The Implications of ICT Solutions for the South African National Health Insurance: A Systematic Literature Review

Abstract

South Africa’s National Health Insurance (NHI) depends on the effective use of information and communication technology (ICT) to support universal health coverage through patient identification, provider accreditation, claims processing, service portability, monitoring, and accountability. However, evidence on the role of ICT in NHI implementation remains fragmented, particularly regarding governance, interoperability, workforce adoption, language inclusion, and public trust. This paper presents a systematic literature review of peer-reviewed and grey literature published between 2015 and 2025, guided by the PRISMA 2020 approach. The review synthesised evidence from South African and comparable low- and middle-income country contexts to examine the benefits, barriers, and implementation requirements of ICT for NHI. The findings show that ICT can improve service delivery, reduce duplicate patient records, strengthen claims administration, enable population health monitoring, and support fraud detection. At the same time, progress is constrained by fragmented electronic health record systems, limited infrastructure in primary healthcare facilities, skills shortages, clinician resistance, cybersecurity risks, regulatory uncertainty, and the exclusionary effects of English-dominant digital health systems in a multilingual society. In response, the paper develops a five-pillar ICT-NHI Implementation Framework consisting of adaptive governance and legal-technical coherence, resilient architecture and shared infrastructure, socio-technical workforce and workflow integration, multilingual semantic and pragmatic interoperability, and trust infrastructure and algorithmic accountability. The paper argues that these pillars must be implemented as an interdependent system rather than as separate components, with governance and trust prioritised because they create the conditions for infrastructure, workforce adoption, language inclusion, and algorithmic accountability to function effectively. The study concludes that ICT can enable a more equitable, efficient, and citizen-centred NHI only if digitalisation is treated as a socio-technical, multilingual, and governance-led reform rather than a narrow technology procurement exercise.