Participation is recognized as an important contribution to implementing the right to health. It features as a key element of the global movement to achieve universal health coverage. The mobilization of groups into collective action is central in this. In South Africa, universal health coverage has become a feature of health policies, with the country’s new National Health Insurance (NHI) scheme in the process of being established. The NHI is considered an experiment in social solidarity. This paper provides insights into civil society’s experiences in the pursuit of universal health coverage via the implementation of the NHI. It explores the interplay of trust, reciprocity, and altruism and how these individual actions can advance toward solidarity and collective action. Our research shows that the road to universal health coverage via the rollout of the NHI will be complex. However, opportunities for collective action exist, including shared learning about human rights, as well as local initiatives within trusted circles. A collective health commitment is based on trust between the government and citizens. Thus, one of the first steps in implementing the NHI should focus on rebuilding trust, which could be developed by establishing platforms for citizen participation.
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