Reforming national health insurances is not a simple task. In South Africa, the Ministry of Health’s concerns to include a wide variety of services has made it difficult to discuss the health benefits package to be provided by the South Africa’s National Health Insurance (NHI).

Among the main pitfalls, one is establishing will who the agency responsible for health technologies assessments (HTA) depend on? In search of optimizing the national capacity for such assessments that, to some extent, are already done in the country. The government promotes an agency attached to the NHI, while the counterpart advocates for an independent agency that uses experts from universities.

Meanwhile, delays in this definition and the increasingly formal requirements of HTA by the Ministry of Finance begins to affect the funding decision of new interventions for the treatment of important diseases such as hepatitis C or breast cancer