Universal healthcare coverage: we might not need to throw the baby out with the bathwater

Abstract

I believe there is not a healthcare worker (HCW) in South Africa, either in the public or private sector, who will oppose the idea of universal healthcare coverage (UHC) for all the people of South Africa. The big question though, which will certainly be a lot more controversial among HCWs, is: What is the optimal healthcare model to achieve this objective in South Africa? Currently, policymakers are aiming to achieve this goal through the establishment of a South African National Health Insurance (NHI). The South African National Department of Health’s (NDoH) medium-term strategic framework for 2019–2024, as well as the NDP’s (National Development Plan) Implementation Plan for 2019–2024, identified achieving UHC by implementing the NHI policy as a strategic goal. The NHI Bill was introduced in Parliament in August 2019 and was passed by the National Assembly in June 2023. At the time of writing, the bill was with the President of South Africa after being passed by the National Council of Provinces’ Select Committee on Health and Social Services for consideration. The NDoH strategic plan document stated that 2026 was being targeted for the implementation of NHI. In the words of the acting director general at the time, ‘The National Health Insurance (NHI) policy of government aims to dismantle the system and introduce several structural reforms’.