Recently, the parliament of South Africa approved a law that allows for the introduction of universal health insurance. Passed on June 13, 2023, the National Health Insurance Bill in the country was applauded and criticized by different stakeholders in businesses, health care sector, opposition position parties and activists. The healthcare system in South Africa is currently operating on an unequal two-tiered model. While the public sector which serves majority of the population is underfunded, the private sector that relies on funds from individuals for medical provisions makes these provisions affordable for a handful of the population.
To ameliorate the situation, the National Health Insurance Bill is to ensure establishment of the universal health coverage. This will be done through the purchase of services from health professionals under a National Health Insurance fund, scheduled for delivery at private and public health facilities. This act will ensure equal access to quality health care by every citizen, irrespective of their race or income. The health minister of South Africa, Joe Phaahla, stated that South Africans would have equitable access to healthcare without financial constraints.
Both countries aim to address disparities in access to quality healthcare.
8.5 percent of South Africa’s Gross Domestic Product (GDP) is currently allocated to health care — a percentage higher than other countries allocate. Despite this enviable allocation, only 16 percent of the population benefits from half of the expenditure and are able to have medical insurance. With this, the public healthcare facility is overburdened with long queues, shortage of staff and deteriorating infrastructure, as it strives to ensure provision of basic health care for the lagging 84 percent of the country’s population.
With the establishment of the National Health Insurance Authority Act 2022, Nigeria undertook a similar initiative. Like the South African law, the Nigerian law is keen on establishing a National Health Insurance Scheme that ensures the provision of access to affordable health care for every citizen. Both laws have a common goal of tackling the current disparities in access to quality health care and promote equitable coverage. However, they address this goal using different approaches and techniques.
Nigeria seeks to provide health insurance coverage for vulnerable groups.
The National Health Insurance fund proposed by South Africa’s National Health Insurance Bill is to be financed through general tax revenues, compulsory contributions from employers and individuals, and payroll taxes. Nigeria, on the other hand, has established a National Health Insurance Authority (NHIA) under its National Health Insurance Authority Act 2022, to operate as a program of social health insurance. The NHIA is financed by contributions from the government, employers and employees. Employers with at least five employees and a minimum annual turnover were mandated by the Act to ensure provision of health insurance coverage for their employees.
Also, the South African Bill is focused on providing universal access to quality health care for every race and income group. It aims at eliminating the necessities for direct contributions to schemes of medical health, while providing coverage for legitimate residents depending on their health care needs and not their socio-economic status. The National Health Insurance Authority Act 2022 seeks to provide to health insurance coverage for vulnerable groups — children, pregnant women, persons with disabilities and elderly citizens — and employees in the formal sector.
There are challenges facing achievement of this goal in both countries.
Additionally, the newly passed bill in South Africa aims at contracting health professionals in private and public sectors by the National Health Insurance fund for delivery of health services. However, in Nigeria, accredited private facilities are permitted to become NHIA-accredited health care providers to be reimbursed for rendered services. Regardless of the differences in addressing equitable healthcare, both countries encounter challenges in the implementation of their health insurance laws. While South Africa is faced by cost implications and management of public facilities, Nigeria is challenged by limited coverage for citizens in rural areas and the informal sector.