THE National Health Insurance (NHI) ACT IS FOR US AND ABOUT US, THE PEOPLE
Thabo Motlhabi
The battle over the future of healthcare in South Africa played out once again in court, as the National Health Insurance (NHI) Act took centre stage at the Gauteng North High Court in Pretoria on Tuesday, 24 February 2026. In Courtroom 4E, legal arguments unfolded around a law that the government says is meant to guarantee universal access to quality healthcare but which a group of litigants is seeking to halt through the courts.
Seven applicants have launched separate legal challenges aimed at stopping the implementation of the NHI Act, in a move widely seen as an attempt to pressure Cyril Ramaphosa and the Minister of Health, Aaron Motsoaledi, to abandon the roll-out of the landmark healthcare reform.
However, proceedings on the day were brief, as both the Department of Health and the seven litigants agreed to pause further engagements pending two related matters currently before the Constitutional Court of South Africa, scheduled to be heard in May 2026. The outcome of those cases is expected to have a direct bearing on the department’s application to consolidate the seven matters into a single case, following proceedings that commenced yesterday.
In a statement released on Tuesday, the Presidency confirmed that following consultations held last week, Cyril Ramaphosa and the Minister of Health, Aaron Motsoaledi, reached a strategic agreement to delay the proclamation of any sections of the National Health Insurance (NHI) Act until the Constitutional Court of South Africa hands down its judgements in challenges brought by the Board of Healthcare Funders and the Western Cape Provincial Government, scheduled to be heard from 5 to 7 May 2026.
This agreement between the President and the Minister of Health was formally noted and made an order of court during proceedings at the Gauteng North High Court on Monday, giving legal effect to the temporary pause on proclamation.
The two matters before the Constitutional Court centre on the public participation process that preceded Parliament’s adoption of the NHI Bill. These challenges are directly linked to the seven cases currently lodged at the Gauteng North High Court, which the Department of Health has sought to consolidate into a single matter.
Despite the delay in proclamation, the Presidency stressed that the Department of Health has “no option but to proceed with preparatory work that has been ongoing to lay the foundation for the full implementation of the NHI,” in line with the President’s directive. The statement further acknowledged that the undertaking by the President will affect the original timetable for implementation but does not halt the overall reform process.
The NHI Act places a clear obligation on the state to deliver universal health coverage for South Africans, a commitment that many in civil society say must not be diluted by legal manoeuvres.
For this reason, organisations including Show Me Your Number, Access Chapter 2, ROLESA, Defend the NHI, and the Positive Women’s Network, alongside ordinary community members and the chairperson of the Gauteng Civil Society Forum, were present in court to demonstrate visible support for the legal defence of the NHI Act.
“We will continue to mobilise South Africans to defend and advance the implementation of the NHI Act,” civil society leaders said, stressing that access to quality healthcare is a constitutional right, not a privilege.
According to Mabalane Mfundisi, Executive Director of Show Me Your Number, the movement will not be deterred by legal pressure. “We are not intimidated by the court of legal arguments, just as we are not afraid of the court of public opinion or any kangaroo court. To the Constitutional Court, we are coming in our numbers from 5 to 7 May 2026,” he said.