The South African health system is tiered with the minority of the population using private health 13 services and the majority relying mainly on tax-funded health services. South Africa (SA) bears a quadruple 14 burden of disease comprising tuberculosis, HIV and AIDS, high levels of maternal and child mortality, injuries, 15 and non-communicable diseases. The burden of these diseases falls most heavily on the poor. In 2007 the SA 16 government committed itself to implementing National Health Insurance (NHI) in order to move the country 17 toward universal health coverage (UHC). This paper, as part of a series of case studies commissioned by the 18 World Health Organization (WHO) to develop appropriate measures of UHC, provides a case study of SA’s 19 current situation in relation to UHC using the WHO-proposed indicator framework. Drawing on different 20 national data sources, the paper shows that disparities exist in the proposed indicators in the SA context. The 21 paper notes that the framework may be more appropriate for monitoring progress towards UHC over time, 22 rather than as a tool for evaluating a country’s status relative to UHC goals at a single point in time. This paper 23 also points to the need to have UHC-related ‘benchmarks’ against which to compare country data. Further, the 24 proposed indicators by themselves do not provide clear insights into health system reforms required to 25 promote UHC; there is need for a more detailed system-level analysis.

This paper is the full country case study to accompany the summary paper “Monitoring and evaluating progress towards Universal Health Coverage in South Africa” that is part of the Universal Health Coverage Collection.