Home Institution

Duke University

Publication Date

Fall 2010

Program Name

South Africa: Community Health


As part of a three-week social analysis study, the African National Congress’ (ANC) proposal for a National Health Insurance (NHI) scheme was examined. Legal commitments in Section 27 of the Constitution and Section 3 of the National Health Act oblige the South African government to work progressively towards realization of the right to healthcare. The latest push for NHI can be interpreted as an attempt to broaden realization of this right.

Information on the NHI proposal was obtained primarily from documents released by the ANC and was supplemented by written analysis found through Internet research. A partial understanding of public opinion was achieved through interviews with South African citizens, including experts in various fields pertinent to the NHI. Time and other logistical constraints limited the amount of data incorporated into this paper. Biases resulting from personal views and/or desires of researchers or interviewees, as well as of the author, must be acknowledged in consideration of the findings.

Using the ANC discussion document released in September 2010, potential flaws in the policy were identified. These included questions of affordability; likely discontent amongst the public with services provided under NHI; a lack of concrete policy and program outlines; the potential for government mismanagement; a reliance on a failing public system; and a lack of information technology systems for collecting data to be used in system evaluation, cost estimation, and policy formulation.

Based on these potential problems and other findings, the author concluded that implementation of the NHI as proposed by the ANC within the suggested time frame is unlikely and would result in a probable system failure. Pursuit of an NHI based on the principles of universal coverage, the right to health, and social solidarity is a laudable and necessary action in the government’s quest to broaden realization of the twenty-seventh right. Implementation of such a system is possible, but must not rushed and should result from fully informed policies and programs that work gradually towards the complete implementation of a National Health Insurance scheme.


Health Policy | Social Welfare


Article Location