As SA prepares to host the G20 Health Ministers’ meeting in Polokwane and the G20 Heads of State Summit this month, it is presented with a unique opportunity – not only to lead the global conversation on health and equity, but also to demonstrate concrete progress at home, writes Helen Clark, former New Zealand Prime Minister, in Business Day.
She writes:
As chair of the G20, this is the ideal time for SA to accelerate its National Health Insurance (NHI) reforms, with the aim of reaching universal health coverage (UHC).
The NHI Act represents one of the most ambitious social reforms in the country’s democratic history. Its objective – to provide access to quality health services for all South Africans, irrespective of their income or where they live – embodies the constitutional right to health and aligns squarely with the third sustainable development goal: “Ensure healthy lives and promote well-being for all at all ages.”
SA’s timing could not be better. Around the world, momentum is building for renewed investment in strong, equitable health systems that can protect populations in good times and bad.
The Covid-19 pandemic was a painful reminder that effective health security cannot exist without universal access to quality health services.
Countries that had already built robust, publicly financed systems were able to respond faster and recover more resiliently.
As a New Zealand citizen and a former Prime Minister and Health Minister, I have personally witnessed the benefits of a truly universal health system.
Through its 1938 Social Security Act, New Zealand became one of the first countries in the world to introduce a tax-financed universal health system, built on the simple principle that healthcare is a public good and a right, not a privilege.
That decision, taken 87 years ago, fundamentally changed the health and well-being of our nation. It brought fairness and social cohesion, strengthened our workforce and underpinned our economic development.
Today, the majority of G20 countries, from Canada, the UK and France to Japan, Australia and South Korea, operate publicly financed health systems that guarantee access for all. More middle-income countries, such as Brazil, Turkey and Thailand, have moved decisively toward UHC.
By launching the NHI, SA is thus following a well-established global trend for nations as they rise up the income ladder to use predominantly public financing to fund their health systems.
The case for accelerating NHI implementation is compelling.
• UHC is the foundation of good health outcomes. When all citizens, not just the wealthy, can access timely and quality care, preventable deaths decline, maternal and child health improves and life expectancy rises. The evidence from countries that have achieved UHC is clear: equitable systems deliver healthier, happier, longer-lived populations.
• UHC strengthens health security and pandemic preparedness. A fragmented system with deep inequalities leaves gaps through which future outbreaks can spread. Integrated public financing allows for co-ordinated national responses, stronger surveillance and more resilient primary healthcare, the front line of any epidemic.
• UHC drives inclusive economic growth. Healthy populations are more productive; UHC reforms create employment opportunities, and reduced out-of-pocket spending frees households from catastrophic financial shocks. In recognising the enormous economic benefits of UHC, in 2015, 268 of the world’s leading economists, including Nobel Laureates, called on all governments to implement pro-poor policy reforms to achieve UHC.
• UHC is one of the most powerful tools for reducing inequality. SA, despite its progress since 1994, remains one of the most unequal societies in the world. By pooling financial resources and ensuring that everyone receives care based on need, not wealth, NHI can narrow both health and income disparities.
• Finally, a universal health system fosters social solidarity and peace. When all citizens are part of a shared system, funded through fair taxation and mutual contribution, it strengthens the social contract between government and people. Universal health coverage is not just a policy – it is an expression of national unity.
Of course, such transformation will not be easy. Building an effective NHI system will require strong governance, sound public financial management and clear communication with citizens to maintain trust.
There will be vested interests that resist change, and there will be complex technical challenges along the way. But the long-term benefits, for health, for equity, for the economy, vastly outweigh the short-term difficulties.
SA’s history shows that it will undertake bold reform when the moral case is clear and leadership is strong. Just as the country once overcame apartheid and built a democratic constitution admired around the world, it can now address health inequalities decisively and deliver on the promise of universal care.
The journey toward UHC is one of the most profound a nation can take. It speaks to our deepest values: fairness, compassion and the belief that every life has equal worth.
As the G20 gathers in SA, the nation has the chance to stand before its peers and show that it is leading by example. By fast-tracking the implementation of NHI, SA can further demonstrate its commitment to equity, solidarity and resilience.
It can demonstrate that health for all is not a slogan but a lived reality.
My hope is that SA will seize this moment in history, accelerate its NHI reforms and build a health system that truly leaves no one behind.
Clark, a former Prime Minister of New Zealand and administrator of the UN Development Programme, is a member of The Elders.
See more from MedicalBrief archives:
Bold promises in SA as world experts urge momentum for UHC
Other options than NHI for quality UHC