The Mpumalanga government is convinced that enough groundwork has been laid to champion the full rollout of the contentious National Health Insurance (NHI), with one district already serving as a pilot site for South Africa’s journey towards universal healthcare.
During a recent sitting of the legislature in Mbombela, Freedom Front Plus leader Werner Weber challenged the provincial department of health to rise above persistent crises and deliver quality care.
“Mpumalanga is not a province of despair. It’s a province of resilience, of strength, of people who deserve the absolute best. That’s why we say our department of health must not be a department of crises but a winning department,” said Weber.
“It must be a department that delivers – working hospitals and clinics staffed with enough doctors, nurses and medical professionals so that any person receives the care they need immediately, and no one is turned away. Mpumalanga can become an example to the rest of South Africa.”
Mpumalanga Health MEC Sasekani Manzini welcomed the remarks, saying the department was already making progress in building a model of accessible and quality care.
“In terms of planning, we are on course,” she told lawmakers. “You can look at Gert Sibande, where we are piloting NHI. We are doing very well, and we are moving towards it as a province. If only all of us could work together and support having one system in terms of universal health coverage.”
According to a departmental report compiled by Dr Cheryl Nelson, the Gert Sibande District, which includes towns such as Ermelo, Secunda, Standerton, Carolina, Piet Retief, Bethal and Amsterdam, continues to “shine as a pioneer” in the implementation of NHI.
It says the district’s work began more than a decade ago and has since “inspired hope, equity and access in healthcare”.
The report notes that Gert Sibande is one of the original 11 national pilot sites and, in the department’s view, has laid the groundwork for a strengthened, people-centred health system. It cites ongoing initiatives including ward-based community outreach, school health services, contracting of private practitioners, and the Ideal Clinic programme, which the department says have “improved governance, access, quality and accountability” across the district.
The department further reports that, so far, 12 new clinics and community health centres have been completed within the district, while five more are under construction.
It also reports that more than 303 000 patients are registered under the Centralised Chronic Medicine Dispensing and Distribution system and that all primary healthcare facilities now use biometric registration and appointment systems to reduce waiting times.
The report attributes several positive outcomes to the pilot, noting that 70 of the district’s 74 facilities have appointed operational managers, and all nine hospitals have executive management teams in place.
Community participation has been strengthened through active clinic committees and hospital boards, which the department says ensures that residents have a voice in how services are delivered.
According to Nelson, Mpumalanga has seen encouraging results in health outcomes. “The district’s journey demonstrates that universal health coverage is achievable and that when systems, people and partnerships work together, health truly becomes a reality for all,” she wrote in the report.
However, private healthcare groups have voiced concern that the NHI could destabilise the sector by centralising control and limiting patient choice.
Hospital networks such as Netcare and Life Healthcare have previously warned that a single state fund might erode service quality, delay payments to providers, and drive skilled medical professionals abroad.
Industry bodies argue that instead of replacing all private medical schemes with one state-run fund, the state should strengthen public facilities and pursue partnership-based
reform.
Mpumalanga’s claimed readiness stands in contrast to the uncertainty surrounding the NHI rollout nationally, which has drawn both optimism and legal challenges since President Cyril Ramaphosa signed the act into law earlier this year.
While opponents question the funding model, timelines and administrative capacity of the future NHI Fund, the provincial health department maintains that the lessons from Gert Sibande will serve as a blueprint for other provinces.
Manzini insists that the groundwork already laid will help Mpumalanga adapt quickly once the national rollout gains traction. “When the NHI comes into full effect, Mpumalanga will not start from scratch. We will start from experience.”
For Manzini, the pilot is more than a policy rehearsal; it is proof of potential. “Our people are already experiencing the benefits of accessible healthcare,” she said. “Now we must ensure that what began in Gert Sibande reaches every community in Mpumalanga.”
