Evidence to Decision Initiative to Strengthen South Africa’s NHI Framework

According to the Department of Health, the E2D initiative will help manage these complexities by providing research-backed insights to guide the reform process.

 

A pioneering collaboration between the Department of Health, the South African Medical Research Council (SAMRC), and Stellenbosch University is set to revolutionise how healthcare policy decisions are made in South Africa. The Evidence to Decision (E2D) initiative, launched in November 2024, seeks to embed scientific evidence at the core of health policy and implementation—particularly in support of the National Health Insurance (NHI) system.

This milestone partnership brings together the government’s policy leadership, the SAMRC’s scientific expertise, and Stellenbosch University’s academic excellence, creating a strong national mechanism for evidence-informed decision-making in healthcare. The project is funded by the Department of Health and represents a critical step toward ensuring that South Africa’s ambitious health reforms are both equitable and sustainable.

Strengthening the Foundation of the NHI

The NHI rollout marks one of the most significant reforms in the history of South Africa’s public health system. It aims to achieve universal access to quality healthcare, regardless of socio-economic status. However, implementing such a sweeping transformation requires a sound evidence base to inform decisions about funding, governance, and service delivery.

According to the Department of Health, the E2D initiative will help manage these complexities by providing research-backed insights to guide the reform process. It will particularly support key areas of transformation—such as financing mechanisms, management structures, healthcare delivery platforms, and the scope of benefit packages offered under the NHI.

Professor Nicholas Crisp, Deputy Director-General for NHI at the Department of Health, emphasised the crucial role of partnerships between academia and government in achieving this vision.

“Key to the success of any evidence-support initiative is an ongoing collaborative working relationship. Such government–academic partnerships ensure timely, relevant, and high-quality research-evidence products,” he said.

A Tri-Partner Collaboration for Systemic Change

The E2D initiative unites three key entities:

• The SAMRC’s Health Systems Research Unit,

• Cochrane South Africa, globally renowned for systematic reviews and evidence synthesis, and

• Stellenbosch University’s Centre for Evidence-Based Health Care (CEBHC).

Together, these institutions aim to produce and translate scientific evidence into actionable policy guidance for health system planners and policymakers. The collaboration will serve as a national evidence-support platform, enabling the government to make faster and more informed decisions in a complex healthcare landscape.

Building Capacity for Evidence-Based Decision-Making

Beyond providing research support, E2D aims to build long-term capacity in evidence synthesis, health systems evaluation, and policy translation. It will develop tools and training programmes to strengthen decision-making processes across different levels of the health sector—from national policymakers to provincial and district administrators.

The initiative also intends to document and evaluate its own implementation journey, creating a model for other low- and middle-income countries seeking to institutionalise evidence-based policymaking.

Academic Leadership Driving Health Reform

Professor Elmi Muller, Dean of the Faculty of Medicine and Health Sciences at Stellenbosch University, described the E2D initiative as a natural evolution of the university’s enduring commitment to public health innovation.

“The E2D initiative marks a pivotal evolution in our long-standing collaboration with the SAMRC and the National Department of Health, building a national infrastructure for systematic evidence synthesis and translation,” she said.

Under her leadership, Stellenbosch University continues to play an instrumental role in developing the next generation of health policy researchers and evidence translators.

SAMRC’s Role in Evidence Leadership

Professor Ntobeko Ntusi, President and CEO of the SAMRC, reaffirmed the Council’s dedication to ensuring that scientific excellence directly informs national health decisions.

“The SAMRC has promoted the highest standards in evidence-based research through its work with Cochrane and other partners for decades. We remain committed to improving the health of all South Africans by ensuring that high-quality, responsive research informs healthcare practices and policies,” he said.

He added that the SAMRC’s long-standing leadership in health research positions it ideally to steer this initiative, bridging the gap between science and policy for more equitable and effective healthcare outcomes.

Towards Evidence-Informed Health Governance

The E2D initiative embodies the growing recognition that strong health systems require not just financial resources and infrastructure but also sound evidence to guide strategic choices. As South Africa navigates the complex path toward NHI implementation, the initiative offers a roadmap for integrating data, research, and policy into a cohesive decision-making framework.

By institutionalising evidence-informed governance, E2D will help ensure that health reforms remain data-driven, context-sensitive, and people-centred. The collaboration also reflects a broader shift within government toward transparency, accountability, and scientific rigour in public policy.

A Model for Africa

If successful, South Africa’s E2D partnership could serve as a continental model for evidence-to-policy systems, demonstrating how multi-sector collaboration can bridge the gap between academic research and national development priorities.

The initiative represents not only a step forward for the country’s health sector but also a reaffirmation of South Africa’s global leadership in evidence-based policymaking.

As the nation advances toward universal healthcare coverage, initiatives like E2D will play a defining role in ensuring that every policy decision is informed by the best available science, local realities, and a shared vision for equitable health access.