Politics of health transitions: Policy evolution from the National Health Act to National Health Insurance for equitable access to health services

Abstract

This study examines the politics of health transition in South Africa, focusing on the evolution of health policy from the National Health Act (NHA) of 2003 to the National Health Insurance (NHI), with particular emphasis on equitable access to health services. Using a qualitative approach underpinned by the constructivist paradigm, this study employs a comparative case study analysis of the NHA and NHI to evaluate their intentions, implementations, and outcomes in addressing inequitable health care access. Data were gathered through document reviews. The findings highlight leadership deficits, inadequate financing, systematic inefficiencies, and weak integration between the public and private sectors as central barriers to equity. It contributes to scholarship by illustrating how governance, justice, and participation intersect with health policy and offering a framework for aligning health systems with democratic values and social justice imperatives. The study concludes that equitable health care in South Africa can only be achieved through intentional reforms that dismantle the dual health system, strengthen state accountability, and ensure that the principle of equity is put into practice as well as in policy.