NHI Accreditation: Can doctors apply now and integrate their records?
Yes – Doctors can start preparing for NHI accreditation and digital integration now.
While the NHI Fund is not yet contracting private providers (the Act was signed in May 2024 but is not operational until a future date), doctors can lay the groundwork to meet the NHI accreditation requirements. According to the National Department of Health (NDoH), “every health care provider may be contracted by the NHI Fund… initiated by the provider and once the provider meets the accreditation requirements they will be contracted”.
In practical terms, this means doctors will eventually need to apply for accreditation when the NHI Fund opens contracting – and there are steps they can take now to be ready:
Ensure Compliance with Statutory and Quality Standards
To qualify for NHI, a provider must be in good standing with regulatory bodies and have a compliant facility. Every doctor must be registered with the appropriate statutory health professional council (e.g. HPCSA) and maintain all CPD and professional requirements. Critically, the health facility or practice must obtain certification from the Office of Health Standards Compliance (OHSC), which inspects clinics/hospitals against quality norms.
Achieving OHSC certification (or meeting “ideal clinic” standards) is a key first step, as “all health facilities must be certified by OHSC to be considered for NHI accreditation”. Doctors should review their practice infrastructure, processes, and patient care standards now to align with OHSC norms (e.g. patient record management, infection control, etc.).
Meet Service and Performance Criteria
The NHI will require providers to deliver a comprehensive package of care and adhere to specific protocols. Providers should assess their service offering against the NHI’s anticipated requirements. The NHI Bill and policy documents outline criteria such as providing the minimum required range of services, having an adequate mix of healthcare professionals in the practice, following treatment protocols and referral pathways, and adhering to formulary medicine lists and pricing guidelines.
While these detailed accreditation criteria are still being finalized by the NHI Fund, doctors can begin integrating clinical guidelines and referral networks into their practice. For example, ensuring you have referral arrangements in place (e.g. with hospitals or specialists) and using standard treatment guidelines will position your practice for smoother NHI onboarding.
Digitize Health Records and Integrate with National Systems
Perhaps the most important preparatory step is moving toward electronic health records (EHRs) and ensuring compatibility with the future NHI digital systems. The NHI will rely on a centralized national health information system so that each patient has a “portable” health record accessible anywhere. In fact, NDoH states that NHI accreditation “includes connection to the Fund’s digital systems and reporting”, and providers must submit health data to the national system to ensure continuity of care.
Doctors should begin transitioning from paper to electronic records now. If you already use practice management or EHR software, verify that it can capture all required data and will be able to link with the Health Patient Registration System (HPRS) or future NHI databases. (The HPRS is already being rolled out as an initial step toward a national patient EHR.) Currently, only about 40% of South African clinicians use digital records, but the “looming NHI will encourage the adoption of EHRs”, improving care coordination and efficiency.
Invest in a reliable EHR system and IT support for your practice and start training your staff in its use. Being comfortable with electronic billing and reporting will be essential, since claims to the NHI Fund will likely be submitted electronically.
Stay Informed and Engage in NHI Initiatives
Keep abreast of communications from the NHI Fund Office and the Department of Health regarding provider accreditation processes. As of now, formal applications for NHI accreditation are not yet open (the “NHI Fund accreditation and contracting requirements are still being developed”), but pilot projects or interim “conditional accreditation” phases may arise.
Take advantage of any pilot contracting opportunities or training workshops that are offered in your area. Engaging early will give you insight into the contracting model (e.g. capitation payment for GPs) and what data or reports you’ll need to submit. In the meantime, ensure your practice’s administrative data is well-organized (patient demographics, clinical coding, etc.), as integration will require clean and complete records.
By taking these steps now, doctors will position themselves to smoothly apply for NHI accreditation when the time comes. In summary, start preparing but understand the timeline: There is a transitional period envisioned where not all providers are accredited at once. Early movers who meet the standards and have integrated their record systems will likely be first in line to contract with the NHI Fund once it begins purchasing services.
The bottom line is that NHI implementation is moving forward, so it’s wise to “prepare… on the fact that roll out will take place.” Proactively strengthening your practice now – both in quality and in digital capability – is the best strategy.
Should We “Peg Our Colours to the Mast” on NHI’s Implementation Likelihood and Timeline?
We should plan on NHI coming to fruition, but with realistic caveats about its timeline and challenges. The National Health Insurance is now enshrined in law (the NHI Act 2023) and is a flagship government policy to achieve universal health coverage.
The government has laid out a phased rollout schedule: “Phase 1, for a period of four years from 2023 to 2026” focused on establishing the NHI Fund and preparing systems and providers, and Phase 2, from 2026 to 2028, which will expand contracting of services and fully operationalize the Fund.
In fact, the Act anticipates the NHI system will be fully operational by 2028. Based on these commitments, it is prudent for us to operate under the assumption that NHI will be implemented, and to guide doctors to prepare accordingly.
Timeline expectations: Barring unforeseen delays, the official timeline is roughly as follows:
2023–2026 (Phase 1)
Establish foundational institutions and legal frameworks. This includes setting up the NHI Fund (as a public entity), developing detailed policies, strengthening healthcare delivery systems, and beginning the “process for the accreditation of health care service providers”.
During this phase, we expect groundwork like patient registration systems (e.g. the national digital registration of patients), pilot projects for contracting certain services (especially for vulnerable groups), and amendments to other health laws to align with NHI. Providers are expected to use this time to get certified by OHSC and otherwise NHI-ready. Notably, Phase 1 also involves preparing a Medical Schemes Amendment to redefine the role of medical aids.
2026–2028 (Phase 2)
Scaling up to full NHI operations. The Act envisages that by Phase 2, the NHI Fund will start actively purchasing services and enrolling providers. This includes “selective contracting of health care services from private providers” – in other words, by 2026–27 we anticipate doctors and hospitals will begin signing contracts with the NHI to serve registered patients.
Additional funding streams (like new taxes or reallocated budgets) would be mobilized in this phase. By the end of Phase 2, the goal is a fully functional single-payer NHI Fund by 2028, covering a comprehensive package of services for all South Africans. The NHI Fund’s benefit package and referral networks should be in full swing by then, effectively transforming how healthcare is paid for and accessed.
Post-2028
If all goes according to plan, from 2028 onward South Africa would have a universal health coverage system. Medical schemes will play a much smaller complementary role, as once NHI covers a service, schemes may not duplicate it (requiring them to adjust their offerings). However, it’s important to note that even after 2028, implementation is expected to be iterative – the NHI benefits will be expanded gradually and the system will need continuous strengthening. The government has indicated NHI is a long-term reform that will be phased in “over many years”.
Given this official trajectory, we should operate under the assumption that NHI is coming. Why? The law has been passed, and the health authorities are actively gearing up for it. If we, as advisors and healthcare leaders, were to assume NHI won’t happen and it does, our constituents (the doctors) would be caught unprepared. Thus, it’s safer to plan for implementation, even as we monitor developments.
Challenges and realistic considerations
That said, we must acknowledge the significant challenges and uncertainties that could affect the rollout timeline. Funding constraints are a major concern – the NHI’s cost has not been fully detailed, and many analysts worry about affordability in a strained economy. There are also legal challenges underway: multiple stakeholder groups (from opposition parties to healthcare associations) have filed or threatened lawsuits questioning the constitutionality and practicality of the NHI Act.
For example, critics argue that certain provisions (like the limitation on private medical schemes and the compulsory membership in NHI) may violate rights and could be struck down. Additionally, operational challenges – upgrading public health facilities, establishing a robust digital health infrastructure, and preventing corruption in the new Fund – are non-trivial and could slow progress. It’s telling that shortly after signing the NHI Act, the President’s office indicated willingness to engage and possibly amend the Act in response to stakeholder backlash. This means the exact shape of NHI could still evolve.
In light of these challenges, some observers have questioned whether the NHI will fully come to fruition on schedule or require substantial changes – one medical editorial even asked if the NHI Act might be “dead on arrival” without major fixes. However, the political will for NHI remains strong.
The government sees NHI as a “generational change” to achieve health equity, and it has the backing of many in the public sector (the largest doctors’ union called it “a monumental shift towards… ensuring every South African has access to quality healthcare”). With national elections (2024) behind us, it is likely that the ruling party will continue to drive NHI implementation, albeit carefully. We should be clear that some delays or adjustments to timelines are possible – for instance, if court cases take time or pilot phases reveal issues, full implementation might slide beyond 2028.
Our stance
Despite the uncertainties, our advice to doctors is to prepare as if NHI will be implemented within the next few years. We do not recommend a “wait and see” approach. We need to openly acknowledge that the NHI is likely to roll out (because the costs of being unprepared are too high), while also educating doctors about the potential hurdles.
Doctors should engage with NHI preparations now – even as experts caution about challenges – because early adaptation will mitigate risk to your practice. We will keep you informed of any changes, but the prudent course is to assume the NHI will proceed and to be ready for it.” This balanced approach ensures doctors are neither complacent nor caught off-guard.
In summary, yes, we commit to the view that NHI will happen, and we provide expected timelines (Phase 1 to 2026, Phase 2 to 2028) while also highlighting the real-world factors that could influence the roll-out. Our goal is to prepare doctors for NHI’s arrival – because even if the program’s scope or timing is tweaked, the push for universal health coverage in South Africa is undeniably in motion.
Key takeaway
The NHI rollout will take place (in some form), and likely within the second half of this decade. By planning for it now, doctors and healthcare organizations can navigate the transition more smoothly. We will continue to monitor policy updates, but we are aligning our guidance with the assumption that NHI is the future of healthcare financing in South Africa, and the prudent path is to be fully prepared for its implementation.
