Business
Ramaphosa halts NHI implementation pending Constitutional Court ruling
South Africa’s long-running National Health Insurance debate has taken another sharp turn. President Cyril Ramaphosa has agreed not to bring any part of the NHI Act into operation until key legal challenges are settled.
For many South Africans who have followed the NHI story for years, this is not a cancellation. It is a pause. But it is a significant one.
What exactly has been put on hold?
The National Health Insurance Act was signed into law in May 2024, just before the national elections. Signing the Bill, however, did not mean the system automatically kicked in. The law still needed to be promulgated, which means officially brought into operation.
Now, Ramaphosa has undertaken not to promulgate any provisions of the Act until the Constitutional Court has ruled on pending challenges. This decision follows a request from Health Minister Aaron Motsoaledi, who asked the President not to activate any part of the legislation while court processes continue.
At the centre of the legal fight are cases brought by the Board of Healthcare Funders and the Premier of the Western Cape, along with several other parties. Earlier this month, the Constitutional Court of South Africa deferred aspects of the matter relating to public participation in the drafting of the Act, pending the outcome of other related cases.
In simple terms, the government is waiting for clarity from the courts before moving ahead.
A scheme years in the making
The NHI is designed to reshape South Africa’s healthcare system by establishing a central fund that would purchase healthcare services on behalf of all residents. The rollout was always expected to take a decade or longer, with the Department of Health laying the groundwork, including the creation of an NHI Fund.
Supporters argue it is a necessary step towards universal health coverage. Critics say it is unaffordable, unworkable, and constitutionally flawed.
The Act itself gives the government the legal framework to begin building that system. But until provisions are promulgated, the machinery does not formally start turning.
Pressure from multiple fronts
The pause comes amid sustained legal pressure.
Trade union Solidarity, one of the organisations challenging the Act, described the development as proof that continued litigation is having an effect. It has long been argued that the NHI should be scrapped entirely and replaced with alternative proposals.
Economist Dawie Roodt and others have previously raised concerns about affordability, pointing to the lack of direct funding allocations. The National Treasury has not committed large, ring-fenced resources to the NHI, a point frequently cited by critics.
Meanwhile, AfriForum has launched a fresh constitutional challenge, adding to a growing list of litigants. These include the Western Cape government, healthcare industry bodies, medical professionals, and business groups.
The objections span a wide range of issues. Some focus on the public consultation process during the drafting of the law. Others question the rationality of signing it into law. Several challenges target constitutional principles, including concerns around freedom of choice in healthcare funding and provision.
Not a retreat, but a recalibration
Importantly, the President’s office has emphasised that he does not act in isolation when deciding whether to bring legislation into effect. Implementation depends on departmental readiness and broader procedural considerations.
Given the scale of the NHI, that caution carries weight. This is not minor legislation. It proposes a structural overhaul of how healthcare is financed and accessed in South Africa.
On social media, reactions have been mixed. Some see the pause as common sense and a victory for accountability. Others fear it delays urgently needed reform in a public health system already under strain.
What happens next?
Solidarity is set to return to court next week in proceedings concerning the consolidation of the various cases against the government over the NHI. The Constitutional Court’s eventual ruling will shape the future of the entire project.
For now, the message from the Union Buildings is clear: no section of the NHI Act will be brought into operation until the apex court has spoken.
In a country where healthcare access remains deeply unequal, the stakes could not be higher. Whether the NHI ultimately survives in its current form, is reworked, or is scrapped entirely will depend not only on politics but on constitutional law.
One thing is certain. The debate over how South Africa funds and delivers healthcare is far from over.
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Source: Business Tech
Featured Image: Polity.org.za
