President Cyril Ramaphosa has agreed to delay the proclamation of any sections of the National Health Insurance Act (NHI) following litigation brought against the President and the Minister of Health.
The National Health Insurance (NHI) is South Africa’s strategy to achieve universal health coverage. The NHI is a centralised, national insurance fund from which the government will buy healthcare services from healthcare providers in both public and private sectors. There will be one pool of healthcare funding for private and public healthcare providers alike.
In a statement on 24 February, the Presidency said the decision to delay the proclamation was taken after consultations between President Ramaphosa and Health Minister, Dr Aaron Motsoaledi, in light of the legal challenges. The proclamation is to be delayed until the Constitutional Court has handed down its judgments in challenges due to be heard on 5 - 7 May 2026.
With the delay to the NHI’s implementation, the divide between private and public healthcare is set to widen. However, the Presidency emphasised that the delay will not affect the broader timetable for implementing the NHI. The Department of Health has indicated that preparatory work, including efforts to strengthen and improve health services, is ongoing.
The NHI Bill was signed into law on 15 May 2024 by the President.
The government’s official framework, as outlined in the NHI Act of 2024, consists of two main phases:
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Phase
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Timeline
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Focus Areas
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1
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2023 – 2026
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Establishing the NHI Fund, creating governance structures, and passing foundational regulations.
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2
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2026 – 2028
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Establishing the Fund as a purchaser of healthcare and implementing the mandatory prepayment system.
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Full Rollout
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2028+
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NHI to be fully operational
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