The start of the NHI in South Africa

Health Minister Aaron Motsoaledi reaffirmed that the National Health Insurance Act (NHI) will still be implemented as planned—and has pointed to a preliminary list of public health facilities earmarked as the beginning of the scheme’s rollout.

His latest remarks follow a last-minute agreement between the ANC and the DA ahead of President Cyril Ramaphosa’s State of the Nation Address (Sona), sparking renewed debate over the feasibility and future of the controversial scheme.

Speaking in a parliamentary debate following Sona, Motsoaledi emphasised that the construction and revitalisation of several public health facilities mentioned by Ramaphosa are part of the NHI’s phased rollout.

These hospitals, identified as the initial sites for implementation, include:

• Limpopo Central Hospital
• Siloam District Hospital in Limpopo
• Dihlabeng Regional Hospital in Free State
• Bambisana District Hospital in Eastern Cape
• Zithulele District Hospital in Eastern Cape
• Bophelong Psychiatric Hospital in North West

According to Ramaphosa, these facilities are either under construction or undergoing significant upgrades to align with the NHI’s broader goals.

Motsoaledi said that this was a deliberate and strategic move, ensuring that the chosen sites play a critical role in the scheme’s success.

“It is going to be a very interesting and well-thought-of list in support of the NHI.

“Hence, the sites of such hospitals will be the beginning of the NHI rollout and will be very strategic for NHI to thrive,” he said.

He also indicated that a more comprehensive list of hospitals involved in the project would be disclosed during his budget vote in the coming months.

The NHI has once again dominated public discourse, with mounting criticism from the private healthcare sector and various stakeholders.

While the Government of National Unity (GNU) has reportedly been exploring amendments to the legislation, the National Health Department has dismissed speculation of any formal agreements to revise the laws.

Ramaphosa’s Sona reinforced the government’s commitment to pushing forward with the scheme despite opposition.

Critics argue that the NHI does not tackle South Africa’s fundamental healthcare challenges and could exacerbate existing inefficiencies.

The Universal Healthcare Access Coalition (UHAC), which includes 28 signatories, such as the South African Medical Association (SAMA), the Progressive Health Forum, and the South African Private Practitioners Forum, has proposed alternative reforms that it believes are more practical and scalable.

Their proposal was submitted in response to Ramaphosa’s 2024 call for private sector engagement, urging stakeholders to present workable alternatives rather than merely opposing the NHI.

However, Motsoaledi remains unwavering in his stance.

Addressing the DA’s concerns, he refuted claims that the scheme’s implementation is contingent on South Africa’s economic growth and that the country needed to be rich to fund it.

“The belief that countries implement NHI because they are rich, they’ve got a big tax base, is not true. NHI is now here. It is here to stay.”

He acknowledged that financial constraints would require the scheme to be rolled out gradually but stressed that this is the norm for universal healthcare adoption worldwide.

“There’s no other way of implementing NHI except gradually. There’s no other country in the world that did it in any other way because it’s impossible. It’s just impossible.”

Motsoaledi also highlighted that strengthening the public healthcare system and introducing national health insurance are not mutually exclusive.

He argued that upgrading hospital infrastructure is a key pillar in ensuring the success of the NHI and that these improvements will serve as the foundation for its full-scale implementation.

While the government doubles down on its commitment to the NHI, the scheme continues to face opposition from various quarters.

The coming months will likely see further debate and scrutiny, particularly as Motsoaledi presents additional details on the implementation strategy and budget allocations.

For now, however, the health minister has made it clear: the NHI is moving forward, and the first steps have already been taken.