of society. It aims to build a health system where everyone gets the care they need, with no one left behind. By joining public and private sectors and setting up strong management systems, South Africa hopes to create a fairer more reachable, and long-lasting healthcare system for all.

For more information on the NHI, visit the NHI government website at: www.health.gov.za