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Billions for NHI continue despite court ordered rollout pause
South Africa’s National Health Insurance plan may be on legal pause, but financially, it is very much alive.
While the formal rollout of the NHI is currently on hold pending Constitutional Court hearings in May 2026, the 2026 national Budget tells a different story behind the scenes. Billions are still being channelled into the groundwork.
In total, around R9.3 billion has been allocated towards the NHI project this year. That figure is already sparking debate in boardrooms, courtrooms and across social media feeds.
What the R9.3 billion actually means
The R9.3 billion allocation forms part of South Africa’s broader health budget, which stands at R310.4 billion for the year. In other words, NHI funding makes up roughly 3 percent of total government health spending.
Still, it is not a small amount.
Of that R9.3 billion, close to R1.5 billion is set aside as direct provincial NHI grants over the next three years. These grants amount to R475 million in 2026, R497 million in 2027 and R513 million in 2028. The figures reflect a steady upward trend from the R467 million spent in 2025.
The bulk of the allocation, more than R7.8 billion, falls under indirect NHI funding. This portion is earmarked for broader public healthcare improvements that support the NHI framework but are not tied to direct NHI service operations. Indirect funding is also rising gradually between 2026 and 2028.
Behind the scenes: what the money is paying for
So what is actually happening with that funding?
The direct grants are largely aimed at preparing provinces for eventual NHI implementation. That includes testing health system reforms, improving services at primary healthcare facilities and aligning provincial infrastructure with national policy.
The indirect funding focuses more on system-wide upgrades. Think infrastructure refurbishment, modernisation of health facilities and investment in digital systems. The emphasis on digital transformation signals a long-term shift towards more integrated patient records and administrative systems across the public sector.
Importantly, none of this spending depends on the formal commencement of sections of the NHI Act. Much of it falls under the Department of Health’s constitutional mandate to strengthen public healthcare regardless of the legal status of the NHI rollout.
The legal standoff
The political tension surrounding the NHI has not cooled.
Ahead of the 2026 Budget, the presidency confirmed that the promulgation of the NHI Act would be deferred until court challenges have been resolved. These legal challenges centre on the public participation process that led to Parliament’s adoption of the Bill.
Trade union Solidarity, one of the key litigants, agreed to pause its case on condition that implementation and further development of the NHI stop immediately. The union has argued that no further funds should be allocated to the scheme until the courts have ruled.
In recent weeks, Solidarity has written to government departments demanding that no additional budget allocations be made towards the NHI. The union has indicated that it is prepared to pursue further legal action if the state continues spending.
President Cyril Ramaphosa, however, has made the government’s position clear. The pause applies to the proclamation of sections of the Act, not to preparatory work. He has said that the state remains fully committed to the NHI and that the Department of Health will continue strengthening the health system while the judicial process unfolds.
The Constitutional Court is set to hear the relevant matters between 5 and 7 May 2026.
A bigger picture beyond the courtroom
For many South Africans, the debate feels both urgent and distant at the same time.
Public healthcare challenges are visible daily in overburdened clinics and hospitals, particularly in urban centres such as Johannesburg. At the same time, the NHI remains a policy promise whose final shape is still being contested.
Supporters argue that improving infrastructure and digital systems now makes sense regardless of the legal process. Critics question whether billions should be committed to a framework whose future structure is not yet settled.
What is clear is this: even with the legal brakes applied, the financial engine has not stalled. The groundwork for a reimagined public health system is continuing, quietly and steadily, while the courts deliberate.
For Joburg residents who rely on public facilities, the real question is less about policy wording and more about whether these investments will translate into shorter queues, better equipment and more reliable care.
The answer may not come from the courtroom alone, but from what happens inside clinics and hospitals over the next few years.
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Source: Business Tech
Featured Image: Daily Investor
