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Reinvigorating South Africa's Universal Health Reforms

LSE Principal Investigators: Elias Mossialos and George Wharton
LSE team: Robert Yates and Stephanie Winitsky
Start Date: 27 January 2025
End Date: 31 December 2025
Funder: UK Foreign, Commonwealth and Development Office (FCDO)
Region(s): Africa
Countries: ESouth Africa
Keywords: Universal Health Coverage, National Health Insurance, health reforms

South Africa stands at a critical juncture in its pursuit of Universal Health Coverage (UHC) as the country recently enacted the National Health Insurance (NHI) Act, establishing a framework for universal tax-financed healthcare. However, the formation of a coalition government including parties with differing views on the NHI, alongside resistance from key stakeholders such as private sector entities and health professional bodies, has created significant uncertainty about the reform's implementation. The South African government has recognised the need for external expertise to navigate these complex political and economic challenges.

This project provides targeted technical assistance to support South Africa's efforts to reinvigorate its Universal Health Coverage reform process. Through stakeholder interviews, high-level consultations, and facilitated dialogue sessions, the project examines the current landscape of support and opposition to the NHI reforms. The research draws on international experiences of countries that have successfully implemented universal health systems despite facing similar political resistance, providing practical insights for overcoming barriers to reform.

The project aims to:

  • Provide strategic technical assistance to reinvigorate South Africa's UHC reform process
  • Facilitate dialogue and build consensus among key stakeholders on NHI implementation
  • Support the development of actionable strategies for overcoming political and economic barriers to UHC reform

By facilitating engagement between government, private sector, and civil society actors, this research contributes to building consensus around health system reform whilst identifying ongoing technical assistance needs to support South Africa's pursuit of equitable access to quality healthcare for all citizens.