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NHI Act heads to court as AfriForum challenges Ramaphosa and Motsoaledi
South Africa’s long-running debate over healthcare reform has now landed squarely in court. Civil rights organisation AfriForum has served a summons on President Cyril Ramaphosa and Health Minister Aaron Motsoaledi, escalating its challenge against the National Health Insurance Act.
The legal move forms part of a growing wave of court action aimed at the NHI legislation, which was signed into law in May 2024. The Act seeks to place healthcare funding under a single, state-run fund, with the goal of delivering universal, free healthcare coverage to all South Africans. In doing so, it significantly limits the role of private medical schemes and providers in favour of a centralised public system.
For supporters, NHI promises equity and access. For critics, it raises serious constitutional and financial red flags.
Why AfriForum says the law is unconstitutional
AfriForum argues that the NHI Act is inconsistent with the Constitution and should be declared invalid and referred back to Parliament.
The organisation’s legal representative, Wian Spies, has stated that their case rests on multiple concerns. Among them are what they describe as the dilution of provincial governments’ constitutional powers, restrictions on patients’ freedom of choice, and limitations on the clinical independence of health practitioners.
Another major point of contention is what AfriForum calls the economic unworkability of the framework. The group contends that the model lacks rationality because it cannot realistically be funded or sustained under current economic conditions.
Ernst van Zyl, AfriForum’s head of public relations, has claimed that the Act affects not only the organisation’s members but also the broader public. The group has framed the NHI as part of what it describes as an ideological policy direction by the governing party.
Louis Boshoff, AfriForum’s spokesperson on health, has gone further, warning that allocating funds equivalent to around 10 percent of the country’s GDP to a system he believes will not function effectively would be disastrous for taxpayers.
The money question refuses to go away
Cost remains one of the most contentious aspects of the NHI debate.
The Department of Health has estimated that an additional R200 billion in annual tax revenue would be required to fund the scheme. However, projections from Momentum Health Solutions place the figure significantly higher. Their estimates suggest the government would need between R900 billion and R1.3 trillion per year to provide care comparable in quality to that currently offered by the private sector.
These numbers have fuelled intense discussion on social media and talk radio, where many South Africans are already grappling with rising living costs, unemployment, and strained public services. For some, the promise of universal healthcare is inspiring. For others, the financial implications feel overwhelming.
A symbolic setting in Gauteng
AfriForum announced that it had served the summons during a media conference at the abandoned Kempton Park Hospital in Gauteng. The choice of location was deliberate. The organisation described the deteriorating public facility as a warning of what could happen to the broader health sector under NHI.
The imagery struck a chord online, with photos of the derelict hospital circulating widely. It added a visual dimension to an already heated policy debate.
A legal battle among many
AfriForum’s case is not the only one. The NHI Act is currently facing around nine different legal challenges. The outcome of these cases could shape the future of healthcare in South Africa for decades.
At its core, this is more than a courtroom dispute. It is a clash between competing visions of how healthcare should be funded and delivered in a country marked by deep inequality.
For now, the courts will decide whether the Act stands as it is, returns to Parliament for revision, or faces further constitutional hurdles. What is clear is that the NHI debate is far from over, and the legal fight has only just begun.
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Source: Daily Investor
Featured Image: Polity.org.za
