67 South Africans are working for a controversial programme that the government is not allowed to implement

The Department of Health (DoH) revealed that 67 posts have been filled at the National Health Insurance (NHI) programme.

This is despite the government not being able to implement any part of the NHI Bill due to a court order.

In a presentation to the Select Committee on Social Services, Director-General of the Health Department, Dr Thembisile Xulu, outlined the DoH’s annual report.

In this presentation, Xulu also touched on the department’s progress regarding the NHI programme.

This comes after the controversial NHI Bill was adopted into law in May 2024. Since then, the legislation has faced severe scrutiny and multiple court cases.

Industry stakeholders raised concerns about the NHI Act’s funding model, viability, enactment, and appropriateness for South Africa’s healthcare system.

Many of these concerns were taken to court, with the NHI facing 15 separate legal challenges.

One of these cases, brought by the Western Cape provincial government and the Board of Healthcare Funders, challenged the NHI Act on procedural grounds.

These litigants argued that Parliament failed to conduct meaningful public participation and consultation before signing the NHI Bill into law.

This matter went to the Constitutional Court, which heard the case in May 2026, but has yet to make a ruling.

In February 2026, President Cyril Ramaphosa and Health Minister Aaron Motsoaledi agreed not to promulgate any provisions of the NHI Act until the Constitutional Court delivered its judgment on this case.

This means implementation of the NHI Act has been put on ice temporarily, with the state blocked from implementing any part of it.

NHI vacancies filling up

In her committee presentation, Xulu noted several developments regarding the NHI programme, including filling vacancies.

She revealed that of 102 NHI vacancies, 67 have been filled as of 31 March 2026. This includes 15 new employees hired to work under the NHI programme.

It is unclear exactly what these employees were hired to do, and what their roles and responsibilities are.

On the NHI, Xulu also said the DoH has met some of its targets for the programme.

One such target was to establish two Ministerial Advisory Committees on healthcare benefits and health technology assessment for the NHI.

The DoH also aimed to develop and finalise an accreditation framework for the NHI programme.

Following the presentation, members of the committee discussed Xulu’s comments. NCOP delegate Patrick Sibande raised some concerns about the NHI.

He questioned how, given all the work undertaken to advance NHI, it could be implemented if the current state of South Africa’s healthcare system remains unchanged.

In response, NHI Deputy Director-General Professor Nicholas Crisp said the main focus of the NHI over the past five years has been on improving the infrastructure and quality of healthcare services.

He said the department has also focused on strengthening reporting mechanisms through the Office of Health Standards Compliance, the entry point into the NHI.

Crisp explained that the mechanisms through which the NHI would operate were under construction. Mechanisms that apply to the health system, irrespective of the NHI, were being implemented. 

However, he acknowledged that NHI-specific interventions would not be implemented at this time due to the temporary pause.