Improving Access to Healthcare in South Africa through the National Health Insurance Scheme: A Hit or a Miss?




National Health Insurance (NHI), Healthcare, Universal Health Coverage, Access, Health Sector


The South African healthcare system is plagued by inequalities at various levels. The National Health Insurance (NHI) Bill was recently passed by the National Assembly and has revived debate on whether the NHI can effectively bridge the gap between the rich and the poor in accessing healthcare services. This paper explores the effectiveness of the NHI as a healthcare system reform aimed at bridging the gap between the public and private sectors of South Africa’s two-tiered healthcare system. To assist policymakers in its effective implementation, the paper explores the constitutional obligations regarding the provision of healthcare services and offers an analysis of whether the NHI Bill meets constitutional muster. In its conclusion, the paper also suggests solutions to address the Bill’s shortcomings by including practical steps that can be taken to ensure that the vision of universal health coverage is achieved.

Author Biography

Tamanda Kamwendo, University of the Free State

Department of Private Law, University of the Free State, South Africa.


Africa Check. 2018. “Does SA’s Private Healthcare Sector only Serve 16% of the Population?” Accessed September 22, 2022.

Amado, Leandra, Nicholas Christofides, Raymond Pieters, and Jody Rusch. 2012. “National Health Insurance: A Lofty Ideal in Need of Cautious, Planned Implementation.” South African Journal of Bioethics and Law 5 (1):4-10.

Bateman, Chris. 2011. “Act Now to Create the Kind of NHI You Want! SAMA.” South African Medical Journal 101 (10): 694–98.

Burger, R., and C. Christian. 2020. “Access to Health Care in Post-apartheid South Africa: Availability, Affordability, Acceptability.” Health Economics, Policy and Law 15 (1): 43–55. DOI:

Department of Health. n.d. “Understanding National Health Insurance.” Accessed October 28, 2019.

Du Toit, Michelle. n.d. “The Constitutionality of the NHI Scheme as a Financing System for Universal Health Coverage.” Accessed November 7, 2019.

Fusheini, A., and J. Eyles. 2016. “Achieving Universal Health Coverage in South Africa through a District Health System Approach: Conflicting Ideologies of Health Care Provision.” BMC Health Services Research 16. DOI:

General Comment No. 14, E/C.12/2000/4 (2000). n.d. Accessed July 16, 2019.

Harris, Paul. 2017. “Access to Healthcare in South Africa and the Proposed NHI Plan.” World Health Organization.

IOM (Institute of Medicine). 1988. The Future of Public Health. Washington DC: The National Academies Press.

Maseko, L., and B. Harris. 2018. “People-centeredness in Health System Reform. Public Perceptions of Private and Public Hospitals in South Africa.” South African Journal of Occupational Therapy 48 (1): 22–27. DOI:

Mukudu, H., K. Otwombe, A. Fusheini, and J. Igumbo. 2020. “Contracting of Private Medical Practitioners in a National Health Insurance Pilot District: What Has Been the Effect on Primary Healthcare Utilisation Indicators?” African Journal of Primary Health Care and Family Medicine 12 (1): a2563. DOI:

National Health Insurance Bill. 2019.

“National Health Insurance in South Africa Policy Paper.” 2011.

Shisana, O., T. Rehle, J. Louw, N. Zungu-Dirwayi, P. Dana, and L. Rispel. 2006. “Public Perceptions on National Health Insurance: Moving towards Universal Health Coverage in South Africa.” South African Medical Journal 96 (9): 814–8.

Some Key Messages on National Health Insurance (NHI). n.d. Accessed November 10, 2019.

Universal Health Coverage. n.d. World Health Organisation. Accessed November 7, 2019.

Weir-Smith, Gina, Tholang Mokhele, and Simangele Dlamini. 2022. “National Health Insurance in the Face of Covid-19: Urban Tendencies in South Africa.” South African Geographical Journal 104 (3): 276–90. DOI:



How to Cite

Kamwendo, Tamanda. 2023. “Improving Access to Healthcare in South Africa through the National Health Insurance Scheme: A Hit or a Miss?”. Politeia 42 (1):11 pages .



Received 2023-10-11
Accepted 2023-11-20
Published 2023-12-28