Each year on December 12, the world marks Universal Health Coverage (UHC) Day to champion the right to accessible, affordable healthcare for all. This year’s theme:“Unaffordable health costs? We’re sick of it!”strikes a deep chord in SA, which is in the grip of a cost-of-living crisis.
With out-of-pocket health spending now consuming a rising share of household budgets, particularly for low- and middle-income earners, this current trajectory is not sustainable. It erodes public trust in the health system, long before people even interact with the National Health Insurance (NHI). The aspiration to provide healthcare to all is embedded in our constitution and supported by broad consensus across sectors.
The NHI Act, signed into law in May 2024, has reignited debate and risks, polarising the healthcare conversation at a time when unity of purpose and clarity of vision are what we need most. At the Board of Healthcare Funders, we believe that UHC is not only achievable but essential, and that the public and private sectors have an indispensable role to play. Rather than framing one sector as the solution and the other as the problem, the real question is: How do we build an integrated health system that harnesses the strengths of both?
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For ordinary citizens, the debate over funding is secondary; what matters is receiving quality care when they need it. The ongoing contestation around financing should never overshadow the core purpose of health reform – delivering better care, now, for the people who need it. However, the current legislative model does not foster integration or collaboration.
It risks dismantling existing infrastructure before viable alternatives are in place, creating the very access gaps UHC aims to close. A well-functioning health system requires strong governance, sustainable financing, and a workforce that is motivated, well-distributed, and supported. It also requires mechanisms to protect individuals from catastrophic out-of-pocket expenses.
In all these areas, medical schemes, healthcare professionals, non-governmental organisations, and the broader private sector can play a catalytic and complementary role. SA already has valuable assets, including advanced tertiary hospitals, digital innovations, skilled healthcare workers, and well-regulated medical schemes. These must not be seen as competitors to the state but as allies in the UHC effort.
The goal should not be to replace one system with another but to integrate the best of both to expand access and improve quality. Low-cost benefit options, community-based plans, and digital primary care platforms offer opportunities to expand coverage to informal workers and lower-income earners. Yet these are not adequately enabled under current regulation. Strategic reform must allow for flexibility, innovation, and risk pooling across income groups.
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