In May 2015, South African Minister of Health Aaron Motsoaledi was still waiting for the presidential cabinet's feedback on a policy paper outlining his ideas for implementing national health insurance (NHI) a mandate from the African National Congress political party and strengthening primary health care. Motsoaledi's team had started rolling out the proposed primary care reforms, with plans to reach all 3,507 public primary health care facilities by April 2018. Impact data were limited, although initial implementation sites had demonstrated improvement in priority reform areas (e.g., human resource capacity, infrastructure) and health outcomes (e.g., incidence of pneumonia, tuberculosis cure rate). Motsoaledi hoped that getting approval of the policy paper and improving primary health care would address critics' concerns. NHI had proven to be a divisive issue, with private health insurance companies and service providers voicing apprehension about their future role in the health system and several academics and government officials questioning the model's feasibility. Would the primary care reforms and policy paper revisions be enough to convince everyone that NHI was the way forward?
Human Sciences Research Council (2026) studied this question.