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To address problems of inadequate public health services, escalating private healthcare costs and widening health inequalities, the South African government has launched a radical new proposal to introduce a universal health system for all South Africans; National Health Insurance (NHI). While most attention has been thus far devoted to the economics and fiscal affordability of universal coverage, relatively less attention has been paid to wider challenges - in particular the important role played by key stakeholders tasked with designing and implementing the reforms. This paper outlines the opportunities and challenges posed by the proposed NHI reforms in South Africa. It begins by explaining the country´s current system of health care provision including its human resource structure, functions and cost implications. It then summarizes the deficits and limitations of the current two-tiered health system and discusses what NHI is trying to achieve within this context and how it hopes to address the problems. Finally, the paper examines the political and institutional challenges the reforms will face with a particular focus on the actors involved. The findings suggest that the government will face considerable challenges to its proposed reform path and that the eventual design of the new system may have to be a compromised version of the system envisaged in the original Green Paper. In particular the government will face significant challenges in garnering the support of sections of the medical profession tasked with implementing the reforms.

There is increasing interest in the significance of social policy in the management of welfare and risk in the developing world. This volume provides a critical analysis of the challenges and opportunities facing social protection systems in the global south, and examines current strategies for addressing poverty and welfare needs in the region. In particular, the text explores the extent to which the analytic models and concepts for the study of social policy in the industrialised North are relevant in a developing country context. The volume analyses the various institutions, actors, instrum

English
Under the UK Conservative government, GP fundholding represented a major increase in the involvement of primary care doctors in the management of local service provision. The Labour government's proposals for Primary Care Groups extends and develops this role. This article examines the experiences of fundholding of a group of general practices which participated in an external evaluation of their work. Opinions about the merits of fundholding were varied. Doctors and managers expressed concern about the administrative burden and questionable clinical value of the scheme. Uncertainties about the overall impact upon professional autonomy were also raised. These reservations are consistent with discussions elsewhere questioning the role of doctors as managers within health care systems.

Discusses involvement of primary care doctors in the management of local service provision; based on experiences of doctors and managers in one total purchasing project; Great Britain. Summaries in French and Spanish.

China's role as an emerging donor and its conceptualization of social policy in Africa has generated polarized reactions in the West. Many argue its 'productivist' approach is driven less by notions of citizenship and social rights, and more in terms of accumulation functions. Social investment is justified for broader economic development goals in contrast to current safety-net or 'welfarist' models of Western donors. While some international organizations perceive the Chinese approach as antithetical to Western goals and practice, others welcome it as an opportunity to develop new ideas about social development.This qualitative research explores to what extent and in which direction Chinese aid to Africa is influencing Western ideas about welfare policy in developing countries. The study comprises a systematic review of Sino-African and Western policy documents and in-depth interviews with senior Chinese, Western and African stakeholders. It investigates how social policy is conceptualized by those involved in Chinese aid to Africa, to what extent this differs from traditional Western approaches, and what it means for Western social development policy. The implications for understanding the drivers of global policy development and links between the economic and social dimensions of welfare are explored.

This article presents the findings of a qualitative study of an income generation initiative developed in South Africa during the late1990s. The initiative reflected a growing policy emphasis that work had to be a main pathway out of poverty, and was designed to encourage entrepreneurship among deprived communities by providing grants for small business creation. The study found several barriers and challenges to successful implementation and policy outcomes of the initiative, including: a lack of capacity in the targeted communites; poor physical infrastructure; a lack of capacity in the implementing department; and policy confusion about the programme's objectives.