Abstract
Universal Health Care (UHC) ensures that everyone can access a range of quality health services they need, without financial hardship. It is a global healthcare goal supported by many nations, including South Africa. On May 15, 2024, the South African Government signed the approval of the National Health Insurance (NHI) Bill. According to Moosa (2022), the World Health Report on Primary Health Care (PHC) in 2008 put forward the ideas of UHC; service delivery reforms that reorganise healthcare services around people's needs, integrating public health actions with primary care and leadership reforms (where governments act as custodians of the whole health system, including private sector and not just of the public service). The success of the NHI will depend on healthcare workers’ understanding and perceptions, as their support is vital for the effective and sustainable implementation.
This cross-sectional study aimed to establish and measure the views and perceptions of healthcare workers in the City of Ekurhuleni (CoE) related to the proposed NHI implementation in South Africa. A quota sampling method was used, employing a self-administered questionnaire to collect data from 384 participants. Data was gathered from healthcare workers across 77 health facilities managed by the City of Ekurhuleni (CoE) municipality. The study also examined the relationships between demographic factors, awareness, knowledge, and perceptions regarding the proposed NHI implementation.
Awareness significantly varied by job title; however, it proved that the job title influences the level of awareness (p < 0.05) of the NHI. Statistically significant positive linear relationships were noted between (age, years of experience) and awareness (p < 0.001). Administrative staff reported the highest uncertainty. The media was the primary information source (over 60%), while workplace-based awareness was minimal. Over 70% of participants expressed uncertainty about NHI funding, training, and implementation readiness. Just under 50% of the participants expressed no significant changes in their workload, with just over 30% projecting an increase in their workload. Fewer than 10% felt confident in their ability to implement the NHI in their current roles. Weak evidence against relationships between job title and perceptions (p > 0.05), and no statistical significance between perceptions and years of experience.
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General concerns about system readiness, infrastructure, and communication gaps were expressed by healthcare workers in the City of Ekurhuleni (CoE), particularly among Doctors and Nurses. The findings highlight the need for targeted stakeholder engagement, clear implementation strategies, and sustained support for frontline workers. Therefore, addressing the concerns raised by the HWCs in Ekurhuleni is essential to ensure successful and sustainable NHI implementation.