What South Africa can learn from other countries for a successful implementation of National Health Insurance – a review of the literature
Keywords:
healthcare reform, health policy, health insurance, stakeholders, policy implementation, public health, private sector, health financing, health inequalitiesAbstract
Objective: This review paper aimed to provide a qualitative summary of evidence on how other countries that have had some success in implementing some form of Universal Health Coverage (UHC) have navigated the structural problems in the health system and used the lessons to inform the implementation of the National Health Insurance (NHI) in South Africa (SA).
Methods: The literature search was undertaken from December 2020 to December 2022 and included literature dated 2010 to 2022. The criteria for selecting the literature was limited to papers written in English and involving discussions on what and how all stakeholders (public and private sectors) can contribute to ensuring the smooth implementation of UHC. A narrative, rather than systematic review, was considered more appropriate.
Results: The review paper has identified opportunities that, if exploited, may clear the way for an all-inclusive stakeholder collaboration to see a successful delivery of the NHI project in SA. The opportunities identified sought to address leadership and governance, healthcare financing, service delivery and health workforce challenges. The challenges of managing the cost escalation and maintaining coverage for vulnerable groups were explored.
Conclusions: The NHI project requires a clear understanding and appreciation of the collaborative efforts expected from all stakeholders. The findings of the review suggest that while the NHI building blocks have been described in legislation, there is deficiency of the detail required to deal with the implementation nuances. This requires further research to unpack the detail required to exploit the opportunities identified for the implementation of the NHI.
