The days following the High Level Meeting on Universal Health Coverage consist of side-meetings between civil society, government and funding organisations. On Tuesday, we attended a session on funding for UHC and the role and voice of patients; and a session on anti-corruption, transparency and accountability. In both sessions, there were important lessons for South Africa. Three key messages stand out.

First, a universal health coverage system must be designed to be universal. The inclusion of civil society and marginalised populations in decision-making and health service coverage is not guaranteed, and universality must be built into the system. South Africa’s intended exclusion of most migrants from health care services under NHI and the marginalisation of health care user and civil society groups from decision-making structures require revision in line with this lesson.

Second, it is time to stand up for sexual and reproductive health rights on an international and domestic level. There cannot be universal health coverage without access to sexual and reproductive health care services and without a recognition of access to such services being a matter of right. In South Africa, we must ensure that any benefits package under NHI explicitly include sexual and reproductive health services and rights.

Third, while there is no fool-proof governance or watchdog model to prevent corruption, civil society and citizen engagement in accountability structures and transparency on the contracts entered into in health are vital to prevent and fight corruption in health. A huge amount of work must be done on the governance, management and other accountability structures under NHI and on ensuring publication of all relevant information in relation to NHI decisions and contracts.

These lessons, learned through the experience of other countries in the process of implementing universal health coverage interventions, will, if implemented, assist South Africa in achieving a model of universal health coverage that is more inclusive, more comprehensive, and protected from corruption and mismanagement.