Can the NHI Deliver an Improved Healthcare System? The Case for a System-based Approach to Health Care

This paper argues that the NHI, as currently proposed, is a one-dimensional solution to a multifaceted problem. The NHI focuses on minimising the financial burden of health services to the citizenry, and hopes to subsequently eliminate inequality in health services access for South Africans. An assumption is made that removing the financial burden of healthcare will solve all other health issues in the country, which is not true. This paper argues that for the NHI to be effective in positively transforming the country’s heathy system, it has to look at the health challenges in a holistic manner - and this can be done using a system-based approach to health care. The approach requires understanding not only the elements of the problem, but the relations between the elements and how they are affected by external factors. For this reason, a systems-based understanding of the context-specific challenges of health is necessary in order not only to inform policy, but to also anticipate possible unintended consequences and compromises.