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Research Nugget

Can South Africa’s Health Information System Support National Health Insurance?

South Africa is preparing to launch a National Health Insurance (NHI) scheme to ensure that everyone has access to quality healthcare. For this system to function effectively, the country needs reliable and well-organised health information. This includes patient records, treatment data, and health system monitoring.

A research study funded by the NRF assessed whether South Africa’s current Routine Health Information System (RHIS) is ready to support the planned NHI. The study set out to assess how prepared the RHIS is to support NHI by focusing on key areas such as data collection, system capacity, staff training, and governance. By identifying strengths and weaknesses in these areas, the research offers a clearer picture of what must be improved before the NHI can be rolled out successfully.

The focus was on 10 NHI pilot districts: OR Tambo, Thabo Mofutsanyana, City of Tshwane, uMzinyathi, uMgungundlovu, Vhembe, Gert Sibande, Pixley ka Seme, Dr Kenneth Kaunda, and Eden. Researchers gathered data from 53 health facilities across seven provinces, including clinics, community health centres, and district hospitals. These facilities represent the key components of the public health system that the NHI will rely on. The study used the Performance of Routine Information System Management (PRISM) framework, which evaluates three aspects of a routine health information system: 

  • Technical factors such as tools and systems
  • Organisational factors including infrastructure and supervision
  • Behavioural factors such as staff knowledge, skills, and motivation

Interviews were conducted with healthcare workers responsible for patient records and data management.

The findings revealed that most facilities do collect data regularly, but that there were noticeable gaps in accuracy, completeness, and timeliness. In many cases, staff did not fully understand how to interpret or use the data they were recording. While monthly reports were produced, they were not always used to guide decisions or improve healthcare services.

Although the District Health Information System (DHIS2) is in place for electronic data collection, most facilities still rely on paper-based registers.

Manual systems are more prone to human error which makes it harder to track individual patients over time. There is limited use of electronic medical records at facility level. Many of the staff responsible for capturing and analysing data had not received formal training in health information systems and, in most cases, nurses or administrative personnel had to take on data duties alongside their clinical work.

Only a few facilities had dedicated data capturers. As a result, data collection was often viewed as a burden rather than a useful management tool. Most facilities received some form of supervision, but this was inconsistent. There were no clear national guidelines outlining how the RHIS should support NHI. In addition, facilities often did not receive feedback on the data they submitted, making it difficult to know whether the data met required standards or was even being used.

Some facilities also struggled with basic infrastructure. Limited access to computers, unstable electricity, and poor internet connectivity were common. Power outages and slow systems delayed data submissions, particularly in rural areas, which were more affected than urban sites.

Overall, the study concludes that while the current RHIS has the basic structure needed to support NHI, it is not yet fully ready. The system remains heavily dependent on manual processes, has limited digital capacity, and lacks consistent feedback and training mechanisms. To ensure the successful rollout of NHI, South Africa must invest in strengthening the RHIS. This includes improving technology, building staff capacity, and encouraging a stronger culture of data use within public health facilities.

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