Civil organisations representing healthcare workers remain concerned about how the National Health Insurance (NHI) will achieve Universal Health Coverage (UHC). The ongoing power crisis and other unresolved issues within the health fraternity continue to raise concerns about the scheme’s success.

South African Medical Association (SAMA) spokesperson Dr Mvuyisi Mzukwa says the implementation of NHI could face numerous obstacles. The power crisis exacerbates these challenges. Steady, reliable electricity directly impacts the availability and quality of healthcare services, two critical tenets of the NHI.

Dr Mzukwa says government must prioritise uninterrupted power supply to all levels of healthcare service provision

During his state of the nation address in February, President Cyril Ramaphosa declared loadshedding a state of disaster. Eskom agreed to exempt hospitals from loadshedding. Currently, only 76 out of the 213 ‘priority’ hospitals are exempt from daily power cuts.

Mzukwa says while service delivery at rural healthcare facilities is dire, the power cuts also impact the level of care urban hospitals and clinics are able to provide. The situation has left SAMA with many unanswered questions regarding the implementation and feasibility of the NHI. 

Shortage of doctors a threat to NHI

The National Health Insurance (NHI) Bill will create a new body, the NHI Fund, which will purchase healthcare services from public and private providers on behalf of the population. This will promote equity, efficiency and quality of services. The DHMO (District Health Management Office) will be responsible for managing and coordinating primary healthcare services at the district level.

The Bill will also move some functions from provinces to the DHMOs and the Department of Health. The CUP (Contracting Unit for Primary Healthcare) will be established under the DHMO. It will manage the provision of primary healthcare services. The NHI Fund will transfer funds directly to the CUP. This is to ensure that primary healthcare services are provided in specific areas.

“SAMA recommended workshops aimed at co-creating the CUP models and their contracting and reimbursement strategies with key stakeholders in the delivery of primary healthcare services. The association believes that the models and the contracting and reimbursement from the workshop will help to improve the efficiency of the UHC/NHI implementation in South Africa,” says Mzukwa. 

He adds the current shortage of doctors at public hospitals in SA is at a critical stage. The ratio has widened to 0.8 doctors per 1000 population. Albania, which has a similar GDP to SA, has a doctor: patient ratio of 1.88 doctors per 1000 people. Peru and Thailand, have similar GDPs to SA but their doctor-to-patient ratio is better. It is 1.35 and 0.95 per 1000 people, respectively. 

Public healthcare in a state of disaster

“This puts tremendous pressure on the doctors currently serving in the public health system. Working overtime severely compromises their ability to deliver quality health outcomes to patients. This results in burnout and mental health issues. The infrastructure at the public health facilities is crumbling. This is both in terms of physical infrastructure, and infrastructure relating to medical equipment, maintenance, and supply,” says Mzukwa.

Mzukwa warns in its current form, NHI will cause the doctor-to-patient ratio will drop even lower. And this will worsen health outcomes for those who need care the most.

He adds this year’s budget speech paid little attention to basic services such as education and health services.

“SAMA members across the spectrum are disadvantaged by the health system. From interns and community service doctors who are not placed and/or paid on time, to practising registrars who are dealing with safety and security issues. Furthermore, public service doctors who are not equipped with equipment and systems to practice, and private practice doctors who are incurring unplanned energy costs,” says Mzukwa.

NHI could curb corruption

Health and Allied Workers Indaba Trade Union(HAITU) Secretary General, Lerato Mthunzi says that the National Department of Health should not wait to renovate all hospitals to implement the NHI. She believes that implementing NHI might help to curb issues of maladministration and corruption in the health fraternity.

“It is a chance for South Africans. Currently, the health fraternity is run by each province. NHI will centralise it,” says Mthunzi.

She says that HAITU supports the proposed NHI implementation mainly on the fact that it will cater for every citizen in a similar way, whether rich or poor. 

“One thing that we have always said is that we are pro-NHI. We support the NHI and we would like to see it implemented in South Africa. Healthcare has got an opportunity to change,” she says.

Is NHI a potential game-changer?

A recently released Protecting Rural Healthcare in Times of Economic Crises second edition report by the Rural Health Advocacy Project( RHAP) states the NHI promises to be a game changer as the country strives towards universal health care. But it is not without risks. And it should be implemented carefully to minimise the inevitable, unintended consequences. Rural health can benefit from the changes but it requires clear interventions and the implementation of well-thought-through strategies.

Phase one of the NHI is expected to roll out in 2026. – Health-e News.


  • Ndivhuwo Mukwevho

    Ndivhuwo Mukwevho is citizen journalist who is based in the Vhembe District of Limpopo province. He joined OurHealth in 2015 and his interests lie in investigative journalism and reporting the untold stories of disadvantaged rural communities. Ndivhuwo holds a Bachelor of Arts degree in Media Studies from the University of Venda and he is currently a registered student with UNISA.