The current South African Healthcare (SAHC) system remains a dual healthcare system, consisting of the public and private healthcare sector. Albeit it unevenly distributed from a gross budget perspective, the gross national spend leans disproportionately towards the private sector coverage of healthcare. This equates to R 243Bn serving approximately 20% of the population as opposed to a similar public budgeted spend of R 247Bn serving approximately 80% of the population. In effect, the private sector serves a minority of the employed population. The SA Government has historically made large government Information and Communication Technology (ICT) investments within the public health sector, regionally based, where the return on capital investments have not been realised. The SAHC sector remains siloed. Health technology is advancing globally, and being propagated by the World Health Organisation (WHO) resulting in a global digital health strategy adopted by many countries. The South African National Department of Health (NDoH) has recently subscribed to its own local version of a ‘Digital Health Strategy’, in accordance with the WHO. The South African Public Healthcare technological infrastructure, in its current state, is deficient with many challenges needing urgent upgrading. The proposed digital or ehealth strategy and the proposed National Health Insurance (NHI) will require the reengineering of a national infrastructural and technological (ICT) environment from the ground upwards. Furthermore, this can only be achieved by reengineering the current state of the public healthcare technological infrastructure including the building infrastructure. This will include a transformation of national legislation. These projects and initiatives must be nationally managed within the ambit of improving the management capacity across all regions and districts that needs to be nationally coordinated. This effort can only be achieved by performing synchronised and well-coordinated implementations of such projects nationally across the SA Public Healthcare sector. This includes the integration of healthcare technologies, or national assets, from district to national level. This study provides further insights into these opportunities and challenges currently facing the South African Public Healthcare sector in preparation for the National Health Insurance (NHI) reform currently in review by the President. It further aims to assist in an approach to a solution addressing this national healthcare crisis.
Keywords: National Health Insurance (NHI), Private Healthcare, Public healthcare, eHealth strategy, healthcare data analytics, healthcare information technology, healthcare modernisation., public health informatics
