National Health Insurance is now law in South Africa

President Cyril Ramaphosa has made good on his promise to sign the National Health Insurance (NHI) Bill into law before the 2024 national election, bringing the contentious healthcare system into South Africa’s reality.

The president signed the NHI into law at a ceremony on Wednesday (15 May).

In his address ahead of the actual signing of the bill, Ramaphosa again hit back at critics of the bill, saying that anyone trying to maintain the status quo was out of line with the global imperative to pursue universal healthcare.

The president said that the NHI aims to level the playing field and merge the country’s fractured systems while removing the imbalance where the private sector caters to only a small percentage of the population while the public sector remains overburdened and underfunded.

The laws have faced vehement opposition from the healthcare sector in South Africa, as well as from business groups, unions, workers and legal experts. While all support the ideal of universal healthcare, they have taken big issue with the NHI’s path to get there, which opts for dismantling private funding.

Other issues relate to various levels of uncertainty around funding, cover, and execution, as well as worries over government corruption, mismanagement, and maladministration, which have become synonymous with state-run entities—which the NHI Fund will now become.

Various legal challenges have been pending for weeks, if not months, waiting for the president to make his move. These challenges are now expected to play out in the country’s courts with the likely outcome being aspects of the laws reaching the Constitutional Court.

Medical aids and other analysts have noted that, even with the laws now in effect, there are unlikely to be any immediate changes to the healthcare sector.

The laws and full NHI system are expected to be rolled out over time, with Discovery CEO Adrian Gore calling it a “multi-decade” process.

Delivering an address ahead of the signing, health minister Joe Phaahla said that the NHI won’t be a once-off event and that the system will roll out over time, with all regulations and implementation processes following the proper processes, including consultation and public comment provisions.

However, he said that work has already started to get things going, with the NHI Fund in particular likely to be established within six to 12 months.

Read: Ramaphosa shrugs off NHI critics – and that’s one of the biggest legal problems he faces