Critical Analysis of the South African Universal Health Coverage Policy in Relation to the World Health Organization's Universal Health Coverage Matrix

Abstract

South Africa is a highly unequal country. The most significant contributors of the poverty index are living conditions (47.5%) and health (39.5%). The country has a two-tiered health system, in which the healthcare system consists of the private sector funded by voluntary health insurance (VHI) and the public sector funded by taxes. Over the last two decades, government transfers as a proportion of total health expenditure (THE) increased significantly from 36% in 2000 to 59% in 2019. Health expenditure per capita and as a percentage of GDP has risen steadily over the period. In South Africa, VHI only covers highincome groups within the private sector leaving shortages of human resources in the public sector. In 2011 the Government published the National Health Insurance (NHI) green paper to introduce a healthcare financing system that will ensure that everyone has access to efficient and appropriate healthcare, based on health needs regardless of ability to pay. This was followed by the white paper, published in 2017, and the National Health Insurance Bill (NHIB) in 2019. The NHIB is currently still undergoing the comments process. Methods: This manuscript uses the WHO framework to critically analyse the South African universal health coverage policy, known as the National Health Insurance policy in relation to World Health Organization's (WHO) framework for health financing and Universal Health Coverage. Findings: The National Health Insurance (NHI) Bill is aligned with the WHO’s universal health care financing framework. The Bill aims to transform the fragmented two-tiered health system, the public and private, unified and equitable health system, revenue rising will consist mainly of public funds, which will be pooled into a single source to enable strategic purchase of services. The Fund will define the benefits once implemented. When finally implementeqd, the legislation will enable efficient and equitable healthcare financing; and access relative to need. Conclusion: The study found that the NHI policy is aligned with WHO’s framework on universal coverage and the desirable attributes. When implemented, the NHI policy will enable South Africa to achieve the intermediate objectives and final goals of universal coverage