The South African health system is tiered with the minority of the population using private health services and the majority relying mainly on tax-funded health services. South Africa (SA) bears a quadruple burden of disease comprising tuberculosis, HIV and AIDS, high levels of maternal and child mortality, injuries, and non-communicable diseases. The burden of these diseases falls most heavily on the poor. In 2007 the SA government committed itself to implementing National Health Insurance (NHI) in order to move the country toward universal health coverage (UHC). This paper, as part of a series of case studies commissioned by the World Health Organization (WHO) to develop appropriate measures of UHC, provides a case study of SA’s current situation in relation to UHC using the WHO-proposed indicator framework. Drawing on different national data sources, the paper shows that disparities exist in the proposed indicators in the SA context. The paper notes that the framework may be more appropriate for monitoring progress towards UHC over time, rather than as a tool for evaluating a country’s status relative to UHC goals at a single point in time. This paper also points to the need to have UHC-related ‘benchmarks’ against which to compare country data. Further, the proposed indicators by themselves do not provide clear insights into health system reforms required to promote UHC; there is need for a more detailed system-level analysis.