OIDA International Journal of Sustainable Development
Open-access peer-reviewed journal
https://doi.org/10.64211/oidaijsd190204
From crisis to opportunity: A path to quality and affordable healthcare in the South African Healthcare System
Kwanda Talente Mngomezulu 1, Mafuku Tholaine Matadi 2*
1,2 University of Zululand, South Africa.
*Corresponding authour: Matadit@unizulu.ac.za
Volume 19, Issue 02, Pg. 49-58, 2026.
Abstract: The South African healthcare system has been plagued by challenges that impede access to affordable and quality healthcare. To count the few, the racial fragmentation imposed by apartheid policies, the two-tier healthcare system, which exacerbates inequality between the affluent and the underprivileged, and, most recently, COVID-19, which exposed the vulnerability of citizens under the current system.
This paper aims to provide a comprehensive critique of the South African National Health Insurance Act 60 of 2023 and assess its feasibility in delivering affordable and quality healthcare. The issue of access to quality healthcare has been highly contentious and has sparked debates across all sectors of society. The Medical Aid schemes want further clarity on the implementation of the National Health Insurance Act. Whereas the poor aspire to access such quality and affordable healthcare. Wherefore, the paper aims to provide clarity on several crucial issues, such as the constitutionality of the Act, the pooling of funds, and the convincing roadmap towards the implementation of the NHI scheme. By addressing these aspects, the paper seeks to contribute to a comprehensive understanding of the NHI’s impact on society at large.
This paper employs the theories of social exclusion and social justice to show that there is unequal treatment of citizens regarding access to healthcare, and to further advocate for the inclusion of the downtrodden masses into the flourishing healthcare system. It is argued that access to healthcare is a right and not a privilege, regardless of one’s financial status. In the current two-tier system, it is an injustice for South Africa to witness such inequality. It is submitted that the National Health Insurance Act presents a marvelous opportunity to improve the quality of life and to free the potential of each person.
The study finds that the introduction of the National Health Insurance Act seeks to achieve the aspirations of the Constitution, and therefore, it should be supported across the spectrum. Moreover, the Act seeks to achieve the United Nations Sustainable Development Goals (SDG), particularly goals 3,8, which envisage Universal Health Coverage. This paper finds that there is disconcerting conduct from the medical aid schemes, which tend to contest the eligibility of the NHI Act.
It is submitted that there is an urgent need for the spirit of cooperation. It becomes the collective responsibility of both the government and the private healthcare sector to collaborate and foster the implementation of the NHI scheme to achieve universal health coverage. Internal resistance and court battles delay the implementation of the NHI Act and continue to inhibit access to quality healthcare.
Keywords: Access, healthcare, equality, implementation, National Health Insurance, South Africa
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