President Cyril Ramaphosa has tripled down on the National Health Insurance scheme, saying that court battles and a pause on promulgating the NHI Act won’t slow down the government’s agenda.
Responding to parliamentary questions this week, the president addressed a question from EFF leader Julius Malema on the government’s progress in implementing the NHI.
The question arises as the NHI Act rollout is on hold amid a mountain of legal challenges from private-sector businesses, political parties, unions, lobbies, and healthcare groups.
Ramaphosa agreed to hold off on promulgating any sections of the NHI Act until specific Constitutional Court challenges have been finalised and the way forward is legally cleared.
The challenges that will be heard by the Constitutional Court concern the public participation process that led to Parliament’s adoption of the NHI Bill.
Despite this, the president said that the NHI “is a commitment we are not prepared to move away from” – the third time in less than a month that he has repeated the line.
Reiterating statements after the promulgation pause, Ramaphosa said that the hold on rolling out the laws will not deter the government from advancing the scheme and continuing the implementation of foundational systems.
“Since the assent to the NHI Act, the Department of Health has been busy with a range of preparatory work,” he said.
“This includes procedures for the registration of people who are going to use NHI, and the accreditation framework and contracting arrangements for healthcare establishments and providers.”
He added that the department is rolling out the digital systems required to trace a patient across different doctors, service providers, healthcare workers, and health facilities – whether in the public or private sectors.
The digital systems include a Health Patient Registration System directly linked to the Department of Home Affairs population register, and an Electronic Medical Record.
These will roll out across more than 3,500 public healthcare facilities over the next 15 months, he said.
Other measures include a host of “practical interventions” to improve the quality and accessibility of healthcare, as well as rebuilding old hospitals and building new hospitals, health centres, and clinics.
The national and provincial Departments of Health are also focusing on the employment of doctors, other health professionals and community health workers.
None of these aspects—key to the rolling out of the NHI—will be stopped, reversed or altered by the legal challenges to the scheme.
The NHI is coming
Ramaphosa said that the government has agreed not to proclaim any sections of the NHI Act until the Constitutional Court has handed down its judgment in legal challenges.
Hearings on the matter will start in May 2026.
“We made this undertaking to ensure that the other legal challenges to the NHI Act, which have been brought on other grounds, are managed in an orderly manner that does not cause prejudice to any party,” he said.
However, he stated that none of this will affect the timetable for the implementation of the NHI, “nor will it stop the work currently underway towards implementation of the NHI”.
“The NHI aims to establish a single national fund that will allow for the equitable purchasing of health services from public and private healthcare providers,” he said.
“This will enable the whole population to access all the potential health resources in the country.”
The president said that the change brought by the NHI is “complex and far-reaching,” and that, as such, the scheme’s implementation will be gradual.
Estimates have put the rollout at around a decade (without court challenges) to multiple decades (with court challenges bogging down the process).
Notably, Ramaphosa said that the implementation of the scheme will be based on the availability of financial resources.
Funding for the NHI has remained a permanent question mark hanging over the scheme, with the government publishing no costing for the system and providing no estimates.
The National Department of Health has repeatedly rejected estimates from analysts and the private sector—ranging from R250 billion to R1.3 trillion a year—without providing an alternative.
The NHI Act itself points to budget allocations, new tax measures (a payroll tax and a healthcare surcharge) and the removal of medical aid tax credits as a means to fund the scheme.
These can only be implemented by the National Treasury through required legislative changes.
The National Treasury has not made any of these changes, nor allocated much direct funding for the NHI over the years, which economists and analysts have taken as a tacit rejection of the scheme.
