Original Research

The views of family physicians on National Health Insurance in Gauteng Province, South Africa

Shane D. Murphy, Klaus von Pressentin, Shabir A. Moosa
South African Family Practice | Vol 66, No 1 : Part 2| a5831 | DOI: https://doi.org/10.4102/safp.v66i1.5831 | © 2024 Shane D. Murphy, Klaus von Pressentin, Shabir A. Moosa | This work is licensed under CC Attribution 4.0
Submitted: 11 September 2023 | Published: 25 March 2024

About the author(s)

Shane D. Murphy, Department of Family Medicine, University of the Witwatersrand, Johannesburg, South Africa
Klaus von Pressentin, Division of Family Medicine, Department of Family, Community and Emergency Care, University of Cape Town, South Africa
Shabir A. Moosa, Department of Family Medicine, University of the Witwatersrand, Johannesburg, South Africa


Background: Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI.

Methods: This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling.

Results: Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level.

Conclusion: Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level.

Contribution: This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level.


family physician; NHI; National Health Insurance; Universal Health Coverage; UHC; District Health System; DHS; governance

Sustainable Development Goal

Goal 3: Good health and well-being


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