Ramaphosa doubles down on NHI in South Africa

President Cyril Ramaphosa has reaffirmed the government’s commitment to implementing NHI in South Africa.

This came after the Pretoria High Court ruled that the promulgation of any section of the NHI Act must cease pending a decision from the Constitutional Court, which will likely only come in May 2026.

It also followed a notice the President released on 20 February wherein he undertook not to promulgate any provisions of the NHI Act.

At the same time, trade union Solidarity, one of the parties currently litigating against the legislation, has also agreed in the Pretoria High Court that it would place its litigation on hold.

The trade union agreed to do this on the condition that the implementation and further development of the NHI cease immediately.

In a press statement released on Tuesday, 24 February, the President explained that he will put the promulgation of the NHI Act on hold until the Constitutional Court has handed down its judgments in challenges due to be heard on 5 to 7 May 2026.

Ramaphosa explained that this was necessitated by the litigation that has been initiated by various parties against the President and the Minister of Health.

“These cases relate to the public participation process that led to the adoption of the NHI Bill by Parliament,” he said.

“It is anticipated that this agreement will be made an order of court on 24 February 2026.”

However, he noted that this undertaking will not affect the timetable for the implementation of the NHI.

“The Department of Health will continue in its constitutional responsibility to strengthen the health system and improve the quality of care,” the President said.

“Government remains committed to the National Health Insurance and will work within the requirements of the law and judicial process to ensure that there is no undue delay.”

Solidarity agrees to a pause

In its own press statement, Solidarity explained that the court’s order means any further implementation of the NHI Act must now be stopped with immediate effect.

“This was decided today in the Pretoria High Court, where Solidarity, as one of the parties, agreed to place its litigation on hold on condition that the implementation and further development of the NHI cease immediately,” it said.

“This arrangement will remain in force until the Constitutional Court has delivered a ruling on the rationality of President Cyril Ramaphosa’s decision to sign the NHI Act in 2024.”

The trade union said Ramaphosa’s legal team agreed to this arrangement “under pressure from Solidarity and others”.

Solidarity added that it has, following the issuance of the court order today, sent a letter of demand to the president, the Health Department, the Treasury, and the relevant ministers, warning them against any disregard of the NHI court order.

“No further budgetary concessions may now be granted in respect of the NHI, and Solidarity intends to institute legal proceedings against the government should it fail to comply,” the union said.

“Such concessions may arise particularly during the 2026 Budget speech, scheduled to take place tomorrow.”

Solidarity also welcomed the provisional suspension of the NHI, calling it a “major breakthrough” in the union’s opposition to the NHI.

“It is beyond comprehension that taxpayers’ money is being used to establish a system that faces such extensive litigation,” Solidarity Research Institute economic researcher Theuns du Buisson said.

“The NHI will never be realised. It is simply unworkable, unaffordable, and irrational. It is deeply concerning that anyone could regard it as a sound policy, particularly given that billions of rands have already been spent on it.”

“Yet these billions of rands in costs would be only a fraction of the far greater sums and the irreversible loss of life that the NHI package would entail if implemented.”

Solidarity added that it will therefore use the court order to ensure that no further funds are wasted and that workable alternatives are pursued.

In its notice, Solidarity specifically calls for renewed and substantive engagement on viable alternatives to the NHI. 

“The preferred outcome of such discussions would be the adoption of the Healthcare Funding Reform Bill,” the union said, referring to a Bill that Solidarity submitted to Parliament in early 2025. 

Du Buisson said the intention to cease all implementation must also be taken into account when considering the future of medical aid tax credits.

“There is no reason at this stage to scrap it. On the contrary, it should be increased,” he said. 

“The Treasury has left it unchanged since 2023, while medical aid members have had to contend with double-digit increases in their premiums.”