The National Health Insurance Act takes away the autonomy of provincial governments to execute healthcare service delivery initiatives and shifts it to the national government. This might upset coalition partners in provinces.

A general election outcome that results in more provinces across South Africa being governed under coalitions could complicate and further delay the implementation of universal health coverage, as promised by the National Health Insurance Act.

The National Health Insurance Act, recently signed by President Cyril Ramaphosa, lays the foundation for reforms aimed at achieving universal health coverage in South Africa.

The Act envisages a unified health system in which a government-controlled fund will buy healthcare services for eligible patients that are free at the point of care in both public and private facilities.

Health experts in conversation in a Money Cents webinar with Daily Maverick's personal finance editor, Neesa Moodley, poked holes in the National Health Insurance Act, saying its principle of universal health coverage was noble, but the Act was unworkable, unconstitutional and unaffordable.

The experts argued that the National Health Insurance Act, in its current form, would undermine the powers of provincial governments, which by law have a degree of autonomy in rolling out healthcare service delivery initiatives.

Currently, healthcare service provision in South Africa's public sector is a function of the national government, which raises revenue through taxes. However, provincial government departments are at the coalface of...