South Africa: The NHI Dream Must Be Built From Below


Universal, single-payer health insurance is what South Africa needs - but we can only make it viable by filling the data and innovation gaps that bedevil our public health system.

Small, step-by-step innovations at the clinic and hospital level are where the real action lies in fixing South Africa's healthcare system. Sourcing money in new ways at the top of the system is only part of the story. Variations of the single-payer system have worked well in several other middle-income countries - but in each case, the health system rises or falls according to how skilfully the details are worked out at the bottom of the system rather than the "big" ideas at the top.

The proposed National Health Insurance system is a big idea. And it evokes strong emotions because it touches on "hot-button" issues in South Africa such as socialism and higher taxes. These are potential slayers of dinner-table conversation - even among friends - and that's before you stir in our anxieties about health.

Another factor in the emotional quotient of the conversation is the sheer complexity of healthcare. For starters, the government bond market is in the red zone: to escape the formidable clutches of IMF...

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