South Africa faces numerous challenges in delivering high quality health services to the majority of its population.
The National Development Plan (NDP) 2030 indicates that the country should deal with the expensive cost of private healthcare and address the problems of quality of public healthcare to ensure Universal Health Care (UHC). UHC is being pursued in South Africa through the government’s policy of National Health Insurance (NHI).
According to the NHI policy, the implementation of NHI would happen in three phases. Phase 1 primarily focused on preparing primary health care (PHC) for NHI through the introduction of health system strengthening (HSS) interventions in 10 NHI pilot districts across the country. Implementation of Phase 1 began in 2012 and came to an end in 2017.
We undertook the evaluation of the NHI Phase 1 implementation in South Africa. The main aim was to assess whether the NHI Phase 1 interventions had achieved their objective of HSS in PHC facilities. Furthermore, the evaluation aimed to identify lessons learnt from Phase 1 in an attempt to sustain and scale up interventions in the future.
We completed secondary data analysis in the form of two literature reviews. The first assessed the implementation of NHI in other low-to-middle income countries to identify lessons that can be learnt by South Africa. The second review summarised previous NHI annual assessments. This review was used to identify gaps in implementation to date and to develop tools for primary data collection.
Primary data collection was completed at national, provincial, district and facility levels. We visited the 10 NHI pilot districts and key stakeholders were interviewed to gain insight to the successes, challenges and lessons learnt from Phase1 implementation.
In parallel, we analysed the quantitative data from the District Health Information System (DHIS) to assess the performance of the NHI indicators in PHC in the last five years. We compiled an in-depth evaluation report which highlighted both the successes and challenges of NHI phase 1 implementation and made recommendations for future planning and implementation, to support the National Department of Health (NDOH) as it transitioned into phase 2 implementation.
The evaluation findings and recommendations were presented in Cape Town, in November 2018, to the then Minister of Health, Dr Aaron Motsoaledi.