NHI falling apart one pillar at a time

South Africa’s top court struck down parts of a law that would enable the government to determine where doctors and other healthcare professionals can work, because their constitutional rights would be undermined. 

Parts of the National Health Act that gave the health minister the power to issue so-called certificates of need that healthcare professionals will require to practice, were unconstitutional and invalid, the Constitutional Court found.

It also ruled that the minister shouldn’t be allowed to determine where medical equipment and facilities could be located.

The judgment complicates the authorities’ plans to implement a sweeping universal health-insurance program aimed at expanding equitable access to care through a centrally managed state fund that would purchase services from public and private providers.

“One of the NHI’s central pillars has collapsed today,” said Anton van der Bijl, the deputy chief executive officer of labour union Solidarity, one of eight parties that filed the lawsuit contesting the National Health Act.

“No government can force doctors, dentists, nurses and other healthcare practitioners through regulations to create quality healthcare where the government itself has failed.” 

Foster Mohale, a health department spokesman, said a response to the judgment would be issued later on Monday. 

Several other legal challenges to the law underpinning the NHI’s implementation are currently before the courts, with applicants arguing that the program hadn’t been properly budgeted for and that the public-participation process used to pass the legislation was flawed.

In February, President Cyril Ramaphosa agreed not to proclaim any provisions of the NHI Act pending judgments in the outstanding court challenges.