South Africa joins the global commemoration of Universal Health Coverage Day 2025

South Africa joins the global commemoration of Universal Health Coverage Day 2025

By: Palesa Chidi and Aphelele Buqwana

For many South Africans, the cost of basic healthcare has become its own kind of emergency. That is the reality that shaped the focus of Universal Health Coverage Day, marked on December 12. UHC Day is a global mark to reaffirm the commitment to ensuring that everyone can access quality healthcare without financial hardship. 

In the commemorations in South Africa that took place in Menlyn, Pretoria, the conversation shifted from abstract policy to everyday financial pressure felt in the clinics, hospitals and overall households. The National Department of Health has used this day to spell out how the next phase of National Health Insurance must directly relieve the burden of out of pocket spending, a message echoed by government leaders and civil society voices.

South Africa commemorated Universal Health Coverage Day under the theme “Unaffordable health costs? We’re sick of it,” with the Minister of Health, Dr Aaron Motsoaledi warning that millions continue to shoulder the consequences of a system that remains both inequitable and financially overwhelming. Despite 85% of South Africans relying on free public-sector services, he noted that quality remains uneven in the absence of a fully implemented National Health Insurance. 

The Minister framed 2025 as a decisive turning point following the signing of the NHI Act, arguing that universal health coverage must move beyond commemoration toward real structural change, so that people can access care without falling into debt or sacrificing basic household needs. Reflecting on the country’s public health gains, he highlighted the decline in maternal mortality and South Africa’s position “on the verge of eliminating HIV/AIDS as a public health threat,” achievements he stressed were not inevitable but the result of deliberate national effort.

But the Minister also issued a sharp warning about the growing financialisation of health care, calling it a trend that risks redefining health itself as a commodity rather than a public good. He said the shift toward profit-driven models is already shaping decisions across the system, even drawing in those least able to afford it and deepening disparities as marginalised communities face rising costs and declining access. 

He argued that primary health care, the backbone of universal access is becoming the “poor cousin,” overshadowed by high-cost, revenue-generating services. Strengthening PHC, he said, is not simply a technical reform but a moral imperative, especially for rural and underserved populations who continue to face catastrophic expenses when seeking treatment for conditions like HIV and TB.

Speaking on civil society perspectives, RHAP Executive Director, Russell Rensburg said South Africa’s push for universal health coverage is ultimately a fight for dignity, not just policy reform. He pointed to the human toll of gaps in the health system and said that preventable deaths continue to occur.

“The sad reality is that in the time that we’ve been here, 30 people have died from the first diagnosis of a curable and preventable disease,” he said.

He warned that inequality still determines who lives and who dies, and that UHC cannot be reduced to financing debates or benefits packages. He said that UHC is about real freedom: a young woman reliably accessing contraception, a diabetic patient receiving continuous care, and rural communities experiencing a system that responds to them, not one that expects them to adjust to its failures.

Russell emphasised that UHC only becomes real when the health system is designed around patients. Despite strong HIV treatment gains, with nearly 70% of people who know their status on treatment. HIV incidence among young women continues to rise because they do not feel safe or supported in clinics. Stock-outs, fragmented chronic care and a hospital-centric system leave rural patients behind, even though more than half of South Africans are under 40 and need accessible primary healthcare. 

“Coverage exists on paper, but not in practice,” he said, calling for rural-proofed planning, integrated services and budgets that prioritise people rather than systems.

Sharing her experience and challenges with accessing healthcare, Thembi Nkomo, a five-time TB survivor and champion from Mpumalanga, said in 2015 she spent R300 out of her own pocket each time she visited clinic for treatment and streptomycin injections as she was on dialysis due to her kidney failure.

“I spent R300 everytime when I had to go to the clinic and get treatment. I was not working and no one at home was working, so sometimes I would rely on my neighbours and relatives to give me money to go there, which was very difficult,” she said.

Speaking on the difficulties of ambulances and the challenges of accessing care quickly, Thembi recalled a time when an ambulance failed to arrive on time when she was very sick, which led her to request a transfer to her nearest clinic.

“There was a time an ambulance couldn’t come when I was too sick and came the following day in the afternoon when it was called in the morning the previous day. I then saw that it was better for me to ask to be transferred to my nearest clinic because it was difficult for me to go to the hospital.”

UHC Day closed with a reminder that the path forward cannot depend on policy commitments alone. The stories shared and the evidence presented all point to the same truth that South Africa’s health system will only improve when reforms translate into real access and real protection for the people who rely on it most. As the country moves deeper into the implementation of NHI, the speakers noted that the challenge is to ensure that dignity, equity and financial relief are not ideals but everyday realities in clinics and communities.