ArticleSouth African family practice : official journal of the South African Academy of Family Practice/Primary Care2020
What we need is health system transformation and not health system strengthening for universal health coverage to work: Perspectives from a National Health Insurance pilot site in South Africa.
Article in South African family practice : official journal of the South African Academy of Family Practice/Primary Care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 25 citations in OpenAlex.
- Research gaps on universal health coverage in the South African context and other low and middle-income countries; putting things into perspective: a scoping review.BMC health services research · 2026Article
- Kerala's Aardram Mission and universal health coverage: integrated time series evidence on mortality reduction and assessment of financial protection and equity gaps.Frontiers in public health · 2026Article
- Perceptions of healthcare practitioners about NHI implementation in the public sector in Sedibeng district, Gauteng province.BMC health services research · 2025Article
- Digital pulse: Social media reaction to South Africa's National Health Insurance implementation.African journal of primary health care & family medicine · 2025Article
- Factors Influencing Primary Healthcare System in the Achievement of Universal Health Coverage in the WHO-AFRO Region: An Integrative Review.Public health challenges · 2025Review
- Barriers to effective management of type 2 diabetes mellitus in primary healthcare facilities.Journal of public health in Africa · 2025Article
- Primary Health Care Systems and Their Contribution to Universal Health Coverage and Improved Health Status in Seven Countries: An Explanatory Mixed-Methods Review.International journal of environmental research and public health · 2024Review
- Effect of households' members disability and serious illness on public health insurance subscription among urban refugees during the COVID-19 pandemic in Kenya.BMC public health · 2024Article
- The views of family physicians on National Health Insurance in Gauteng Province, South Africa.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2024Article
- Testing the contextual Interaction theory in a UHC pilot district in South Africa.BMC health services research · 2022Article
- Public health communication: Attitudes, experiences, and lessons learned from users of a COVID-19 digital triage tool for children.Frontiers in public health · 2022Article
- The Utility of an Online Forward Triage Tool During the SARS-CoV-2 Pandemic: Health Care Provider and Health Authority Perspectives.Frontiers in public health · 2022Article
- The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa.African journal of primary health care & family medicine · 2021Article
- A Narrative Synthesis Review of Out-of-Pocket Payments for Health Services Under Insurance Regimes: A Policy Implementation Gap Hindering Universal Health Coverage in Sub-Saharan Africa.International journal of health policy and management · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGlobally, universal health coverage (UHC) has gained traction as a major health priority. In 2011, South Africa embarked on a UHC journey to ensure that everyone has access to quality healthcare services without suffering financial impoverishment. National Health Insurance (NHI) and primary healthcare (PHC) re-engineering were two vehicles chosen to reach UHC over a 14-year period (2012-2026). The first phase of health system strengthening (HSS) initiatives to improve the quality of health services in the public sector began in 2012. These HSS initiatives are still being carried out by the Department of Health in conjunction with other partners.
methodsA qualitative case study design utilising a theory of change (TOC) approach was employed. Data were collected from key informants (n = 71) during three phases: 2011-2012 (contextual mapping), 2013-2014 (Phase 1) and 2015 (Phase 2). In-depth face-to-face interviews were conducted with participants using a TOC interview guide, adapted for each phase. All interviews were audio-recorded and transcribed verbatim. An iterative, inductive and deductive data analysis approach was utilised. Transcripts were coded with the aid of MAXQDA 2018.
resultsSix broad themes emerged: make PHC work, transform policy development, transform policy implementation, establish public-private partnerships, transform systems and processes and adopt a systems lens.
conclusionA third great transition seems to be sweeping the globe, changing how health systems are organised. Actors in our study have identified this need also. Health system transformation rather than strengthening, they say, is needed to make UHC a reality. Who is listening?
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.