The South African health sector and the World Health organization South Africa’s health sector and its preparedness for the National Health Insurance (NHI): Challenges and opportunities

• Pages: 245-261
• Date: 01 December 2021
• Published date: 01 December 2021
• Author: Nduduzo C. Ndebele,Victor H. Mlambo,John N. Molepo,Sibiya LM
• Subject Matter: Derecho Público y Administrativo

Special Issue

December, 2021

European Journal of Economics, Law and Social Sciences

IIPCCL Publishing, Graz-Austria

ISSN 2519-1284

Acces online at www.iipccl.org

334

The South African health sector and the World Health organization

South Africa’s health sector and its preparedness for the National Health

Insurance (NHI): Challenges and opportunities

Nduduzo C. Ndebele

University of Zululand, Public Administration Department

Ndebelen@unizulu.ac.za

Victor H. Mlambo

University of Zululand, Public Administration Department

halavico@yahoo.com

John N. Molepo

University of Mpumalanga, Public Administration and Management Department

John.Molepo@ump.ac.za

Sibiya LM

sibiyaLM@unizulu.ac.za

University of Zululand, Public Administration Department

Abstract

The South African health system was and still characterized by social exclusion underpinned

by those who can and those who cannot aord. Reecting on the health sector during the

apartheid era, prioritization was to ensure that the minority had access to the best healthcare

services available while the majority lingered in poverty unable to access quality basic healthcare

services. To gain a deeper understanding of South Africa’s health sector, it challenges and the

imminent implementation of the NHI, this paper seeks to systematize the existing empirical

literature on the South Africa’s health sector. By systematically addressing existing empirical

research, the paper provides a sound basis for a more evidence-based discussion of this highly

debated and politicized issue. The study results highlighted corruption, lack of infrastructure

and shortage of well-trained healthcare workers as chronic challenges facing South Africa’s

healthcare sector. Therefore, the study concludes that although NHI’s quest to address injustices

of the past and ensuring citizens access healthcare without being subjected to aordability

criteria can be characterized as noble, we argue however that, it implementation need to factor

in the current challenges in the health sector as without addressing these challenges, the NHI

is bound to encounter serious operational issues.

Keywords: Healthcare, Services, NHI, Access, Inequality, System.

Introduction

The South African health system was and is still characterized by social exclusion

underpinned by those who can and those who cannot aord. Reecting on the health

sector in an apartheid South Africa, prioritization was to ensure that the minority had

European Journal of Economics, Law and Social Sciences

IIPCCL Publishing, Graz-Austria

Special Issue

December, 2021

ISSN 2519-1284

Acces online at www.iipccl.org

335

access to the best health care services available while the majority lingered in poverty

unable to access basic healthcare services. The current challenges in the health sector

can be traced back to the apartheid period (1948–1993) in which the healthcare

system was highly fragmented, with discriminatory eect, between four dierent

racial groups (Maphumulo & Bhengu, 2019). Insofar as the right to have access to

health care services is a basic human right guaranteed by the Constitution, 26 years

into freedom, health care inequality in South Africa is even worse for poor, black

South Africans than it was under apartheid (Norris, 2010). While signicant eorts

have been made to improve the quality of healthcare delivery in South Africa since

1994, there are still considerable challenges that remain. Rampant corruption, brain

drain, infrastructure degradation and an increase in those seeking medical services

factors compounding the development of the healthcare sector. Notwithstanding

these challenges, the South Africa government has advocated for the implementation

of the National Health Insurance Scheme which is designed to pool funds to provide

access to quality aordable personal health services for all South Africans based on

their health needs, irrespective of their socio-economic status. For the government,

the inequality in terms of accessing health care is the reason why some South Africans

cannot aord the best health care available, hence the government hopes the NHI

would rectify this anomaly. However, while this is commendable, there have been

questions and doubts with regards to implementing the NHI, especially, relating to its

cost. Aard Montalto, believes that NHI would cost SA R165 billion while the initial

rollout is expected to cost R33 billion (Hlatshaneni, 2019). The question is where will

this money come from? For the government, ensuring that South Africans have access

to quality healthcare outweighs the cost involved, besides, the NHI will narrow the

gap between the rich and poor in terms of standards of healthcare. While the authors

see the nobility in the NHI, we argue that, that South Africa’s push to implement

the NHI fails to the reect the economic position of country. Malakoane et al (2020)

agree that while welcome, the NHI cannot be implemented at the current state. The

authors argue that the South African health care sector is chronically challenged and

if these challenges are not addressed, it will be impossible for the NHI to succeed.

Additionally, while countries such as Finland, France, Germany, Greece, Iceland and

Ireland have universal health care, there is a strong commitment to good governance,

accountability and transparency in these countries, not the same can be said for South

Africa. It is with the above, therefore, that the study seeks to examine the current

state of South Africa’s healthcare sector and its preparedness for the rollout and

implementation of the NHI. We seek to understand possible opportunities that will

be available for the NHI and the challenges that are bound to confront it. This will

help examine South Africa’s readiness for the NHI implementation.

Methodological issues

This paper employed a qualitative research approach where the review of the literature

was undertaken to answer the underlying arguments of the paper. This approach

allowed the collection of data from a local, regional and international perspective. This

approach was employed to contextualize the understanding of the National Health