Assessing stakeholder management practices in South Africa’s National Health Insurance Program: a project management perspective

Résumé

The National Health Insurance (NHI) program in South Africa is a premier reform initiative aimed at attaining Universal Health Coverage. Nonetheless, its performance is largely contingent upon proficient management of project stakeholders throughout all stages of the program life cycle. Principal stakeholders express significant apprehensions over the policy revision and implementation procedure. This study aimed to identify program stakeholders and evaluate the degree to which the National Department of Health (NDoH) implemented project stakeholder management methods during the design and initial execution of the NHI. A qualitative, exploratory research design was utilised, utilising secondary data derived from document analysis. Primary data was obtained using a combination of semi-structured interviews and electronically distributed questionnaires with representatives from five principal stakeholder groups: private health insurers, professional organisations, regulators, and a governmental oversight agency. Despite the existence of a roadmap for NHI implementation, thematic analysis indicated that the stakeholder management strategy employed did not adhere to recognised project management standards. Findings reveal deficiencies in the NDoH stakeholder engagement strategy, including selective consultation, inconsistent response, inadequate openness, and ineffective communication and feedback systems, all of which erode confidence and hinder consensus-building. Comparative analyses from Nigeria and Thailand illustrate the significance of inclusive, partnership-oriented governance frameworks for the implementation of extensive health reform initiatives. The study indicates that enhancing stakeholder identification, analysis, and effective engagement tactics is crucial for the NHI's legitimacy and long-term viability. Utilising private sector knowledge is crucial throughout the whole program life cycle. The study is constrained by the lack of engagement from the NDoH, which hinders the triangulation of stakeholder perspectives.

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