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NHI - Deep Dive into Healthcare in South Africa

Updated: Apr 3

This content was taken from the NHI website.


Since the dawn of democracy, the health sector has undergone many reforms to try and create a more equitable, accessible and affordable healthcare system, that can service all South Africans. However, these past reforms have been too little and too slow.

Everyone deserves equal access to quality and affordable healthcare. Fundamental changes need to occur to create a strengthened healthcare system.

The problem: South Africa’s health system is very complicated and expensive. The health outcomes do not match the resources invested to the system. Both the public and private sector have challenges that make the healthcare delivery system unsustainable to service all South Africans.

The plan to strengthen the health system: South Africa is a member of the United Nations community and has committed to implement universal health coverage for all. The desired outcome is that “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship”.

The National Health Insurance (NHI) is South Africa’s strategy to achieving universal health coverage.

The NHI is a fund from which the government will buy healthcare services for South Africans from healthcare providers both in the public and private sector. The NHI will make healthcare more affordable, by reducing the cost of healthcare for all. It acts like a medical aid for everyone, and all of us will contribute to this fund through taxes and special contributions in line with what we can afford. It will ensure that everyone is entitled to free healthcare when they need it. There will be no fees charged at the facility because the fund will cover the costs of care.

NHI’s History: The NHI is a journey to transform South Africa’s health sector. It will take many years to be fully realised and requires input from all sectors to ensure no one is left behind. For the NHI Fund to be effective, the entire health system will undergo reform for many years to come. These reforms include partnerships between the private and public sectors, making both sectors more effective and more efficient, and implementing robust governance structures.

The NHI is not a new concept, nor specific to South Africa. Many countries around the world implement a similar structure to provide affordable and accessible quality healthcare. The NHI journey started in 2011 when the NHI Green Paper was published for public consultation. This was followed by NHI pilot projects in 2012 with a focus on health system strengthening initiatives. The NHI White paper was published in 2015 laying the foundation for the NHI as the vehicle to achieve universal health coverage and a unified health system.

The passing of the NHI Bill in June 2023 by the National Assembly is a key milestone that paves the way for ensuring better collaboration between our private and public health systems, guaranteeing universal and comprehensive quality health coverage for all.


The NHI 2022-23 Annual Report and 2023 Bill are accessible here:

Download PDF • 2.27MB

Download PDF • 200KB




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