2. What are we trying to achieve? First principles

South Africa has been struggling to find its path to UHC for more than two decades. Despite differences in policy, rhetoric and plans, the intention has always been the same: to improve equity between the provinces and health sectors, to ensure quality care is provided at the lowest possible cost, and to ensure that the health system is governed optimally and with sound leadership. To support this report, we conducted a comprehensive literature and stakeholder review of NHI in South Africa 8. Based on the review, five policy objectives were identified that have been consistently present across policy documentation as South Africa has been trying to move closer and closer to UHC. These policy objectives are:

1. To improve equity in the health system, including the sharing of resources (human and other) across the public and private health systems. 2. To address escalating costs in the private health sector and contain future escalations in costs across the health sectors. 3. To provide universal access to quality healthcare. 4. To ensure efficiency in service provision and administration. 5. To ensure good governance and stewardship.

These key objectives of the health reform process will be used as benchmarks to assess the feasibility of various policy choices and pathways that were put forward during the UHC debate. This report may also assist in guiding the sequencing of current reform proposals. Throughout this document, we propose that the combination of cost, quality and efficiency could collectively be reconceptualised as orienting the South African healthcare system towards value.