NHI another step closer to reality

Health Minister Aaron Motsoaledi has gazetted regulations for public comment that seek to establish the governance structure of the National Health Insurance (NHI) Act.

The highly contested NHI was signed into law by President Cyril Ramaphosa last year and seeks to create a universal healthcare fund, with the state acting as the primary healthcare buyer for South Africans.

However, the Act has received major criticism, with questions raised about the limited roles of medical aid schemes in the country and the poor performance of other government-owned entities.

As per the regulations, the Department of Health will need to attract the widest pool of candidates with skill sets and diverse backgrounds for the NHI board.

The nominations will come from diverse stakeholders, such as health professional associations, representative trade unions and employer organisations, and civil society organisations.

The Director General of the Department of Health will create a nomination committee. The Minister will send the nomination committee’s recommendations to the cabinet for approval.

Once the board is established, it must recruit a suitable candidate for the NHI’s CEO position. The CEO will also need the approval of the minister and cabinet.

The CEO will be appointed for a term not exceeding five years, renewable only once by the board in consultation with the Minister.

As per the Act, the CEO will need to establish the following units to ensure the efficient and effective functioning of the fund:

• Planning;
• Benefits Design;
• Provider Payment Mechanisms and Rates;
• Accreditation;
• Purchasing and Contracting;
• Provider Payment;
• Health Products Procurement;
• Performance Monitoring; and
• Risk Management and Fraud Prevention Investigation.

The CEO will be in charge of the income and expenditure of the Fund and will need to submit an annual report to the Board.

The CEO and the board will meet with the Director General of the Health Department and the CEO of the Office of Health Standards Compliance at least four times per year to exchange information to carry out their responsibilities.

Public comments on the proposed regulations are due by Friday, June 6, 2025, at noon, and responses can be sent to [email protected] or by completing the public comment survey.

Court challenges

However, the state will need to deal with yet another court battle over the Bill after the Hospital Association of South Africa (HASA) filed a legal challenge.

HASA is South Africa’s largest hospital group, and its members include Life Healthcare, Netcare, Mediclinic, the Lenmed Group and Joint Medical Holdings.

HASA’s legal papers, which were submitted to the Gauteng High Court in Pretoria at the end of January, argue that the NHI should be aside as it is constitutionally invalid. 

Its main point of contention is that the scheme violates Section 27 of the Constitution, which guarantees every South African the right to access healthcare services. 

It also argued that the government failed to conduct a recent financial feasibility study on the likely costs of implementing the NHI.

The association believes that the plan could lead to dire consequences for the entire healthcare system if there is no evidence that the scheme is affordable.

HASA were also left frustrated by the government’s unwillingness to engage constructively with stakeholders. 

Despite the legal challenges, Motsoaledi recently reaffirmed that the NHI will still be implemented as planned.

Speaking in a parliamentary debate following President Cyril Ramaphosa’s State of the Nation Address (SONA), Motsoaledi emphasised the construction and revitalisation of several public health facilities as per the NHI’s rollout, including:

• 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

Ramaphosa said these healthcare facilities are either under construction or undergoing significant upgrades to align with the fund’s goals.