The Views of Public Service Managers on the Implementation of National Health Insurance in Primary Care

Abstract Background The South African government is implementing National Health Insurance as a monopsony health care financing mechanism to drive the country towards Universal Health Coverage. Strategic purchasing, with separation of funder, purchaser and provider, underpins this initiative. The NHI plans contracting units for primary healthcare services to function as independent sub-district purchasers and District Health Management Offices to support and monitor these contracting units. This decentralised governance model to the operational unit of primary healthcare, the heartbeat of any universal healthcare system, is critical to programme success. The views of district-level managers, who are at the centre of the planned phased rollout will shed light on current policy implementation. Objectives This is a qualitative study to explore district and sub-district managerial views on National Health Insurance and its implementation