National Health Insurance in the face of COVID-19: urban tendencies in South Africa. (Special Issue: Health and wellbeing in urban South Africa.)

South Africa is set to implement a universal health care system, called National Health Insurance (NHI). The country is plagued by inequality at various levels, and the NHI will attempt to provide more equitable access to health. A national online COVID-19 survey in 2020, measured respondents' favour or not of such a system. Multivariate logistic regression identified unique determinants of perception of NHI among urban residents (total respondents 12,682) in South Africa. Data were benchmarked using 2019 mid-year population estimates. Results showed that the majority (77.5%) of urban residents were in favour of NHI in South Africa. Furthermore, township (aOR = 1.36, 95% CI [1.10-1.69], p = 0.005) and informal settlement (aOR = 1.55, 95% CI [1.09-2.20], p = 0.016) residents were significantly more likely to be in favour of NHI than those residing in inner cities. This research sheds light on urban people's perception of the NHI system for South Africa. The findings showed, respondents were mostly in favour of the NHI. It is recommended that the question of NHI be repeated in future research, during a time when knowledge of the COVID-19 pandemic has broadened and to a population with more representative education levels.

Spatial analysis of perceived health system capability and actual health system capacity for covid-19 in south africa

Introduction: People’s confidence in the health system's capability in managing the COVID-19 pandemic can determine public support, risk perceptions, and compliance to the required behaviors during the pandemic. Therefore, this paper investigated people’s perception of health system capability to manage the COVID-19 pandemic in different spatial areas across the country using data from an online survey. Methods: Multivariate logistic regression models were used to examine factors associated with people’s perception of the health system capability to manage the COVID-19 pandemic at the national and provincial levels. Spatial comparative analysis was conducted to contrast spatial density indicators of the number of hospitals, hospital beds, and ICU beds per given population across various provinces. Results: Findings showed that South Africans had low confidence in the health system capability, with only two in five (40.7%) reporting that they thought that the country’s health system was able to manage the COVID-19 pandemic. Sex and knowledge on COVID-19 were significantly associated with the people’s perception of the health system capability to manage the pandemic at the national level and in four of the nine provinces. Conclusion: Overall, the findings of this study clearly highlight challenges facing the country’s health system, both perceived or real, that needed to be addressed as part of the preparation for the COVID-19 pandemic. Timeous implementation of a countrywide National Health Insurance (NHI) system is now more critical than ever in improving healthcare outcomes of the South African population beyond the existence of the COVID-19 epidemic.