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The objective of the study was to assess the factors that motivate or demotivate households to choose among the three healthcare facilities, public healthcare, private health care and traditional healthcare facilities in South Africa as revealed by Statistics South Africa . The utilisation of healthcare facilities in South Africa is such that more households prefer public healthcare facilities more than other healthcare facilities. The multinomial logit model was used, with traditional/self-medication category as the reference or baseline category. The results indicated that gender, income and access to grants were significant in influencing the probability of a household choosing a public healthcare facility, while age, income, grants, salaries/wages/commission and pensions were significant in influencing the choice of private healthcare institutions. Therefore the study recommends that due to a large portion of households that are using public health facilities compared to private and traditional facilities, the government must invest more in public healthcare facilities in South Africa.

The main aim of this article is to explore how performance-based budgeting has an effect on primary health care service delivery in the Eastern Cape. This article assessed the performance-based budgeting system in the Eastern Cape Department of Health in an attempt to advocate for effective and efficient health service delivery. The Eastern Cape Province is succumbing to insufficient funding at the provincial level and this has a clear-cut reflection on the administration of services within respective departments. The article is premised on a constructivist paradigm that adopts a qualitative approach where document analysis was employed for collecting data. The Eastern Cape Province is succumbing to insufficient funding at the provincial level and this has a clear-cut reflection on the administration of services within respective departments. The article employed the Public Choice Theory and the Concept of New Public Management. Three main findings emerged from the article of the crippled funds in the province, the human resources crisis, poor public finance management, and shortage of health equipment. Data were analyzed using thematic analysis to examine the distinctive themes and sub-themes identified from within the reviewed literature. Recommendations were thus given based on the discussed and derived themes to ensure that there is an appropriate budgeting system to ensure efficient and effective provision of health care services in the Eastern Cape Department of Health.

Equity is one of the basic principles of health systems and features explicitly in the Nigerian health financing policy. Despiteacclaimed commitment to the implementation of this policy through various pro-poor health programmes and interventions,the level of inequity in health status and access to basic health care interventions remain high. This paper examines theequity of health care expenditure by individuals in Nigeria. The paper evaluated equity in out-of-pocket spending (OOP) forthe country and separately for the six geopolitical zones of the country. The methodological framework rests on KakwaniProgressivity Indices (KPIs), Reynold-Smolensky indices and concentration indices (CIs) using data from the 2004 Nigerian National Living Standard Survey (NLSS) collected by the National Bureau of Statistic. The results reveal that health financing is regressive with the incidence disproportionately resting on poor households with about 70% of the total expenditure on health being financed through out-of-pocket payments by households. Poor households are prone to bear most of the expenses in the event of any health shock. The catastrophic consequences thus push some into poverty, and aggravate the poverty of others. The paper therefore suggests that the country’s health financing systems must be such that allows people to access services when they are needed, but must also protect household, from financial catastrophe, by reducing OOP spending through risk pooling and prepayment schemes within the health system.

The South African national department of the health system is piloting the National Health Insurance (NHI). This is in preparation for the overhaul of healthcare services so that they are efficient and equitable to all citizens immaterial of their socio-economic status. This article aims to evaluate healthcare providers' perceptions of improved service delivery by the government’s health department during the first piloting phases of the NHI. The context of the study is a health district center in a rural area of KwaZulu-Natal province in South Africa. The article is interdisciplinary in that it interrogates governance issues in the health sector. A quantitative research methodology was utilized to collect data from 30 participants who were the center’s staff. The findings indicate that the significant areas of concern are lack of improvement in response rate to emergencies, ambulances, provision of resources, and specialized staff. The implication is that the government’s health department working with provincial departments, still has major healthcare reforms to address if the NHI program contributes effectively to healthcare service delivery.

South Africa’s journey toward universal health coverage through the proposed National Health Insurance (NHI) scheme reflects a deeply contested terrain of political, economic, and institutional interests. At the heart of the debate lies the struggle to transform an inequitable, dual-tiered healthcare system into a unified platform for equitable access. This article examines the political economy underpinning the NHI discourse by critically unpacking the roles, incentives, and power dynamics of key stakeholder groups, including government institutions, private healthcare providers, civil society, trade unions, political parties, and international actors. Using a political economy analysis framework, the study explores how stakeholder preferences and alignments shape the pace, design, and legitimacy of NHI reforms. It interrogates the conflicting narratives of equity and efficiency, state capacity versus market reliance, and centralized control versus decentralized delivery. Drawing on diverse reports, policy analyses, public submissions, and academic critiques, the research highlights how divergent ideological, financial, and institutional positions influence both policy content and public perception. Evidence from the research indicates that health reform in South Africa is not merely a technical endeavor but a deeply political process. Stakeholders engage in strategic behavior to either support, contest, or reshape the NHI, with implications for policy coherence, implementation feasibility, and constitutional alignment. The article concludes that sustainable health reform depends not only on sound policy design but also on transparent negotiation, inclusive dialogue, and adaptive political strategy. A nuanced understanding of stakeholder dynamics is therefore essential to realizing South Africa’s vision of health equity and universal coverage.

Amidst the strategic priorities of any government is the strengthening of public service delivery to citizens, the developmental state to more effectively serve the needs of the people and act as a driving force for socio-economic transformation and upliftment. The key priority in this regard is the strengthening of healthcare service delivery for a healthy citizenry, ensuring more efficient and caring service delivery. The purpose of this research report is to outline the challenges faced by the Eastern Cape Province in delivering quality services to the people of the Eastern Cape in the Health department. The objectives of the study were to provide and ensure accessible comprehensive integrated quality health services in the Eastern Cape, emphasis is on the primary health care approach, optimally utilizing all resources to enable all its present and future generations to enjoy health and quality of life. Although the Eastern Cape delivery of health is facing a myriad of challenges it is however pleasing to note that it’s in line with the implementation of the National Development Plan, the Medium-Term Strategic Framework (2014-2019), the Minister’s Negotiated Service Delivery Agreement (NSDA), National Health Council Priorities. Although the province is failing to fully provide quality health service in so far as Maternal Children’s and Women’s Health (MCWH) package, if the number of reported medico-legal cases from the province is anything to go by promotion of a better life for all is seemingly becoming a pipe dream. The research which was conducted throughout the province looking at the performance enablers in the form of social determinants of health qualitatively and quantitatively looked at the service delivery points and the infrastructure to determine Improvements on the quality and continuum of primary healthcare. However, from the results of the study it is clear that the Province is still managing to reduce morbidity and mortality due to communicable diseases and non-communicable illnesses and conditions by implementing high impact strategies to address prevention, detection, management and support at all levels of care despite the corollary of both institutional failures and Apartheid legacy.

This article employs a structured, theory-guided comparative policy analysis to examine the persistent deficits in community trust that undermine primary health care (PHC) service delivery in Nigeria. Despite numerous reforms targeting financing and administrative structures, PHC utilization remains low and citizen confidence fragile. Drawing on policy learning theory, this study argues that Nigeria’s PHC reforms have predominantly involved first-order, instrumental adjustments, failing to foster deeper shifts in governance philosophy or state-citizen relations essential for building trust. Using Rwanda as a contrasting case, the analysis illustrates how its post-genocide PHC reconstruction leveraged second- and third-order policy learning to embed community trust within governance through co-production, robust accountability mechanisms, and deliberate institutional design. The paper identifies context-sensitive policy lessons for Nigeria, emphasizing that trust must be recognized and actively governed as a strategic resource for legitimate, responsive, and sustainable PHC systems, rather than merely a residual outcome of service delivery.

The National Health Insurance (NHI) program in South Africa is a premier reform initiative aimed at attaining Universal Health Coverage. Nonetheless, its performance is largely contingent upon proficient management of project stakeholders throughout all stages of the program life cycle. Principal stakeholders express significant apprehensions over the policy revision and implementation procedure. This study aimed to identify program stakeholders and evaluate the degree to which the National Department of Health (NDoH) implemented project stakeholder management methods during the design and initial execution of the NHI. A qualitative, exploratory research design was utilised, utilising secondary data derived from document analysis. Primary data was obtained using a combination of semi-structured interviews and electronically distributed questionnaires with representatives from five principal stakeholder groups: private health insurers, professional organisations, regulators, and a governmental oversight agency. Despite the existence of a roadmap for NHI implementation, thematic analysis indicated that the stakeholder management strategy employed did not adhere to recognised project management standards. Findings reveal deficiencies in the NDoH stakeholder engagement strategy, including selective consultation, inconsistent response, inadequate openness, and ineffective communication and feedback systems, all of which erode confidence and hinder consensus-building. Comparative analyses from Nigeria and Thailand illustrate the significance of inclusive, partnership-oriented governance frameworks for the implementation of extensive health reform initiatives. The study indicates that enhancing stakeholder identification, analysis, and effective engagement tactics is crucial for the NHI's legitimacy and long-term viability. Utilising private sector knowledge is crucial throughout the whole program life cycle. The study is constrained by the lack of engagement from the NDoH, which hinders the triangulation of stakeholder perspectives.

South Africa is dedicated to attaining Universal Health Coverage via the National Health Insurance program, with the NHI Bill set to be enacted into law in 2024. The primary healthcare system, essential for Universal Health Coverage delivery, encounters ongoing challenges such as a shortage of healthcare professionals, insufficient infrastructure and medication shortages, financial limitations, and inadequate governance frameworks. The Johannesburg health district has experienced high turnover among trained primary healthcare nurses over the past two financial years, leading to staff shortages and decreased morale. This situation threatens the achievement of Universal Health Coverage. Additionally, patients were often turned away from primary health facilities due to early closures and staff shortages, limiting access to healthcare and hindering UHC goals. To achieve UHC, healthcare services must be available, accessible, affordable, and of high quality.To explore the experiences of professional nurses with regards to the implementation of Universal Health Coverage at Primary Health Care facilities in the Johannesburg health district, Gauteng. A qualitative, exploratory, descriptive methodology was employed. Eleven participants, comprising operational managers, professional nurses, and an area manager, were purposefully selected from eight primary healthcare facilities in Regions C and G of Johannesburg. Semi-structured interviews were performed, audio-recorded, and thematically evaluated using Braun & Clarke’s framework. Three themes emerged: (1) Hhuman resource limitations and professional erosion including staff shortages and high turnover, (2) healthcare system inadequacies  and patient accessibility such as poor infrastructure and medication stockouts; and (3) financial and policy constraints that impede effective UHC implementation. Nurses' experiences indicate structural obstacles hindering the implementation of UHC. It is essential to address personnel shortages, infrastructure deficiencies, and policy inefficiencies. Enhancing governance and prioritising nurse involvement in policymaking are crucial for attaining equitable, high-quality healthcare in South Africa.

The successful implementation of the National Health Insurance (NHI) policy in South Africa depends largely on the effectiveness of public administration systems. Therefore, this study examines the importance of public administration in translating NHI policy objectives into practical outcomes. Guided by the Institutional Theory, the study explore how administrative capacity, coordination and institutional structures influence policy implementation. This study adopts a theoretical approach. The analysis relies on existing literature, government reports, policy documents, and case studies of countries that have implemented national health insurance systems. The findings reveal that weak administrative capacity, bureaucratic inefficiencies, and fragmented coordination, poor finances, and lack of engagement continue to undermine the realization of universal health coverage. These institutional constraints illustrate how organizational pressures and systematic weakness affect the delivery of public health reforms. The study contributes to policy discourse by highlighting that strengthening administrative capacity and implementing institutional reforms are essential for improving the effectiveness of NHI. It recommends targeted training, enhanced interdepartmental coordination, and streamlined decision-making process to ensure efficient policy implementation.