In South Africa, less than 16% of people have private medical insurance, and nearly three-quarters of those insured are white. Despite only serving a small portion of the population, private healthcare consumes about 50% of the country’s health expenditure.
With the remaining 50% of the health budget, the public health sector manages to provide Universal Health Care services to 70% of the population. This includes reproductive, maternal, newborn, and child health services and care for infectious and non-communicable diseases.
While the public healthcare system faces challenges, the private sector struggles with issues like overservice and inconsistent care quality, as highlighted by the 2019 Health Market Inquiry.
Introduction of the National Health Insurance (NHI) Act
Before the recent elections, the ANC government passed the National Health Insurance (NHI) Act. This move sparked significant debate and concern among the public. However, public health practitioners and social justice activists view the NHI as a transformative health policy opportunity.
The NHI aims to promote primary healthcare, which includes preventive, promotive, rehabilitative, and palliative care. Primary healthcare is cost-effective and essential for achieving universal health coverage. The World Health Organisation supports this approach, which it says enhances social protection, economic growth, and health outcomes.
Despite the potential, the NHI faces challenges, particularly in reaching rural and underserved areas. The current health infrastructure standards may favour urban and well-funded hospitals, leaving primary healthcare facilities disadvantaged.
Blended funding model
A blended funding model and more robust primary care systems are suggested to address these disparities. The implementation of the NHI requires a focus on primary healthcare, community involvement, and social accountability. Strengthening governance and operational processes and adapting to real-life experiences will be crucial for its success.
Investing in primary healthcare can improve health outcomes, reduce hospital reliance, and enhance economic contributions from a healthier population. South Africa’s journey towards equitable healthcare is complex, but with determination and strategic planning, the NHI could significantly transform the country’s health system.
- Tracey Naledi is a Public Health Medicine Specialist, an Associate Professor of Public Health Medicine and Deputy Dean of Social Accountability and Health Systems at the Faculty of Health Sciences, UCT.
- Krish Vallabhjee is a Public Health Medicine Specialist, an Adjunct Associate Professor at the Health Systems and Policy Division, School of Public Health, University of Cape Town, and a Technical advisor to the Clinton Health Access Initiative ( CHAI).
- Atiya Mosam is a Public Health Medicine Specialist, independent consultant, and founder of Mayibuye Health, which specialises in health systems strengthening, PHC, and health financing.
- Mark Heywood is an adjunct professor at the Nelson Mandela School of Public Governance at UCT and an independent health and human rights activist.
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