The NHI as an alternative to developing South Africa's healthcare system : a retrospective analysis

Abstract

The purpose of this study is to retrospectively analyse the formulation phase of the National Health Insurance (NHI) policy in South Africa. This policy was formulated in 2007 by the ANC-led government to bridge the gap between the private and public healthcare sectors so as to create a unified healthcare system. This study contends that the NHI policy faces implementation challenges today because the policy formulation stage reflected an exclusionary criterion when selecting stakeholders during the policy formulation stage. This study argues that policy formulation in South Africa is elite-driven and characterised by the bureaucracy adopting a top-down policy formulation approach. Furthermore, South Africa healthcare policies are incrementally path dependent. This suggests that new policies are only slightly different from older policies. This illuminates the reality that despite having laws and policies in place, South Africa still faces poor implementation of these policies. This is due to public policies remaining stuck on a specific historical path coupled with institutional rigidity.

The study employs a retrospective policy analysis based on a document review of both primary and secondary data sources. The primary sources include the ANC’s 2007 Polokwane Conference resolutions document. This document outlines resolutions 53, 54, 55, and 67 which speak specifically to the NHI. This study also reviews the Green Paper (2011) and the White Paper (2017) of the South African National Department of Health. The secondary sources include the works of policy scholars to generate a deeper understanding of policy formulation, incrementalism, path dependency, bureaucratisation, and elitism in policymaking whilst expanding on the challenges that the NHI policy faces in its implementation.