South Africa’s Health Care System and its aim to achieve universal coverage


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Høgskolen i Oslo og Akershus. Fakultet for samfunnsfag

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Master in International Social Welfare and Health Policy


The South African government is in process of implementing health financing reforms, through the implementation of a national health insurance. The aim of my thesis is to present the plans outlined within the National Health Insurance Policy. Emphasis is placed on the social, economic and health background of South Africa as well as the history of reforms. How universal coverage is defined as well as the key factors that need to be addressed when attempting to implement universal coverage. The theory of trust is explored. The focus is on what is understood by trust and how trust functions within the context of a health system, particularly how it functions in the process of implementing universal coverage. The thesis also briefly explores experiences of Ghana, Rwanda and Mexico in implementing universal coverage. It presents the guiding principles and the objectives of the National Health Insurance Policy as well as the financing model proposed. This is followed by a discussion on the challenges and essential changes that have to be implemented in order to realise the objectives as set out in the National Health Insurance Policy. The following aspects need to be addressed in order to effectively implement the National Health Insurance Policy, keeping in mind South Africa’s current health system structure and financing: 1) The access to health services is very important in extending health insurance, but equally important is ensuring that services are utilised. This includes providing education on benefit packages and continuous communication with communities and considering whether patients will be able to reach health facilities in order to receive services, this is particularly important in rural areas. 2) Continuous monitoring and evaluation is required in the process of implementing health finance reforms. 3) Good governance, stewardship and most importantly accountability are emphasised by different scholars. 4) In order to provide effective financial protection through national health insurance, significant cross-subsidisation has to occur from the rich to the poor and the healthy to the sick. This requires social solidarity which is important particularly in the context of South Africa’s high inequality. In addition, in order to develop social solidarity, government has to build on the trust relationship between state, the health system and its citizens.


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