Despite a hold on the rollout of the National Health Insurance (NHI) scheme in South Africa until specific court challenges are heard, the government is still allocating billions of rands to continue work in the background.
The latest 2026 budget allocates around R9.3 billion to the NHI.
This includes close to R1.5 billion in direct NHI grants over the next three years, as well as over R7.8 billion in “indirect” NHI funding.
The direct funding—provincial NHI grants—are relatively small, amounting to R475 million, R497million and R513 million over the medium term (2026-2028).
This is in line with the spending on NHI grants in 2025, which totalled R467 million, reflecting an upward trend.
Similarly, indirect funding is also escalating, from R2.56 billion to R2.6 billion, then to R2.7 billion, between 2026 and 2028. Over R3.3 billion was spent in 2025.
The direct grant generally relates to the National Department of Health’s preparations for the implementation of the NHI on a provincial level.
This includes testing reforms, improving the services of primary healthcare facilities, and aligning infrastructure with national and provincial policy directives.
The indirect financing, meanwhile, is usually more focused on background public healthcare improvements that are part of the general NHI project, but not related to direct NHI healthcare services.
This includes infrastructure upgrades and the modernisation of healthcare systems, with a strong focus on digital.
While both these types of spending are tied to the implementation of the NHI, they are not necessarily tied to the scheme’s operations.
The R9.3 billion total is also only a fraction (3%) of the overall healthcare funding for the year, where total consolidated government spending on health is set at R310.4 billion.
According to President Cyril Ramaphosa, the stay on the NHI healthcare rollout—now an order of the court—will not impact the Health Department’s work to improve public healthcare.
Another fight brewing
Ahead of the 2026 Budget, the presidency announced that it had agreed to defer promulgation of the NHI Act until court challenges to the scheme were resolved.
These cases relate to the public participation process that led to Parliament’s adoption of the NHI Bill.
One of the key litigants challenging the NHI on several grounds, trade union Solidarity, agreed to stay its case on the condition that the implementation and further development of the NHI cease immediately.
From the union’s view, the hold on the rollout of the NHI also means no more money should be spent on the scheme until the matter is settled.
In an attempt to entrench this view, the union sent a letter to various government departments, including the presidency, demanding that no further budgetary concessions be granted in respect of the NHI.
The union said it intends to institute legal proceedings against the government if it fails to comply.
However, Ramaphosa made it clear that the state would continue to lay the groundwork for the policy.
Addressing his decision to place on hold any promulgation of the NHI Act, the president said that the government is still fully behind the NHI.
The decision to agree to the stay was to “work within the requirements of the law and judicial process to ensure that there is no undue delay to the scheme,” he said.
Crucially, he said that preparatory work for the NHI has been ongoing, referring to improvements in health services funded by the budget.
The agreement was to delay the proclamation of any sections of the NHI Act until the Constitutional Court has handed down its judgments in legal challenges due to be heard on 5-7 May 2026.
However, the improvements to public healthcare are happening before any sections of the NHI Act have been commenced.
“The undertaking (to hold the rollout) will not affect the timetable for the implementation of the NHI,” Ramaphosa said.
“The Department of Health will continue in its constitutional responsibility to strengthen the health system and improve the quality of care.”
