Access to adequate healthcare for all citizens is enshrined in the Constitution of South Africa (Constitution of South Africa, 1996). However, academic and other literature shows that the healthcare system suffers from the apartheid legacy, which is characterised by inequality and is hence constrained to fulfil the constitutional right (Coovadia, Jewkes & Barron et al., 2009; Mayosi et al., 2012; Walls et al., 2016). Against this background, the ruling African National Congress party decided, at their annual 2007 Conference held in Polokwane, to correct healthcare accessibility disparities. Their solution was a single-tier government-administered fund dubbed the National Health Insurance (McIntyre & van den Heever, 2007; Madore et al., 2015).
Several scholars such as Nkosi (2014), Madore, Yousif, Rosenberg, Desmond & Weintraub (2015), Mhlaba, Parry and Blaauw (2016), Surender, Van Niekerk and Alfers (2016), Armstrong, Erasmus and Rich (2017), as well as institutions such as the Council for Medical Schemes (2012) have criticised this supposedly noble intervention. They cite problematic content, structure, governance, operations and financing of the National Health Insurance as constraints to its effective implementation. Regardless, most of these criticisms point out the design issues, but ignore the policy process that should contribute to the successful implementation of the policy. This research intends to address the gap, the NHI policy process and its effects on its outcomes, if any. We are confident that this will contribute to the general NHI discourse and the South African perspective.
Firstly, this chapter conceptualises how such research should look by articulating 'what' we should focus on and 'why', using Wotela's (2019) proposed approach to research conceptualisation. The approach suggests interrogating literature on the research problem before moving on to identifying the knowledge gap. More generally, this implies employing a summative thematic content analysis of literature, academic or otherwise, on the National Health Insurance (NHI) policy process in South Africa from 2007 to 2019. To structure our understanding of the research problem, we loop in the problem tree, trend analysis and the theory of constraint.
We undertake a physical context or setting analysis in Section 2 before undertaking a research problem analysis in Section 3. This undertaking sets us up for the research knowledge gap analysis in Section 4. Based on the knowledge we garnered in Sections 2 through 4, we then conceptualise our research in Section 5 to articulate the: (i) research problem statement; (ii) purpose statement; and (iii) associated research questions. Following on, we also propose the most appropriate research strategy, design, procedure and methods for such research, as well as the possible interpretive framework. We are convinced that the multiple streams framework propounded by Kingdon (1984) is the most appropriate as it focuses on policy design and processes.