Factors that hamper the effective implementation of the building blocks for National Health Insurance in South Africa

Background: The National Health Insurance (NHI) project requires a clear understanding and appreciation of the collaborative efforts expected from all stakeholders and a clear policy perspective that identifies the role of all stakeholders and aligns them to the objectives of the programme. The objective of the study was to investigate the factors that contribute to the inability of the health system to effectively and sustainably implement the six NHI building blocks: (a) Leadership and governance; (b) Healthcare financing; (c) Health workforce; (d) Medical products Methods: An exploratory, qualitative study design was used to investigate and describe these factors. This took the form of focus group discussions where a semi-structured questionnaire was used to collect the data for this research. There were five focus groups with participants varying from three to five depending on their availability. The participants were from health statutory bodies, voluntary bodies concerned with healthcare issues, medical aid schemes and medical aid administrators. Results: Five themes and their attendant sub-themes were identified. These were found to embody the contributing factors to the inability of the healthcare system to sustainably and consistently implement the NHI building blocks. The sub-themes provided the detailed and pertinent areas where appropriate intervention needs to take place in order to ensure that the NHI project is a success. Conclusion: The study suggests five key considerations to enable the effective and sustainable implementation of the NHI building blocks. These align to similar findings in related studies undertaken in low- to middle-income countries.