The implementation of the National Health Insurance in South Africa is a noble attempt to address the inequities and scarcities of healthcare resources in the country. However, while South Africa’s status as a developing country does not preclude the success of universal healthcare, as evidenced by certain international models, its success is threatened by corruption, mismanagement of resources, and poor-quality institutions. Rather than build a new system on poor foundations, existing facilities need to be overhauled. Increased transparency, as well as improvement in challenges such as cleanliness, personnel attitudes, and long waiting times may secure public ‘buy-in’. Without these and other changes, public confidence will not be inspired – and, even more importantly, the system may fail in its goal of bringing about equitable resource allocation and improved healthcare.