The idea of a National Health Insurance (NHI) has been a priority of the ANC since the 1990s’ and was then reflected in the White Paper on Transformation of Health Services of 1997. The immediate priority of the Mandela government in 1994 was to look at some immediate improvement in Universal Health Coverage (UHC). The fact that apartheid local government had a large and pervasive number of public preventive clinics geographically dispersed enough and that progressive clinicians had been training nurse clinicians since the 1970s created an opportunity to drastically improve access to the population. This translated into primary health care (PHC) with a service package based on these nurse clinicians. This UHC addressed improved access to nurse-clinician competency defined package of services free to the full population, a major leap from the apartheid past. The apartheid government on the other hand, from the late 1980’s, deregulated the private sector anticipating that the days of privileged access for the white community to the publicly-funded specialist and hospital services were limited.
As government progressed in the 1990′ and 2000’s to improve the physical access (with a clinic upgrading and building programme) and service package (with further nurse training) the private sector pulled in much of the human resources of doctors and specialists as it burgeoned with less regulation and more spend. This made the divide between public and private very evident to ordinary citizens, despite improved access to them in the post-apartheid era. This highlighted the challenge of service quality and led to renewed calls in the late 2000s’ by voters for a National Health Insurance system that addressed this divide.
There have been a resulting series of documents, starting with the Green Paper on National Health Insurance (spelling out much of what is contained in the current Bill) and Policy for PHC Re-engineering in 2011. The 2011 Policy spelt out District Clinical Specialist Teams (DCST), Ward Based PHC Outreach Teams (WBOTs), School Health Teams (SHTs) and GP contracting-in (i.e. GPs contracted to do sessions in public clinics). This has culminated in the NHI Bill that is currently being considered by Parliament. Prof Shabir Moosa has been close to those developments with work done for National Treasury in 2017-18. These various developments are captured in the NHI Developments page.
The National Department of Health (NDOH), in preparation for NHI, had asked each province in August 2022 to set up a Proof of Concept for the Contracting Unity for PHC (CUP) in a subdistrict. Gauteng chose Soweto, Johannesburg as that site. Prof Shabir Moosa, as a senior family physician in Johannesburg Health District, has been appointed as the Lead Project Manager for this process in Johannesburg, Gauteng. These developments are captured in the NHI Joburg page.
Prof Shabir Moosa, as a joint appointee with the Department of Family Medicine and Primary Care in the University of Witwatersrand, has set up a Research Group called COPC4NHI, covering everything between PHC and NHI, with an emphasis on community-orientation. This brings together postgraduate students (doing PhDs and Masters), senior researchers/officials with research interest in the field, and potential researchers. These developments are captured in the NHI Research page.