The Challenge
Currently, only 20% of the South African population has health insurance. Faced with tough problems of access, efficiency, quality, and equity in its health system, the country has embarked on an ambitious, 14-year strategy to join global efforts to achieve universal health coverage and develop a national health insurance system.
To succeed, major changes will be required in how South Africa raises revenues for health, how those funds are paid to health providers, and how the new national health insurance system will be organized and governed–from the national to provincial to district levels, and across the public and private sectors. Technical, economic, and political challenges abound.
The Opportunity
In 2011, the South African cabinet approved a Green Paper on National Health Insurance (NHI). A multi-year implementation plan is envisioned, including phases for strengthening government health services, improving regulation of providers, testing various forms of contracting and payment for services, and the development of a National Health Insurance Fund to act as a single, public sector purchaser of health services for all. Over the past two years, small-scale pilot activities have started in select districts. The government is also working to turn the Green Paper into a White Paper, making the NHI policy an official position.
South Africa’s National Treasury will be instrumental in helping refine and roll-out NHI. Supporting the National Department of Health, the Treasury wants to ensure that the design of NHI achieves a high level of population coverage, provides South Africans with a wide range of health services, reduces out-of-pocket payments, is efficiently operated and fiscally sound, and is built upon a sustainable financing foundation.
Through a unique engagement with National Treasury, funded by The Atlantic Philanthropies, R4D is helping to translate international expertise on major health financing reforms into practical answers to immediate policy questions that South Africa’s Treasury and Department of Health officials face in these early years.
Our Work
In this project, R4D is leveraging its global experience with health finance reform via the Joint Learning Network, and its knowledge and relationships in the health sector in South Africa based on its longstanding work on HIV/AIDS in the country), to provide policy advice and options that are grounded in global best practice and in South Africa’s unique domestic conditions.
R4D is supporting Treasury and its partners on a number of technical issues in the early design and piloting of NHI through 2015. R4D serves as a sounding board for Treasury; sources ideas, lessons, and global expertise on key issues in NHI; and tailors that expertise into practical advice for South Africa. R4D’s approach connects local South African experts on particular health purchasing and organizational challenges in South Africa with R4D staff and international experts who help identify the most relevant international experience to draw from—producing stand-alone reports and rapid-response feedback for Treasury as dictated by events on the ground.
In 2012, R4D developed options for mobilizing revenues for NHI and convened an expert workshop in Pretoria to survey the myriad financing challenges for NHI. In year two, R4D is advising Treasury on NHI financing policy development, including the design of “active purchasing” pilots (where health service purchasing modalities should actively incentivize efficient and high-quality provision of services); the structure and core functions of the proposed National Health Insurance Fund; and the approach that South Africa should take in defining the health benefits that NHI will cover.
