Will the NHI Cover the Full Cost of Saving a Life?
The public health sector serves roughly 84% of South Africans, yet per-person spending in private healthcare is around five times higher. The National Health Insurance (NHI) is designed to change that equation. As President Ramaphosa stated, the right to healthcare “cannot depend on where you were born, how much you earn or where you live.”
For patients with blood cancer and blood disorders, that promise could not be more urgent. On World Health Day 2026, Palesa Mokomele, Head of Community Engagement and Communication at DKMS Africa, says this is an opportunity to ask whether the NHI is being designed to reach them. “Blood cancer and blood disorder patients depend on highly specialised treatment pathways – exactly the kind the NHI has an opportunity to strengthen. They cannot be an afterthought in the benefit package conversation.”
The NHI Act was signed into law in May 2024 but has not yet commenced, with key constitutional challenges set to be heard in May 2026. Despite legal uncertainty, the government has been clear that foundational work will continue.
The Reality on the Ground
Stem cell transplantation is one of the most effective treatments for blood cancers and blood disorders, and among the most resource-intensive, requiring specialist physicians, trained nurses, dedicated infrastructure, and in 70% of cases, a matched unrelated donor (MUD).
The capacity to deliver these treatments is already under severe strain. Just 25% of South Africa’s oncologists serve more than 75% of the population. Long treatment delays, limited resources, high patient volumes, and advanced disease at presentation make for a deeply challenging environment.
“What we see is a system doing its best under enormous pressure,” says Mokomele. “The NHI has a real opportunity to address those structural gaps, but it requires deliberate investment where the need is greatest.”
What Universal Coverage Must Include
The NHI benefit packages for the treatment of blood cancer and disorders have yet to be finalised. With South Africa projected to see a 78% increase in cancer incidence by 2030, whether those packages cover the full cost of finding, matching, and transplanting an unrelated donor will be a test of whether universal health coverage means what it says.
“We are not here to debate the merits of the NHI,” shares Mokomele. “We are here to make sure that when it is implemented, it works for every patient. The full treatment pathway must be funded, and the clinical infrastructure to deliver it must be in place.”
President Ramaphosa has called for genuine partnerships between the public and private health sectors, academic institutions, NGOs, and communities. “That vision of cross-sector collaboration reflects exactly how we believe this challenge must be met,” notes Mokomele.
A Blueprint for Access
DKMS Africa’s Access to Transplant programme offers a practical example of barrier-free access in the public sector. Working across six provinces, it aims to invest in infrastructure upgrades at public hospitals, training for specialist nurses and mobilises its global network to collaborate with physicians, and patient support services addressing practical barriers, such as transport and housing, that often cause patients to abandon treatment.
“When you remove barriers systematically, outcomes improve,” points out Mokomele. “Each barrier removed is a patient who makes it to transplant. That is the model the NHI needs to learn from and scale.”
The organisation is also preparing for a more centralised system, ensuring its programmes can integrate into national frameworks while maintaining global standards – through early diagnosis education, donor registry diversification, stronger referral pathways, and local research capacity.
Your Health System, Your Voice
The decisions being made about the NHI benefit package today will shape healthcare for decades. Young South Africans will inherit both the growing burden of disease and the system designed to address it.
“World Health Day is a reminder that universal means everyone,” concludes Mokomele. “We are asking young South Africans to support us in uniting towards a healthcare system that works for everyone.”
