Increasing the fiscal space for health in Africa

Tax-based financing is increasingly recognised as one of the better ways to finance universal health coverage.

But how feasible is it for low- and middle-income countries to increase tax revenue, and how likely is it that the public health sector will benefit from additional revenue? In other words, how easy is it to increase the fiscal space for health?

I have contributed to a study by the research consortium RESYST which explores some of these issues, using Kenya, Lagos State (in Nigeria) and South Africa as case studies.

See here for documents from this study.




GNHE universal health coverage assessments for Bangladesh, Peru, South Africa, Taiwan, Tanzania and Uganda

To celebrate Universal Health Coverage Day, GNHE (the Global Network on Health Equity) is releasing a series of assessments about the progress towards financial risk protection and access to quality health care for all in:



South Africa




Go to the GNHE website to download the assessments.

Further assessments will be released over coming weeks.

Getting South Africa ready for National Health Insurance: critical next steps

Here are the powerpoint slides for a recent presentation I gave about National Health Insurance to a Symposium by Economic Research Southern Africa (ERSA) on 6 February 2014:   ERSA NHI presentation_Jane Doherty 

The theme of the Symposium was “Critical choices regarding universal health coverage” and it was held at the Stellenbosch Institute for Advanced Study.

My presentation was titled “Getting South Africa ready for NHI: critical next steps.” 

If you look on ERSA’s website you will find more details on the Symposium.

Legislation on the for-profit private health sector in East and Southern Africa

Here is some information on my latest policy brief, as well as the report on which it is based:


EQUINET Policy Brief 35: Legislation on the for-profit private health sector in East and Southern Africa

Doherty J (2013) with UCT HEU, TARSC. Wemos Foundation,  Policy brief 35, EQUINET, Harare



While the private sector contributes new resources to the health system, international evidence shows that if left unregulated it may distort the quantity, distribution and quality of health services, and lead to anti-competitive behaviour. As the for-profit private sector is expanding in east and southern African (ESA) countries, governments need to strengthen their regulation of the sector to align it to national health system objectives. This policy brief examines how existing laws in the region address the quantity, quality, distribution and price of private health care services, based on evidence made available from desk review and in-country experts. It proposes areas for strengthening the regulation of individual health care practitioners, private facilities and health insurers.  A more detailed discussion paper (#87) on the laws and information in the brief is available at

Regulating the for-profit private health sector in Africa

EQUINET (the Network on Equity in Health in Southern Africa) have just published an editorial and report on legislation governing the for-profit private health sector in east and southern Africa. To access these publications, click on the links below:


Doherty J. 2013. We cannot afford to leave the for-profit private health sector unregulated in Africa (editorial). EQUINET Newsletter 150: 01 August 2013. Available at:


Doherty J. 2013. Legislation on the for-profit private health sector in east and southern Africa. EQUINET Discussion Paper 99.  Harare: HEU, EQUINET. Available at:


Can the private health sector fix the failings of public health systems?

My latest book chapter has just been published:

Doherty J, McIntyre D. 2013.  Addressing the failings of public health systems:  should the private sector be an instrument of choice?  In:  Surender D, Walker R (eds). 2013. Social policy in a developing world.  Cheltenham, UK:  Edward Elgar.

Research on the for-profit health sector in Africa

I would like to get into contact with researchers, policy-makers and legal experts working on appropriate policies and legislation governing the for-profit private health sector in Africa.

Or perhas you do work on other low- or middle-income countries that might be relevant to the African situation?

On the ‘About Jane Doherty’ tab above you will find my e-mail address if you want to let me know about the work you are doing or have research or reports to share.

On the ‘Private health sector’ tab you will find my own work on the private sector (with links to the electronic versions where available). Of particular interest might be:

  • FORTHCOMING: A situation analysis of private sector legislation in East and Southern Africa which is still in an early draft form
  • FORTHCOMING: Doherty J, McIntyre D. (2013)  Addressing the failings of public health systems:  should the private sector be an instrument of choice?  In: Surender R, Walker R.  (2013)  Social policy in a developing world.  Cheltenham, UK:  Edward Elgar
  • Doherty J.  2011. Expansion of the private for-profit health sector in East and Southern Africa. EQUINET with HEU, UCT and TARSC Policy Brief 26. Harare: EQUINET.
  • Doherty J.  2011.  Expansion of the private health sector in East and Southern Africa.  EQUINET Discussion Paper 87.  EQUINET:  Harare.
  • A report summarising research on the for-profit private health sector in South Africa from the 1980s to 2003:  Doherty J, Steinberg M.  2003.  Priority health care information needs for reform:  what role for BHF?  Johannesburg:  Board of Healthcare Funders.

Health financing and expenditure in South Africa

Colleagues and I have just published a new chapter on health financing and expenditure in South Africa:

McIntyre DE, Doherty JE, Ataguba JE.  (2012)  Health care financing and expenditure – post-1994 progress and remaining challenges.  In:  Van Rensburg HCJ (ed).  Health and health care in South Africa (2nd edition).  Pretoria:  van Schaik Publishers. ISBN: 9780627030130

NHI Snippets (6): The high cost of private health care in South Africa

So, I’ve elaborated a little on the poor health of South Africans relative to the country’s level of economic development and wealth.

The second major point I made at the beginning of this blog series was that a huge proportion (43%) of all the money spent on health care in South Africa is paid as premiums by people on medical aid (medical aid is what is know internationally as ‘voluntary private health insurance’).  In fact, the proportion is so huge that South Africa tops the list of countries around the world in this regard, even outdoing the United States.

If you want to see this point displayed graphically, click on this link – Proportion of spending on health insurance – for a slide by Prof. Di McIntyre of the Health Economics Unit at UCT.1   On the extreme right of the graph are South Africa and the United States, each spending a large amount on voluntary private health insurance (the red section of the bars).  The other countries shown in the graph have health systems which are getting close to achieving universal health care coverage (in a later blog I’ll explain this term but in broad terms it means that most citizens are able to access and afford adequate health care).  You’ll see that, for these countries, the red section of the bar is very small.

The last bit of information you need to know to appreciate this graph is that ‘the big red bit’ of South Africa’s bar is spent by only 16 percent of the population.2  So the following picture emerges:

1.  Only a very small proportion of South Africa’s population has access to high quality care (this is assuming that lots of resources translates into good quality, which isn’t wholly true, so I’d like to qualify this statement in a later blog as well as note that good quality care is also available in the under-resourced public sector);

2. Private health care is very expensive and funding this care places a very high financial burden on those who can afford it.

3. Countries achieving universal health care coverage have not relied on private voluntary health insurance to do so (I’ll elaborate this point later and, of course, we need to have the discussion about why universal health care coverage is desirable.)



1. McIntyre D.  2011.  Options for South Africa:  Financing.  Presented at National Department of Health Consultative Conference on “National Health Insurance:  Lessons for South Africa”, Gallagher Estate, Midrand, 7-8 December 2012.  Available at:

2.  McIntyre DE, Doherty JE, Ataguba JE. (forthcoming). Health care financing and expenditure – progress since 1994 and remaining challenges. Health and health care in South Africa (2nd edition). Van Rensburg H. Pretoria: van Schaik Publishers.