FACT SHEET
UNIVERSAL HEALTHCARE ACCESS COALITION (UHAC) – Proposed framework for healthcare
reform in SA
About the Universal Healthcare Access Coalition
The Universal Healthcare Access Coalition (UHAC) represents the majority of SA’s healthcare
professional organisations, joined by hospital and medical scheme representative bodies, patient
advocacy organisations and related academic and civil society bodies. Currently, 28
representative organisations are signatories to the UHAC proposal. (Full list of signatory
organisations at the end of this document.)
The purpose of the coalition is to enable strategic conversations on health system reform in the
public space in order to build broad consensus on achieving the Constitutional right to unimpeded
access to healthcare for all who live in South Africa.
About the proposal
The UHAC believes that maintaining the status quo of a healthcare system in crisis is
unacceptable. Waiting for the implementation of the NHI – which is fiscally and institutionally
unimplementable in its present form – is equally unacceptable.
The proposal addresses the current crisis in accessibility, quality and affordability of healthcare
with pragmatic and evidence-based solutions that are within the capability of government to
implement without delay, i.e. without needing extensive legislative or taxation amendments, and
within current budgetary constraints.
The UHAC proposals provide a balanced, feasible, and sustainable pathway to achieving universal
health coverage in South Africa. They align equity and efficiency objectives, improve governance,
and integrate public and private systems. While the NHI aims for universal healthcare, its design
and implementation challenges make it less likely to succeed without significant revisions.
Comparison of the UHAC proposals with the current healthcare system
The current system is polarised, with an underperforming public sector and an expensive private
sector. UHAC addresses these issues by improving governance in the public system and regulating
the private system for cost efficiency and equity.
The NHI does not materially depart from the weaknesses of the current system but instead
centralises control without resolving fundamental problems.
Central strengths of UHAC proposals
Governance Reforms:
• UHAC addresses governance failures by separating political influence from healthcare
management through independent supervisory boards. This would improve accountability,
reduce corruption, and enhance service delivery efficiency.
Equity and Pooling:
• By separating income and risk pooling at the national level and localising purchasing functions,
the UHAC framework ensures equitable distribution of resources.
• Targeted subsidies for low-income groups prioritise those most in need while allowing higher-
income groups to contribute through regulated contributory schemes.
Integration of Public and Private Systems:
• The UHAC framework leverages the private sector's capacity through mechanisms like risk
equalisation, social reinsurance, and standardised benefits. This integration reduces the
burden on public resources and improves overall system efficiency.
Scalable and Sustainable:
• UHAC builds on existing systems incrementally, avoiding the systemic disruptions that a
complete overhaul (as proposed by the NHI) might cause.
• Its mixed funding model (general taxes and contributory systems) aligns with South Africa’s
fiscal constraints, ensuring long-term sustainability.
Cost Control:
• The UHAC approach introduces multilateral tariff negotiations, independent regulation, and
competitive alternatives to address rising costs in the private sector. These measures are more
nuanced and targeted than the NHI's reliance on centralised purchasing.
Summary of key features of the UHAC proposals vs the current system and NHI proposals
Aspect Current South African UHAC Proposals NHI Proposals
Health System (status quo)
Governance Politically influenced, with Decentralised governance Centralised governance
resulting weak leadership with independent under the NHI Fund with
structures. supervisory boards for political appointments into
hospitals and district health all key leadership positions.
authorities.
Primary Care Fragmented and inefficient, Autonomous district health Remains fragmented, with
with long wait times and authorities to ensure reliance on a centralised
stockouts. localised accountability and structure with no localised
improve primary care accountability.
services.
Hospital Services Overcrowded, poorly Autonomous hospitals with Centralised control without
equipped, and plagued by revenue retention and clear plans for addressing
poor leadership. better governance existing inefficiencies.
frameworks that allow for Implies that centralised
public/private integration. purchasing approaches will
resolve governance failures.
Healthcare Lack of strategic planning Governance reforms for Unclear focus on workforce
Workforce and execution, with training workforce planning, development.
challenges. training, and financing.
Critical Care Inadequate framework for National framework for No clear framework
Services universal access to universal critical care access provided for critical care
emergency and critical care integrating the public and services.
services. private systems of financing
and provision.
Equity and Access Polarised between public Focus on equity through Aims for universal access
(free but underfunded) and targeted subsidies and but fails to provide a
private (costly). improved governance to feasible pathway to achieve
prioritise low-income equity.
groups.
Funding Mix of general taxes and Tax-funded free services for Places the entire UHC
Mechanism private medical schemes. the poor and contributory burden on tax-finances by
insurance for higher-income excluding the private
households. contributory system.
Aspect Current South African UHAC Proposals NHI Proposals
Health System (status quo)
Private Sector Role Operates largely Strategic integration into Marginalised under the
independently with no UHC through regulation of centralised NHI structure.
strategic integration into a the private sector achieved
system of UHC. through strategic subsidies,
mandatory minimum
benefits, open enrolment,
community rating,
mandatory participation,
risk equalisation and social
reinsurance.
Role of Provincial Responsible for health Provinces retain authority Provincial role
Government services but hindered by but with improved diminished/eliminated, with
corruption, inefficiency, and governance frameworks and most authority centralised
weak capacity. autonomy for facilities under the NHI Fund.
increasing responsiveness to
local communities.
Equity and Pooling Constrained and inefficient Separates pooling (national) Centralised pooling
income and risk pooling, from purchasing (local), exclusively through the tax
with inequities between ensuring equity and system under the NHI Fund
public and private systems. efficiency through targeted but with limited
income and risk-adjusted mechanisms to address
cross-subsidies. inequities effectively.
Essential Benefit Public sector provides basic Unified essential benefit Unclear centralised and
Regimes care, private schemes offer packages for public and politicised benefit
prescribed minimum private systems, aligned determination, risking
benefits (PMBs) with no with financial sustainability misalignment with fiscal and
formal and independent determined through a well- operational realities,
process to determine either. governed independent conflicted determinations
inclusive process. and equity failures.
Free Services at Available in public sector Free services for income- Universal free services at
Point of Service but undermined by poor compromised households the point of care, financed
service quality and with improved governance through general taxation
accessibility issues, with the and service quality, with and state-determined
private sector accessing mandatory medical scheme service provision.
Prescribed Minimum benefits covered without
Benefits. co-payment.
Aspect Current South African UHAC Proposals NHI Proposals
Health System (status quo)
Cost Control in the Minimal government Risk equalisation, social Focus on centralised
Private Sector oversight, leading to rising reinsurance, multilateral purchasing without
costs and inefficiencies. tariff negotiations, and addressing systemic
standard benefit packages inefficiencies in cost
control costs and perverse structures or the feasibility
incentives to over-service. of a universal scheme.
Implementation Incremental changes and Scalable and pragmatic Ambitious but lacks
Feasibility limited strategic vision. reforms aligned with fiscal feasibility and alignment
constraints and the with the existing system or
capabilities of the state and the capabilities of the state.
the health system.
Accountability Weak, with high corruption Independent supervisory Weak, with centralised
levels in public sector structures to depoliticise accountability (i.e. far from
governance. healthcare management. the served communities)
under the NHI Fund with
the existing politicised
approach retained.
Signatories to the UHAC proposal
South African Medical Association
Progressive Health Forum
South African Private Practitioners Forum
Radiological Society of South Africa
Association of Palliative Care Centres
Association of Plastic Reconstructive and Aesthetic Surgeons of South Africa
Board of Healthcare Funders
Clinical Psychology Forum
Day Hospital Association of South Africa
ENT Society of South Africa
Faculty of Consulting Physicians of South Africa
Iso Leso Optics
Izandla Consulting Physiotherapists
National Pathology Group
Ophthalmological Society of South Africa
Paediatrician Management Group
Psychiatry Management Group
Society of Radiographers of South Africa
South African Association of Audiologists
South African Dental Association
South African Gastroenterology Society
South African Optometric Association
South African Orthopaedic Association
South African Society of Anaesthesiologists
South African Society of Obstetricians and Gynaecologists
South African Urological Association
Surgicom
The South African-Speech-Language-Hearing Association
UHAC information website: https://progressivehealthforum.net/uhac/
