Ramaphosa asking for trouble

President Cyril Ramaphosa has found himself under intense scrutiny after comments he made regarding the National Health Insurance (NHI) Act.

Trade union Solidarity, which has a pending legal case against the legislation, is now investigating whether Ramaphosa is in breach of a recent court order that has temporarily prohibited the promulgation of any part of the NHI Act.

This comes after a recent National Assembly question-and-answer session, where EFF leader Julius Malema asked the President what progress the government has made in implementing the NHI Act.

In his answer, Ramaphosa outlined various steps the Health Department has taken to prepare for the implementation of NHI in South Africa.

“This includes procedures for the registration of people who are going to use NHI, and the accreditation framework and contracting arrangements for healthcare establishments and providers,” he said.

“We are also rolling out the digital systems that are required to trace a patient between different doctors, service providers, healthcare workers and health facilities – whether in the public or private sectors.”

He added that provincial and national health departments are also focusing on employing doctors and other health professionals.

These comments come after a recent High Court ruling, which stated that the government may not take any further implementation or development steps regarding the NHI Act until the Constitutional Court has delivered a ruling in the pending legal cases regarding this Act.

There are currently at least seven court cases ongoing against the NHI, with two cases before the Constitutional Court regarding the public participation process that led to Parliament’s adoption of the NHI Bill.

These two cases, from the Board of Healthcare Funders and the Western Cape Premier, are due to be heard at the beginning of May 2026.

Following the High Court order, the President and Health Minister Aaron Motsoaledi undertook not to proclaim any sections of the NHI Act until the Constitutional Court has handed down its judgment.

However, during the National Assembly session, Ramaphosa explained that they made this undertaking to ensure that the other legal challenges to the NHI Act, which have been brought on other grounds, are managed in an orderly manner that does not cause prejudice to any party.

“This undertaking, which has been made an Order of Court, will not affect the timetable for the implementation of the NHI, nor will it stop the work currently underway towards implementation of the NHI,” he said.

“We are determined to ensure that every South African has equal access to quality health care regardless of their ability to pay.”

Ramaphosa under a microscope

In response to Ramaphosa’s comments in the National Assembly, Solidarity released a press statement on Friday, 13 March.

The organisation said that while Ramaphosa’s comments gave the impression that the NHI Act’s implementation is continuing, this may not be the case.

“The President is trying to create the impression that the NHI already has momentum and that implementation is inevitable. This is not the case,” Solidarity Research Institute economic researcher Theuns du Buisson said.

“The position is clear – the NHI must not proceed at this time.” 

Solidarity pointed out that many of the examples Ramaphosa presented as preparation for the NHI do not actually relate to the implementation of an NHI system.

This includes the renovation of hospitals, the construction of new health facilities and the appointment of doctors. Du Buisson claimed it is misleading to present “such basic state functions” as NHI actions.

“That kind of thing should be done in any case, without any mention of an NHI,” he said. 

“It would, of course, be good if doctors were appointed, and hospitals were built and maintained. Unfortunately, this has not been done and has been neglected for many years.”

Regardless, Solidarity said its legal team will study the President’s statements “carefully” to determine whether such steps could potentially be a violation of the court order.

Following the High Court order, Solidarity sent a formal notice to the President, the Department of Health, the National Treasury and relevant ministers, warning them against any possible disregard of the court order.

In this notice, the organisation expressly stated that no implementation, preparation or budget allocations regarding the NHI may now take place, and that any action in violation of the court order may lead to further litigation.

“The government cannot, through political rhetoric or administrative manoeuvres, continue with a system that is currently stalled by a court order,” Du Buisson said.

Solidarity said it will monitor the situation closely and will not hesitate to consider further legal action if the government tries to circumvent the court order.