South Africa’s NHI war rages on

Despite comments from Finance Minister Enoch Godongwana urging the parties in lawsuits related to the National Health Insurance (NHI) Act to settle, some stakeholders are unwilling to back down.

In particular, trade union Solidarity, which currently has a lawsuit in the Constitutional Court regarding the NHI Act, has released a statement saying it will not abandon its opposition. 

This comes after Godongwana’s statements made to the National Assembly on 13 January 2026.

Godongwana said implementing the NHI scheme is critical to ensuring South Africans’ need for self-sufficiency and the need to move with speed in addressing universal access to healthcare.

“Despite a series of court cases, I believe that we can find a solution. These will delay the implementation of the NHI,” he said.

The minister said it is interesting that both protagonists in court proclaim that they support universal coverage and access.

“It is my submission that these parties must meet and craft a settlement. We want to move ahead with the implementation of the NHI. These court cases are going to delay it for more years,” Godongwana said.

Since its inception, the government’s NHI scheme has faced severe backlash from industry stakeholders and other parties.

After President Cyril Rampahosa signed the NHI Bill into law in May 2024, this backlash has not stopped, with several court cases filed opposing various parts of the legislation.

According to Spotlight, at least nine different court cases have been launched against the NHI Act.

One case was filed by Solidarity, with the matter heard in front of the Gauteng High Court in 2024.

This court ruled that sections of the NHI Act, which Solidarity argued amounted to limits on private medical practice, were irrational and unconstitutional.

Following this ruling, the matter went to the Constitutional Court, which will either overturn or confirm the High Court decision.

The Constitutional Court reserved judgment in the case in September 2025, with a ruling not yet forthcoming.

‘Litigation without hesitation’

In a statement released on 15 January 2026, Solidarity responded to Godongwana’s plea that the parties to NHI legal disputes reach a settlement.

“Solidarity will not abandon its opposition to the NHI Act, despite Finance Minister Enoch Godongwana’s call for critics of the policy to ‘bury the hatchet’,” the trade union said.

“While Solidarity remains open to constructive dialogue and engagement, this will only be possible if a sustainable alternative is seriously considered – and not any version of the NHI.”

Aside from its legal case opposing NHI, Solidarity also submitted an alternative piece of legislation, the Healthcare Funding Reform Bill, to Parliament in early 2025. 

According to the trade union, this Bill provides a “practical and equitable alternative” to the government’s NHI scheme.

Solidarity said its Bill is the only basis on which it is prepared to engage in further discussions.

Solidarity Research Institute researcher Theuns du Buisson said no meaningful consideration has thus far been given to the trade union’s solution, “rendering the latest calls for engagement on alternatives questionable”.

“No form of the NHI is acceptable to us. As long as the NHI remains the minister’s point of departure, reconciliation is simply not possible,” Du Boisson said. 

“Our proposal is already on the table and offers a realistic path to universal healthcare without stripping people of their existing benefits.”

Solidarity claimed it is the first and leading litigant challenging the NHI and continues to play a vital role in ensuring that universal healthcare is made available to all South Africans in a fair and sustainable manner.

Du Boisson said Solidarity’s efforts in opposing the NHI Act are in the interest of all South Africans, as healthcare “cannot be entrusted to a state whose existing public healthcare system is already failing”.

“As the legislation currently stands, both medical practitioners and patients will be stripped of any right of choice and left at the mercy of bureaucratic decision-making,” Du Buisson claimed. 

“This will result in people who currently have access to healthcare being subjected to the decisions of an unworkable NHI system.” 

“This will place lives at risk, and Solidarity cannot and will not reconcile with a policy that carries such consequences.”

He said the alternative proposed by Solidarity entails that all working South Africans obtain their own private health cover. 

“This would significantly relieve pressure on the public healthcare system and, in doing so, make better healthcare possible for all,” he said.

“Our position has always been that universal healthcare is essential. However, it must not come at the expense of people’s existing rights, benefits, or access to care. No one may be worse off.”

Solidarity noted that it remains willing to engage with Godongwana and other decision-makers.

“That has never changed,” Du Buisson said. “Instead of replacing the existing system with something unaffordable and unworkable, the real deficiencies within the current system should be addressed.”

“Solidarity remains committed to protecting lives and averting the devastating consequences of the NHI. Should no viable alternative be accepted, it will continue litigation without hesitation.”

Godongwana’s comments welcomed

The Health Funders Association (HFA), which also has an ongoing lawsuit regarding the NHI Act, has welcomed the minister’s comments.

The HFA, which represents 45% of all medical scheme members in South Africa, said it is committed to working with the government, healthcare professionals, organised labour, and all stakeholders to strengthen South Africa’s health system.

“HFA’s decision to pursue legal action against the NHI Act was not taken lightly and followed years of making constructive inputs (along with many other stakeholders), which were ignored,” the organisation said in a statement released on 16 January.

“Litigation was undertaken as a last resort, out of concern for the sustainability and stability of South Africa’s health system.”

HFA CEO Thoneshan Naidoo said the organisation fully supports the goal of NHI, but that it is important to be realistic about what will work in practice.

“To achieve Universal Health Coverage (UHC), we need a plan that is implementable, financially sustainable, and leverage what is already working well in both the public and private sectors,” Naidoo said.

Similarly to Solidarity, the HFA has put its own proposal forward for an alternative to the government’s NHI scheme.

The HFA’s alternative proposes a hybrid, multi-fund model that builds on the NHI Fund, incorporates global best practice, “and preserves what is already effective within South Africa’s healthcare system”, Naidoo explained.

“HFA believes that the path to UHC must prioritise the urgent expansion of good quality primary and preventive healthcare, through both the public and private sectors, as this is the most effective way to improve population health outcomes.”

“This would act as a stepping-stone to NHI, while reducing out-of-pocket spending and relieving pressure on public hospitals.”

Naidoo said the HFA is ready to engage in good faith. “Collaboration and utilising the excellence that exists in both the public and private sectors is how we can build a health system that works for everyone,” he said.