South African healthcare reforms towards universal healthcare – where to next?


  • G Solanki Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; NMG Consultants and Actuaries, Cape Town, South Africa
  • T Wilkinson Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • N G Myburgh Faculty of Dentistry and World Heath Organization Collaborating Centre for Oral Health, University of the Western Cape, Cape Town, South Africa
  • J E Cornell Nelson Mandela School of Public Governance, University of Cape Town, South Africa
  • V Brijlal Clinton Health Access Initiative, Pretoria, South Africa



Universal health coverage, Health financing reform, National Health Insurance, South Africa


The National Assembly approval of the National Health Insurance (NHI) Bill represents an important milestone, but there are many uncertainties concerning its implementation and timeline. The challenges faced by the South African healthcare system are huge, and we cannot afford to wait for NHI to address them all. It is critical that the process of strengthening the health system to advance universal healthcare (UHC) begins now, and there are several viable initiatives that can be implemented without delay. This article examines potential scenarios after the Bill is passed and ways in which UHC could be advanced. It begins with an overview of the trajectory of health system reform since 1994, then examines the scenarios that may emerge once the Bill is passed by Parliament and makes a case for finding ways in which UHC could be advanced within the country, regardless of any legal or financial barriers that may delay or limit NHI implementation.

Author Biographies

  • G Solanki, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; NMG Consultants and Actuaries, Cape Town, South Africa

    Senior Specialist Scientist: Health Systems Research Unit, SAMRC

  • T Wilkinson, Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

    PhD student


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How to Cite

Solanki G, Wilkinson T, Myburgh NG, Cornell JE, Brijlal V. South African healthcare reforms towards universal healthcare – where to next?. S Afr Med J [Internet]. 2024 Mar. 18 [cited 2024 Apr. 21];114(3):e1571. Available from:

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