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National Health Act, 2003 (Act No. 61 of 2003)


National Health Insurance Policy towards Universal Health Coverage

Chapter 1 : Introduction and Background

1.1 Introduction


1. National Health Insurance (NHI) is a health care financing system that is designed to pool funds to actively purchase and provide access to quality, affordable personal healthcare services for all South Africans based on their health needs, irrespective of their socioeconomic status. NHI is intended to move South Africa towards Universal Health Coverage (UHC) by ensuring that the population has access to quality health services and that it does not result in financial hardships for individuals and their families.


2. NHI represents a substantial policy shift that will necessitate massive reorganisation of the current health care system, to address structural changes that exist in both the public and private sectors. It reflects the kind of society we wish to live in: one based on the values of justice, fairness and social solidarity. Implementation of NHI is consistent with the global vision that health care should be a social investment.


3. NHI derives its mandate from Section 27 of the Bill of Rights of the Constitution of the Republic of South Africa in which a commitment is made for the State to take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of the right to health care.


4. The implementation is underpinned by Vision 2030 of the National Development Plan (NDP), which envisions that by 2030, everyone must have access to an equal standard of care, regardless of their income, and that a common Fund should enable equitable access to health care, regardless of what people can afford or how frequently they need to use a service.


5. NHI will cover services that are delivered on a people-centred integrated healthcare service platform to ensure a more responsive and accountable health system that takes into account socio-cultural and socio-economic factors whilst prioritising vulnerable communitiesa. Such a people-centred integrated healthcare service platform should also improve user satisfaction, lead to a better quality of life of the citizens and improved health outcomes across all socioeconomic groups. This will contribute towards improved human capital, labour productivity, economic growth, social stability and social cohesion. Therefore, NHI will contribute towards reduction of poverty and inequalities inherited from the past.


6. Universal population coverage under NHI will ensure that all South Africans have access to comprehensive quality healthcare services. This means that people will be able to access healthcare services closest to where they live. The healthcare services will be accessed at appropriate levels of care and will be delivered through certified and accredited public and private providers.


7. The population will be registered at designated health facilities using the unique identifier linked to the Department of Home Affairs identification system. Vulnerable groups will be prioritised for registration.


8. Preparatory activities on NHI were aimed at strengthening of the health system and service delivery platform. This included implementation of re-engineering of Primary Health Care (PHC) and the Operation Phakisa Ideal Clinic Realisation Programme to improve performance and quality of health services in the PHC facilities. Other preparatory activities undertaken include infrastructure improvement as well as improving planning for human resources for health.


9. The Office of Health Standards Compliance (OHSC) was established for the inspection and certification of health facilities to ensure compliance with the norms and standards regulations.


10. Central hospitals will be transformed into national assets operating as training platforms, research hubs and centres of excellence locally, regionally and internationally. The central hospitals will be semi-autonomous to improve their management and governance and to position them as providers of choice for highly specialised and affordable services for the whole population.


11. The NHI Fund will be created to actively and progressively purchase personal healthcare services on behalf the entire population. This will be realised through the establishment of a fully functional administrative structure with its governance function. The Fund will be strategic purchaser with accreditation and risk mitigation systems, health technology assessment as well as systems for monitoring and evaluation. Additional resources will be mobilised for revenue for the NHI Fund through the introduction of mandatory prepayment in the latter phases of implementation.


12. Health facilities that are compliant with certification requirement of the OHSC and meet set criteria will be accredited by the NHI Fund as part of strategic purchasing. The Fund will contract directly with accredited public hospitals (including regional, tertiary, central and specialised hospitals). In the latter phases of implementation, NHI will also contract with certified and accredited private providers at higher levels of care based on need.


13. Emergency Medical Services (EMS) and National Laboratory Health Services (NHLS) will be contracted for personal health services by the Fund in the latter stages of implementation. The coverage for EMS will be such that every area of the country is covered and response time between rural and urban are optimised for effective referrals.




a Vulnerable Communities is contained is Chapter 1, Section 4(2)(d) of the National Health Act