This paper examines the South African National Health Insurance (NHI) policy process from 2007 to 2019, focusing on the lack of implementation and the limited involvement of the private sector and civil society. Using summative thematic content analysis and applying the Multiple Streams Framework (MSF), the study investigates factors contributing to delays in policy execution. Key findings include challenges in evidence-based policymaking, value judgments, ideological influences, interest group power, misunderstandings of incremental and non-incremental reforms, lack of risk analysis, and compliance issues. The research provides valuable lessons and recommendations for improving NHI policy processes in BRICS countries, emphasising the role of the private and third sectors, regardless of the government’s level of involvement. This analysis offers insights into the complexities of achieving universal health coverage (UHC) and the importance of inclusive, collaborative reform strategies.
