Global health systems are in a period of profound disruption. From overburdened hospitals in Europe to strained clinics across Africa, the Covid-19 pandemic didn’t just test our systems; it exposed deep-rooted flaws. But disruption can be clarifying. It forces us to ask: What kind of healthcare system can withstand future shocks while serving all people equitably and sustainably?
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This was the central theme at the 2025 International Federation of Health Plans (iFHP) CEO Forum in Singapore, where I had the honour of representing the Board of Healthcare Funders (BHF). The answer, across regions and different healthcare models, was clear: resilience is built not in isolation, but through the integration of sectors, systems, ideas, and people.
Good intentions do not guarantee good outcomes
Nowhere is this lesson more critical than in South Africa and the broader Southern African Development Community (SADC), where health inequities are compounded by economic and infrastructural constraints. And yet, we stand at a policy crossroads.
South Africa’s National Health Insurance (NHI) Act is an ambitious attempt to equalise access to care. But good intentions do not guarantee good outcomes.
The current design of the NHI risks creating a single-point-of-failure system by centralising funding and removing a viable role for medical schemes and private sector partners.
Rather than building resilience, the NHI as it stands may undermine it by reducing patient choice, straining already fragile public services, and ignoring the fiscal realities of implementation.
Without a clear, sustainable funding mechanism or operational readiness plan, the NHI threatens to replace existing strengths with uncertainty.
Smart, strategic integration
To be clear, equity cannot be achieved through exclusion. It must come from smart, strategic integration of public and private capacity, governed by accountability, and aligned to outcomes, not ideology.
Importantly, resilient, equitable health systems are flexible, layered, and collaborative.
This principle is already visible across SADC, where BHF members are helping pilot integrated care models that extend services to underserved communities, often in partnership with governments and civil society.
Examples include:
- Medical schemes offering low-cost benefit options tailored for lower-income workers.
- Community-based risk pooling initiatives.
- Partnerships with civil society, including the Gift of the Givers, to rehabilitate health infrastructure, restore water access in hospitals, and fund specialist training.
These are not stopgaps. They represent a different way of thinking where the private sector is not merely tolerated in the pursuit of universal health coverage (UHC) but is strategically engaged to close systemic gaps.
Too often, reforms focus on mechanisms rather than outcomes. But the real test of any health system is this: Can it deliver timely, quality care where and when it’s needed?
Resilience begins with frontline functionality, including adequate staff, reliable infrastructure, clean water, and access to diagnostics and medicines.
Partnerships that address the social determinants of health, from infrastructure to education and water security, are key. These factors drive long-term health outcomes more than policy documents alone.
Innovate from insurer to innovator
Medical schemes have a critical role to play in these partnerships. In the 21st century, the medical scheme sector must evolve from insurer to innovator.
It must deliver not only coverage but impact. Critical to achieving this is the government creating platforms for structured collaboration, including:
- Health outcomes-based contracts.
- Incentives for infrastructure investment and training.
- Data-sharing frameworks that protect privacy while driving integration.
- Co-governance models for regional health preparedness.
Such mechanisms don’t dilute the state’s control over the public health sector, but rather enhance it by making it more effective, better resourced, and more accountable to real-world outcomes.
At the iFHP CEO Forum, it was clear that Africa has something vital to offer the world. In countries like Rwanda, Namibia, and Kenya, hybrid models are already delivering UHC-aligned services through strategic public-private partnerships.
These are the stories that must shape global health thinking, not just stories of aid, but of agency and innovation.
South Africa, and Africa more broadly, does not need a revolution in healthcare. It needs a reconfiguration of what already works, and a clear-eyed recognition of what doesn’t.
That means reforming without dismantling. Innovating without alienating. Expanding access without eroding quality.
We can’t afford to chase ideals at the expense of functionality. Resilience must be engineered through cooperation, not confrontation.
And the private sector, if wisely regulated and ethically engaged, can be a powerful force for equitable, sustainable health.
In this new era, resilience is not about returning to what was. It’s about designing what’s next with all hands on deck.
