In May, President Cyril Ramaphosa signed the National Health Insurance (NHI) Bill into law, aiming to implement Universal Health Coverage (UHC) in South Africa. However, this move has sparked debates and potential court challenges questioning the Act's constitutionality, including opposition from political parties within the Government of National Unity (GNU).
The government will implement NHI over several years, but clear next steps remain undefined. Kaymarlin Govender, Research Director at HEARD, University of KwaZulu-Natal, emphasised that social determinants significantly influence health outcomes.
These include historical injustices, economic disparities, and inadequate infrastructure, all contributing to the fragmented healthcare system where the public sector serves 84% of the population and the private sector serves 16%. Post-1994 efforts to expand primary healthcare (PHC) through a decentralised district health system marked progress.
Yet, challenges such as high disease burdens, inadequate PHC access, and weakened infrastructure persist. The COVID-19 pandemic further strained the healthcare system despite efforts to adapt services. A significant milestone was the rollout of antiretroviral (ARV) treatment in the early 2000s, driven by advocacy from the Treatment Action Campaign (TAC).
South Africa boasts the most extensive ARV programme globally, primarily funded domestically. However, reducing HIV incidence remains challenging due to social and structural factors. NHI aims to provide all South Africans with quality, affordable healthcare, regardless of socioeconomic status. However, opinions vary on its potential success.
Key considerations include reducing financial hardships, addressing discrimination, and strengthening PHC. Effective UHC implementation requires multisectoral collaboration, community participation, and robust data systems to ensure accountability and sustainable health improvements.