By Saul Molobi
Dr Aaron Motsoaledi, South Africa’s Minister of Health, addressed the pressing challenges facing the country’s healthcare system – at the Kgalema Motlanthe Foundation’s Drakensberg Inclusive Growth Forum held at the Champagne Sports Resort in KwaZulu-Natal – underscoring the significance of implementing National Health Insurance (NHI) to achieve universal health coverage. In his speech, Dr Motsoaledi stressed the critical need for reform, pointing out that South Africa’s healthcare system is structured in a way that makes it one of the global “outliers” alongside the United States, with significant inequalities between private and public healthcare provisions.
According to Dr Motsoaledi, the World Health Organization (WHO) has set six essential “building blocks” for a robust healthcare system: leadership, access to essential medicines, health workforce, healthcare financing, health information, and healthcare delivery. Addressing these building blocks in South Africa is critical to improving the overall system, Dr Motsoaledi argued. “We are not putting these blocks in order of importance because they are all co-important,” he said, highlighting the importance of balancing the needs across the entire healthcare system.
One major focus of Dr Motsoaledi’s address was the role of healthcare financing. He outlined the three main methods used worldwide: mandatory payment, voluntary payment (such as medical aid), and out-of-pocket payments, which are the norm across much of Africa. “(Generally), healthcare is paid for in cash in Africa, and that’s why this is a disaster – there is no way a continent can survive like that.”
South Africa and the U.S. are unique in their reliance on voluntary payments like medical aid, which leaves 86% of South Africans dependent on an underfunded public healthcare system while 14% benefit from 51% of healthcare spending. “The WHO calls countries like ours outliers, as our system lies outside the stream of where other countries are going,” Motsoaledi noted, stressing the need for NHI to equalize healthcare funding.
In advocating for NHI, Motsoaledi pointed out that similar reforms were undertaken in the UK after World War II, at a time when resources were scarce. He drew attention to South Africa’s spending of 8.5% of its GDP on health — exceeding WHO’s recommended 5% — yet, he argued, this investment has not translated into improved outcomes for the majority of the population. “Despite the high spending, 51% of this is going to only 14% of the population, while 86% are left with the remaining 49%,” he said. This imbalance, he suggested, is a central challenge that NHI could address.
Dr Motsoaledi also took aim at the rising costs within the private healthcare sector, criticising market concentration that he argued has driven prices beyond the reach of most South Africans. “The beds in private healthcare were shifted between the three main hospital groups,” he said, pointing out that increased control by a few major players has led to higher prices. “Look at the cost of healthcare,” he added. “It was already on the rise, but now it’s about to hit the ceiling.”
South Africa’s fragmented system, he explained, not only puts healthcare out of reach for many but also jeopardizes the country’s economic future. “The private healthcare cost, the lowest graph there, was going up until it started steeply rising in 1998,” he noted. As a former general practitioner, Motsoaledi expressed dismay over the increased burden on practitioners. “I’m showing you only one thing which makes me cry, because I was once a GP,” he reflected, illustrating how costs and access limitations have left primary healthcare practitioners stretched thin.
Dr Motsoaledi urged stakeholders, policymakers, and the public to consider the benefits of NHI, despite opposition and potential obstacles. “I am here to give you hardcore information in the form of facts and figures and leave it to your conscience to decide what must happen,” he concluded, reiterating his commitment to transforming South Africa’s healthcare system.
The speech underscored the challenges of healthcare in South Africa and the urgent need for NHI to address inequities, reduce costs, and improve access. Dr Motsoaledi’s remarks highlighted the necessity of a unified national approach to healthcare, calling on South Africans to rally for a system that supports the majority and secures the nation’s future health.
The event was sponsored by ABSA, the Embassy of the People’s Republic of China, the European Union, and Champagne Sports Resort. The program director, Maurizio Mariano, trustee and Secretary of the KMF Board, was occasionally relieved by panel facilitators, broadcasters Aldrin Sampear and Iman Rappetti.