Abstract
This paper examines the South African National Health Insurance (NHI) policy process from 2007 to
2019, focusing on the lack of implementation and the limited involvement of the private sector and civil
society. Using summative thematic content analysis and applying the Multiple Streams Framework (
MSF), the study investigates factors contributing to delays in policy execution. Key findings include
challenges in evidence-based policymaking, value judgments, ideological influences, interest group power,
misunderstandings of incremental and non-incremental reforms, lack of risk analysis, and compliance
issues. The research provides valuable lessons and recommendations for improving NHI policy processes in
BRICS countries, emphasising the role of the private and third sectors, regardless of the government’s level
of involvement. This analysis offers insights into the complexities of achieving universal health coverage
(UHC) and the importance of inclusive, collaborative reform strategies.