The South African National Health Insurance (NHI) Act, 2023, aimed at realising the constitutional right to universal healthcare, remains stalled as courts weigh challenges over public participation and legal validity. Despite President Cyril Ramaphosa signing the bill in May 2024, it has not come into force pending Constitutional Court rulings expected after hearings in May 2026.
Section 27 of the South African Constitution affirms that “everyone has the right to have access to – (a) health care services, including reproductive health care,” providing the legal foundation for healthcare reform efforts. The government cites this to justify the NHI as essential to reducing inequities in South African health services.
However, the implementation of the NHI Act is entangled in multiple legal disputes. Challenges focus on whether Parliament complied with constitutional public participation requirements when enacting the Act. The Constitutional Court began hearing these consolidated applications from 5 to 7 May 2026, but judgment has been reserved and remains pending as of July 2026.
Meanwhile, on 18 May 2026, the Constitutional Court declared sections 36 to 40 of the National Health Act unconstitutional. These provisions governed the “certificate of need” system designed to regulate healthcare provider locations. The Court found them an unjustifiable limitation on individuals’ freedom to choose their profession. Still, the Department of Health emphasised this ruling did not invalidate the NHI Act itself. “No section of the NHI has been declared unconstitutional,” the department stated at the time.
President Ramaphosa has committed that no part of the NHI Act would be promulgated until the Court’s ruling on the public participation litigation. The department insists the recent judgment affects healthcare regulation broadly but does not directly impede the NHI reforms.
The ongoing judicial scrutiny has slowed government efforts to reform healthcare funding and delivery. Supporters argue the NHI is a constitutional imperative and necessary to address historic inequalities in access to quality care. Critics raise concerns about the scheme’s affordability, governance, and practical rollout design.
At this stage, the constitutional right to healthcare remains firmly established. But the legal and political processes determining how and when universal healthcare reforms will be implemented are unresolved. Claims that the NHI will decisively prevail or that courts will block universal care are not supported by confirmed rulings. Instead, the ultimate outcome depends on forthcoming judgments and ongoing debates about the scheme’s structure and financing.
For South Africans seeking clarity on healthcare’s future, the Constitutional Court’s decisions will be pivotal. CapeFlats.co.za will continue to monitor and report on these developments as judgment in the public participation challenge is expected but not yet delivered.