Paper short abstract:

The paper explores the tensions between utopian political narratives of the public good, embodied in plans for a National Health Insurance programme, and configurations of the public good among health professionals in a rural hospital.

Paper long abstract:

The move towards a National Health Insurance (NHI) programme in South Africa signifies attempts to extend responsibilities for the public good to the private sector, while also infusing debates about the public good with a nationalist discourse centred around the so-called 'National Democratic Revolution' (NDR). This is a theory of revolutionary progression from capitalism to socialism that has roots in the anti-apartheid struggle and resonates deeply with many South Africans. Intended to widen access to health care and reduce inequalities, some have suggested that the NHI embodies a fundamental hostility towards private healthcare provision, and serves as a mechanism for the nationalisation of the sector. Yet many have highlighted that the NHI is unrealistic given the profound obstacles it faces, including staff shortages, poor management, high costs and corrupt spending. The paper explores the tensions between utopian political narratives of the public good and the ways in which the public good is being debated and enacted by nurses whose work is embedded within the constraints of daily service provision.