One issue remains clear amid the debate over South Africa’s National Health Insurance (NHI): Primary healthcare is vital for creating a sustainable and equitable health system. However, achieving this will require significant investment in workforce training, healthcare delivery, and system reform.
Primary healthcare (PHC) differs from the traditional medical model in that it focuses on community involvement and addresses the social, economic, and environmental factors influencing health. It also emphasises integrated, continuous care by a multidisciplinary team, promoting health and preventing illness alongside treatment and rehabilitation.
The Gaps in South Africa’s Primary Healthcare System
Despite its importance, neither the public nor private sectors in South Africa deliver PHC as envisioned. To improve equity and access, four key areas must be strengthened:
Human Resources: South Africa’s 2030 Human Resources for Health strategy reveals a looming shortage of healthcare workers, with an estimated 87,614 more needed by 2025 to meet PHC goals. Despite the crucial role of nurses and other healthcare professionals, inadequate training and low financial incentives hinder recruitment and retention.
Training: PHC-focused education needs to be improved. Many healthcare workers receive limited exposure to PHC during training. Additionally, interdisciplinary collaboration, essential for team-based care, is often overlooked.
Public-Private Integration: Integrating the public and private sectors is critical for expanding PHC access, but differences in funding models, such as fee-for-service in the private sector, create challenges. The NHI’s proposed capitation model offers a solution, incentivising efficient, preventive care.
Social Accountability: Community involvement is essential for creating a responsive health system. However, governance structures like clinic committees and district health councils are often ineffective. Initiatives such as Operation Sukuma Sakhe demonstrate how community engagement can improve health outcomes.
For NHI to succeed, South Africa must reshape its PHC workforce, focusing on early training in teamwork, leadership, and interdisciplinary care. A blended payment model under NHI, combining salaries and performance-based incentives, could also ensure fair compensation and quality care delivery.
Building stronger public-private partnerships and fostering a culture of accountability through community engagement are vital steps in achieving universal health coverage. These reforms will create a more resilient, sustainable, and equitable healthcare system, ensuring access to high-quality care for all South Africans.
- Atiya Mosam is a public health medicine specialist; Sue Goldstein is a public health medicine specialist; Krish Vallabhjee is a public health medicine specialist; Tracey Naledi is a public health medicine specialist; Mark Heywood is an adjunct professor at the Nelson Mandela School of Public Governance at UCT.
This article first appeared in the Daily Maverick