Policy developer’s perceptions on the implementation of National Health Insurance in South Africa: a qualitative study

Abstract

Background

Universal health coverage has gained significant momentum internationally as the policy solution to address healthcare system deficiencies and promote equitable distribution of quality healthcare. The South African government has adopted this option and developed policy papers for discussion on a National Health Insurance (NHI) system for South Africa. A large part of the policy has been focused on promoting functionality of the primary healthcare system (PHC); to promote an efficient referral pathway. This study sought to explore potential barriers perceived by policy developers that could hinder achieving the NHI goal. Furthermore, given that a large focus is centred on PHC re-engineering, it was imperative to understand participant’s opinions and perspectives on the role of a pharmacist at this level.

Methods

A qualitative research design was adopted in this study. Semi-structured interviews were conducted with ten policy developers that were selected via a referral technique. These were audio recorded using a digital voice recorder on an online platform, transcribed verbatim and saved on Microsoft Word^® documents. NVivo^®, was utilized to facilitate the analysis of data. A thematic analytical approach was used to categorize codes into themes.

Results

The findings revealed that participants were in agreement that healthcare system reform is crucial in promoting equitable distribution of healthcare services in South Africa. However, the reality of this is dependent on addressing key concerns perceived by participants that have been reported as three major themes: (1) the benefit of NHI implementation; (2) concerns about NHI implementation; (3) implications for pharmacy.

Conclusions

South Africa is in the second phase of NHI implementation. This phase is focused on the development of sound NHI legislation and structures. This study identified a number of concerns regarding legislative anomalies and role-player involvement that could compromise the efficient implementation of NHI.

Keywords:

• National Health Insurance
• Universal Health Coverage
• South Africa
• Pharmacist

Acknowledgements

Not applicable.

Author contributions

VB and FS: supervised this study. FS, VB, and VN: conceived the idea of this manuscript. FS, VB and VN: collaborated on sample selection. VN: data collection. VB and VN: analysis of the data. All authors contributed to the writing and editing of the final manuscript.

Funding

The author(s) received no financial support for the research.

Availability of data and materials

The data sets generated or analyzed during this study are included in this published article.

Declarations

Ethical approval and consent to participate

Ethical clearance was obtained from the Biomedical Research Ethics Committee at the University of KwaZulu-Natal (BREC Ref No: BE625/17).

Consent for publication

All authors have read and given approval for the submission of this manuscript in accordance with the manuscript checklist.

Competing interests

None of the material has been published previously, is under consideration or accepted for publication elsewhere. The authors declare that they have no competing interest financially and non-financially. All authors have read and given approval for the submission of this manuscript.

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