Feb 2016 1st Edition

Affordable healthcare on the cards for SA

Written by More Matsediso and Priscilla Khumalo
Government is close to implementing the National Health Insurance (NHI), which will ensure that South Africans live long and healthy lives.

The National Health Insurance will give vulnerable groups access to quality healthcare.The NHI will cover vulnerable groups, such as women, children, older persons, people with disabilities, orphans, youths and rural populations.

The NHI, a health financing system that is designed to pool funds to provide access to quality, affordable healthcare, is part of government’s major health sector reforms and is being rolled out over a 14-year period.

Cabinet has approved that the national

Department of Health publishes the White Paper on the NHI for public consultation.

A White Paper is a developed document, which states the government’s policy.

The paper was drafted by the Department of Health, and will be discussed in Parliament. Other committees within Parliament may propose amendments.

Before the NHI can be implemented the White Paper must be finalised and there has to be a consultation processes.

The finalised White Paper will be used to inform the drafting of the NHI Bill, which will have to go through both Cabinet and Parliamentary approval before being made law. There will also be a process of public consultation on the NHI Bill.

Speaking about the White Paper, Health Minister Dr Aaron Motsoaledi said it lays the foundation for moving South Africa towards universal health coverage and is in line with the vision of the National Development Plan.

The NHI seeks to transform the financing of the health system, in pursuit of the goal of universal health coverage.

Minister Motsoaledi said the NHI as a major transition in health and said it is going to change healthcare irreversibly.

“It’s going to be a real transition. The transition is not going to be a sprint, it’s going to be an ultra-marathon that takes place for a very long time,” said Minister Motsoaledi.

The White Paper states that the NHI will be implemented over a 14-year period and in three phases.


The first phase extends from 2012/13 to 2016/17. Pilots started in 2012 in 10 districts across the country.

This phase has largely focused on improving public health service delivery and strengthening management and governance systems, particularly to improve the quality of health services.

All health facilities will be inspected and certified by the Office of Health Standards Compliance, using agreed upon quality of care norms and standards.

The second phase will extend from 2017/18 to 2019/2021. The population will be registered and issued with a NHI card at designated public facilities, using the unique identifier linked to the Department of Home Affairs.

This phase will focus on work to develop and implement risk identification and a fraud management system.

In the early stages of phase two a transitional fund will be established to purchase primary healthcare services from certified and accredited public and private providers at a non-specialist level.

The third and final phase of implementation will take place over the last four years and will focus on ensuring that the NHI Fund is fully functional.

Protection from financial hardship

Those who are legally entitled to benefit from the NHI will be protected from financial hardship, as they will not have to pay directly at the point of healthcare. Services provided will be paid for through the NHI Fund.

NHI cardholders will not be expected to make any out-of-pocket payments, such as co-payments and user fees at the point of healthcare delivery. This will help to prevent demands for informal payments.

The NHI is based on the principles of the right of all citizens to have access to quality health services that are delivered equitably, affordably, efficiently, effectively and appropriately, based on social solidarity and health as a public good.

NHI coverage

All South Africans will have acccess to the NHI, irrespective of their socio-economic status. Coverage will also extend to legal permanent residents.

By extending effective population coverage, priority will be given to the population that is in greatest need and those who struggle with access to care.

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