Designing inclusive NHI PHC Contracting in South Africa
1
National Health Insurance Branch, National Department of Health, Pretoria, South Africa
2
Family Medicine and PHC, University of Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Universal Health Coverage requires strategic purchasing arrangements that balance purchaser accountability with provider viability and user access. South Africa's National Health Insurance (NHI) Act 2023 establishes a national health fund that will contract with accredited primary health care (PHC) providers as the foundation of the health system. Developing service level agreements acceptable to all stakeholders remains challenging globally. International evidence from PHC capitation-based contracting in China, Indonesia, Ireland, Scotland, and the UK demonstrates that contract design significantly influences provider participation, service quality, and health outcomes. This session presents South Africa's NHI PHC contracting framework and engages diverse stakeholders in deliberating contract content preferences.
METHODS:
This interactive session employs a deliberative democracy approach over 60 minutes. Following a 15-minute presentation on South Africa's NHI PHC Service Level Agreement framework—covering capitation payment models, accreditation requirements, performance-based incentives, and district health system integration—participants divide into three stakeholder-specific buzz groups for 20 minutes: (1) Health System Managers/Purchasers, (2) PHC Service Providers, and (3) Users/Community Representatives. Each group deliberates on two questions: "What do I want to see in a PHC contract?" and "What do I NOT want to see in a PHC contract?" Groups report back over 20 minutes to identify convergences, divergences, and tensions between stakeholder perspectives, followed by a 5-minute synthesis.
RESULTS:
Anticipated outputs include a comparative matrix of stakeholder PHC contract preferences across governance, payment, quality assurance, accountability, and dispute resolution domains. The session will generate real-time evidence on priority contract elements and potential points of conflict requiring negotiation in PHC purchasing globally.
CONCLUSIONS:
Inclusive PHC contract design processes that incorporate manager, provider, and community perspectives strengthen health systems by building ownership and reducing implementation resistance. This participatory methodology is transferable to other countries implementing strategic PHC purchasing reforms for universal health coverage.
Universal Health Coverage requires strategic purchasing arrangements that balance purchaser accountability with provider viability and user access. South Africa's National Health Insurance (NHI) Act 2023 establishes a national health fund that will contract with accredited primary health care (PHC) providers as the foundation of the health system. Developing service level agreements acceptable to all stakeholders remains challenging globally. International evidence from PHC capitation-based contracting in China, Indonesia, Ireland, Scotland, and the UK demonstrates that contract design significantly influences provider participation, service quality, and health outcomes. This session presents South Africa's NHI PHC contracting framework and engages diverse stakeholders in deliberating contract content preferences.
METHODS:
This interactive session employs a deliberative democracy approach over 60 minutes. Following a 15-minute presentation on South Africa's NHI PHC Service Level Agreement framework—covering capitation payment models, accreditation requirements, performance-based incentives, and district health system integration—participants divide into three stakeholder-specific buzz groups for 20 minutes: (1) Health System Managers/Purchasers, (2) PHC Service Providers, and (3) Users/Community Representatives. Each group deliberates on two questions: "What do I want to see in a PHC contract?" and "What do I NOT want to see in a PHC contract?" Groups report back over 20 minutes to identify convergences, divergences, and tensions between stakeholder perspectives, followed by a 5-minute synthesis.
RESULTS:
Anticipated outputs include a comparative matrix of stakeholder PHC contract preferences across governance, payment, quality assurance, accountability, and dispute resolution domains. The session will generate real-time evidence on priority contract elements and potential points of conflict requiring negotiation in PHC purchasing globally.
CONCLUSIONS:
Inclusive PHC contract design processes that incorporate manager, provider, and community perspectives strengthen health systems by building ownership and reducing implementation resistance. This participatory methodology is transferable to other countries implementing strategic PHC purchasing reforms for universal health coverage.
| eISSN: | 2654-1459 |
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