In this episode, Barry Childs sits down with Andrew Donaldson — economist, former National Treasury official, and academic — to unpack South Africa’s complex journey with health financing reform. Drawing on decades of experience in public finance and health policy, Andrew reflects on the lessons of the Taylor Committee, the stalled momentum of institutional reforms, and the challenge of balancing bold policy visions like National Health Insurance (NHI) with the practical realities of implementation. We explore how South Africa’s health financing debates have evolved since the 1990s, the milestones and reform efforts that shaped the conversation, and why progress toward universal healthcare has slowed over time. We also unpack the risks of chasing “big ideas” without delivery, and highlight the importance of trust, experimentation, and partnerships in building a stronger, more equitable healthcare system. Connect with Chris Watney on these platforms: LinkedIn: https://saldru.uct.ac.za/contacts/andrew-donaldson Insight LinkedIn: https://www.linkedin.com/company/insight-actuaries-&-consultants/ Instagram: https://www.instagram.com/insight_za/ Visit our website: https://www.insight.co.za/