Professor Susan Cleary argues that the NHI is a wide-ranging reform with both positive and controversial aspects. The key will be to find a middle ground in order to continue the journey to universal health coverage.

President Cyril Ramaphosa signing the National Health Insurance (NHI) Act on the eve of the elections is a smart move from the perspective of a political party seeking to shore up its base. The concern, though, to those of us working to strengthen the health system is whether the NHI will enable the country to move closer towards universal health coverage.

For the NHI naysayers, perhaps it would be important to alleviate some fears and concerns. The NHI is a long-term project. In the 2024 budget, Treasury reduced the conditional grant allocations to the NHI in comparison with what was allocated in the 2023 budget. While signing the NHI Bill into law is a step forward, the reduction in resources towards NHI implementation reminds us that this is a long-term project. In addition, it is likely that there will be legal challenges which will lead to considerable delays for the scheme to be fully implemented.

The NHI is a wide-ranging reform, with many positive aspects sitting alongside some key controversial aspects. Positive aspects include the opportunity to enable greater use of evidence and transparency in priority-setting through the further institutionalisation of health technology assessment processes (akin to "NICE"...