Strengthening health systems is vital to achieving universal health coverage (UHC), a critical part of the United Nations’ third Sustainable Development Goal (SDG), which aims to ensure healthy lives and promote well-being for everyone. As a member of the UN General Assembly and a signatory to the SDGs, South Africa is working to unify, integrate, and improve its health system in preparation for the National Health Insurance (NHI) program. In 2018, President Cyril Ramaphosa hosted the first Presidential Health Summit, where many stakeholders signed the first Presidential Health Compact. This compact began a collaborative effort between the government, private sector, labour unions, healthcare professionals, civil society, academia, and patient groups to reform the health system. Since then, significant progress has been made. A five-year plan for human resources in health was developed, and a R300 million public health enhancement fund was established to train and deploy over 100 medical doctors and 34 PhD candidates. Additionally, 149 primary healthcare facilities have been built across various provinces, and a health patient registration system is now being implemented. One of the priorities identified in 2018 was ensuring that medicines are available in public health facilities. Since the compact’s signing, public facilities have maintained medicine availability at over 85%, even during the Covid-19 pandemic. In 2023, the second Presidential Health Summit was held to assess the health system’s readiness to implement NHI and to identify steps needed to strengthen the system, accelerate NHI reforms, and build resilience. There was a strong sense of unity, with all stakeholders renewing their commitment to UHC and pledging to work together to implement the summit’s outcomes. During the summit, President Ramaphosa emphasised the importance of NHI in ensuring equal access to healthcare. The second Presidential Health Compact, expected to be signed by multiple stakeholders soon, will build on these efforts. This new compact will assess the impact of the human resources plan, develop policies for public procurement in healthcare, and advance the development of an electronic medical record system and digital health strategy. Innovative financing models will be explored to support the health system’s resilience and NHI implementation. The government recognises that funding from sources beyond the national budget will be necessary to achieve these goals. Despite some entities withdrawing from the first compact, the process for the second compact remains on track. Over 230 stakeholders, including representatives from the private sector and health professionals, are expected to sign the new compact, demonstrating their commitment to bringing quality healthcare closer to all. The NHI Act, signed into law after extensive public and parliamentary consultations, represents South Africa’s dedication to achieving UHC by 2030 as part of its SDG commitments. While some organisations have contested the act’s constitutionality, the government respects the independence of the courts and remains focused on delivering the benefits that the public expects from NHI. With the support of hundreds of organisations, South Africa is dedicated to strengthening its health system and achieving UHC through NHI, ensuring that all citizens have access to high-quality healthcare.
- Dr Olive Shisana, an honorary professor, is a special adviser to President Cyril Ramaphosa.