What is the the Universal Health Access and Coverage policy framework?

The journey toward Universal Health Coverage (UHC) in South Africa has long been trapped between constitutional ambition and systemic underperformance. On 26 March 2026, the Wits School of Governance (WSG) and the Steve Biko Centre for Bioethics sought to break this deadlock, hosting the Ethics Alive Symposium: Building a Policy Consensus on Universal Health Coverage in South Africa. 

The keynote address, delivered by WSG Adjunct Professor Alex van den Heever, moved beyond the polarised debates surrounding the National Health Insurance (NHI) to present a pragmatically grounded alternative: the Universal Health Access and Coverage (UHAC) policy framework. Van den Heever’s presentation highlighted a sobering reality: As much as South Africa’s health crisis is about a lac

Drawing on decades of policy research, he outlined how persistent provincial underperformance and "symbolic centralisation" have stalled reform. The UHAC framework introduces three distinct pathways for the nation’s future. While UHC0 represents the failing status quo and UHC2 represents the highly centralized NHI model, the symposium focused heavily on UHC1, a reform pathway centered on institutional strengthening, purchaser-provider separation (essentially through the establishment of an autonomous hospital and district system), and decentralised governance. 

"The real policy choice," van den Heever noted, "is between continued drift and an accountable, decentralised reform path." The framework emphasises subsidiarity, placing authority at the lowest level capable of using it effectively, ensuring that money actually becomes care at the bedside. 

The second half of the event, facilitated by activist Mark Heywood, engaged a diverse community of stakeholders in an open dialogue. The objective was not to identify "no-regrets" moves that strengthen the system regardless of the final financing path chosen. As the proceedings concluded, the message was clear, equity cannot be improved without first repairing the institutions and platforms intended to deliver it. By documenting these discussions into a public report, WSG and its partners continue to lead the national effort to build a credible, workable consensus for a healthier South Africa.