NHI hits a roadblock in South Africa
The National Department of Health has told Parliament that it should not expect any updates on the progress of the National Health Insurance (NHI) implementation, as it is on hold until further notice.
This comes as the Constitutional Court has yet to rule on the case heard in May 2026 regarding the public consultation processes for securing the NHI’s passage into law.
The department briefed parliament’s Select Committee on Social Services this week on its annual report for 2025/26, outlining its various outcomes for the year ending March 2026.
As part of the presentation, the department also included updates on the implementation of the NHI, which is said to be continuing on an indirect basis.
This includes the establishment of advisory structures, accreditation systems and electronic health records.
When the committee raised concerns about and asked for clarity on the rollout of the NHI—and why there appeared to be limited evidence of impact for South Africans—the department said that it was on hold.
“The committee heard that they will not see the implementation of NHI-specific interventions until the Constitutional Court has issued a judgment,” it said.
The full rollout of the NHI has effectively been put on hold since February, after President Cyril Ramaphosa agreed not to promulgate any further aspects of the laws until the Constitutional Court had ruled on fundamental challenges.
The scheme is facing a multitude of court challenges, with the Constitutional Court set to rule on one of the more foundational issues: whether the laws themselves are valid.
It’s a no-win situation for the NHI, however. If the apex court rules that the correct processes were not followed in enacting the NHI Act, it will send the process back years.
If the court rules that the processes were valid and the laws remain in effect, it will trigger the next wave of litigation waiting in the wings.
In either case, implementation of the NHI will face further delays.
The various provisions of the Act that are being challenged include:
- The public participation process (with the Constitutional Court);
- The rationality of signing the Act into law;
- Various sections related to private medical aids;
- Sections related to specialist services;
- The overall constitutionality of the Act, particularly in relation to arbitrary deprivation of business, removal of freedom of choice, and limiting access to healthcare.
Attempts have been made to bring the various litigating parties and the government together to settle the matters out of court, but both sides have rejected them.
Still going, and still getting money
Despite the dial on the NHI not shifting in 2026 so far, pending the Constitutional Court’s ruling, the government has by no means backed away from its support for the scheme.
Ramaphosa has on several occasions doubled and tripled down on the scheme, positing the plan as the only solution to South Africa’s healthcare problems.
This position has also been supported by the National Treasury, which has allocated billions of rands to enable the plan to proceed indirectly.
In the February 2026 budget, Finance Minister Enoch Godongwana allocated over R9 billion to the NHI.
This included R1.43 billion in direct NHI grants over the next three years, as well as over R7.8 billion in “indirect” NHI funding.
The direct grant generally relates to the National Department of Health’s preparations for implementing the NHI at the 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 direct funding—provincial NHI grants—is relatively small, around R500 million over the medium term.
Indirect funding is escalating from R2.56 billion to R2.6 billion, then to R2.7 billion, between 2026 and 2028.
In the Medium Term Budget Policy Statement (MTBPS) earlier in October, minor adjustments were made to the allocations.
There was an adjusted allocation of R1.427 billion for 2026/27, representing a minor net reduction of R7.3 million from the original appropriation of R1.434 billion due to internal shifts across subprogrammes.
The subprogramme allocations include:
- Health Financing and NHI: R1.376 billion
- Health Products Procurement: R35.5 million
- Programme Management: R8.8 million
- Digital Health System: R6.5 million
However, on the indirect side, approved spending was higher for different streams.
The Health Facility Revitalisation grant for improving provincial infrastructure alone was R275 million higher, at just under R8 billion.
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