South Africa: We Must Look At the Costs of NHI 20 Years From Now Before Rushing in - There Are Cheaper, More Effective Alternatives


The wrong actions at the wrong time bear consequences. There is the risk of starting a large-scale reform of our medical system that we simply cannot afford to see through to the end. The proposed NHI design lends itself to being unresponsive to citizen needs and to waste and corruption. There are at least four less expensive options.

Shivani Ranchod is an actuary, part-time academic at the University of Cape Town and the co-founder and CEO of Percept, a multidisciplinary consulting firm. Anja Smith is a development economist, with positions at Percept and Stellenbosch University. Jodi Wishnia is a public health specialist at Percept and in the final months of her PhD in public health at the University of the Witwatersrand.

This article is an extract from the Inclusive Society Institute's research report Trade-offs on the road to UHC: A quantitative assessment of alternative pathways for South Africa. It can be accessed at

What decision would you make about the structure of our country's future health system if you were given the responsibility for our collective care? What might you change about the timeline, the accountability mechanisms or the approach to delivering care? Does the proposed trajectory take us...

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