The implementation of the National Health Insurance (NHI) is one of the government's strategic priorities. From a services management perspective it is suggested that the project necessitates a fundamental review, analysis and in some instances adaptation of key healthcare delivery and support systems to realise the strategic objective of providing patients with quality care and cost effective health services. It is envisaged that the project will be implemented over a 14 year period and cost over R300 billion. It would seem that the project will feature as one of the most ambitious, costly, complex, and multidisciplinary systems re-engineering projects ever undertaken by the Department of Health (DOH). The dysfunctionality of healthcare service delivery and the underpinning support systems appear to be generally acknowledged and the question posed is one of what needs to now be done to address the situation from a systems management perspective. The question posed is explored by means of a multi-disciplinary, contemporary literature study in order to gain an understanding of the management issues involved. Healthcare informatics, critical skill sets and organisational culture emerge as essential factors of transformation management that need to be taken into consideration.