Parliament’s Select Committee on Social Services was told this week that it will not see any National Health Insurance (NHI)-specific interventions until the Constitutional Court issues a judgment on the challenges to the NHI Act. The statement, issued on Thursday 29 October after the committee’s briefing on the Department of Health’s 2025/26 annual report, is the clearest public signal yet that the scheme’s rollout has no timetable while the court case is open.
What Parliament says the committee heard
According to Parliament’s media statement, committee members asked for clarity on progress with NHI implementation and on why there appeared to be limited evidence of impact. The statement records that “the committee heard that they will not see implementation of NHI-specific interventions until the Constitutional Court has issued a judgment”. The wording is Parliament’s summary of the exchange, so it does not attribute the answer to a named official.
The same statement quotes Director-General Dr Thembisile Xulu saying that implementation of key elements of the NHI continues. She named the establishment of advisory structures, accreditation systems and electronic health records. In practice the department is describing groundwork that supports the scheme, not the launch of any NHI service.
Why the rollout stopped in February
The pause dates from the Presidency’s statement of 24 February. SAnews reported that President Cyril Ramaphosa, after consulting Health Minister Dr Aaron Motsoaledi, agreed to delay the proclamation of any sections of the NHI Act until the Constitutional Court has handed down its judgments in challenges due to be heard on 5 to 7 May 2026. Those challenges concern the public participation process that preceded Parliament’s adoption of the NHI Bill, and the statement said the agreement was expected to be made an order of court on 24 February.
A letter from Ramaphosa’s legal team, quoted by Engineering News, put the undertaking this way: “The President undertakes not to promulgate any provisions of the NHI Act prior to the Constitutional Court handing down judgment in the public participation challenges”. At the time the Presidency said the delay would not affect the broader NHI timetable. Eight months on, with no judgment, the committee has now been told that NHI-specific interventions are on hold.
The case that was heard in May
The two cases were combined for hearing. Daily Maverick reported on 5 May that the Board of Healthcare Funders (BHF), which it describes as a nonprofit representing 65 medical aid schemes, administrators and managed care organisations covering 4.5 million beneficiaries, argued that Parliament failed to run a meaningful public participation process when it considered the Bill. The BHF’s case names the Speaker of the National Assembly, Ramaphosa and Motsoaledi as respondents. The court joined it with a second matter brought by Western Cape Premier Alan Winde and set aside three days. Outside court, former health minister Nkosazana Dlamini-Zuma told Daily Maverick the government had a strong case, and Motsoaledi agreed.
We have not found any record of a judgment in these cases, and neither the Department of Health nor Parliament has given a date for one.
A separate ruling is not the NHI judgment
A different Constitutional Court ruling on 18 May has sometimes been conflated with the NHI case. That judgment declared sections 36 to 40 of the National Health Act of 2003 inconsistent with the Constitution. The Department of Health said at the time, according to SAnews, that “the judgement is not a judgement relating to the National Health Insurance (NHI) Act” and that no section of the NHI had been declared unconstitutional. The public participation judgment that now governs the NHI timetable is still outstanding.
What BusinessTech adds on funding and the court risk
The figures on money come from BusinessTech, which reports them as budget allocations rather than as part of the committee briefing, and we have not checked them against the budget documents. It says the February 2026 budget gave the NHI more than R9 billion: R1.43 billion in direct grants over three years and more than R7.8 billion in indirect funding. Direct provincial grants are about R500 million over the medium term, and indirect funding rises from R2.56 billion to R2.6 billion and then R2.7 billion between 2026 and 2028. After the October Medium-Term Budget Policy Statement, BusinessTech reports an adjusted 2026/27 direct allocation of R1.427 billion, a net cut of R7.3 million from R1.434 billion, and a Health Facility Revitalisation grant R275 million higher at just under R8 billion.
BusinessTech also lists other challenges outside the public participation case, including the rationality of signing the Act into law, sections on private medical aids and specialist services, and broader constitutional complaints. It reports that attempts to settle out of court were rejected by both sides, and judges the position a “no-win situation”: if the court finds the process flawed, the process goes back years, and if it upholds the Act, further litigation follows. That is the outlet’s assessment, not a court finding.
What it means for business
Medical schemes, hospital groups, suppliers and anyone planning around health-sector contracts cannot assume an NHI start date. The pause applies to NHI-specific interventions, while the preparatory work Xulu described continues. For employers weighing benefits, contribution increases are a more immediate issue, as our coverage of Discovery Health’s 2027 contribution increases shows, and our report on the Health Funders Association’s compulsory medical aid proposal covers another part of the debate over how South Africa funds health care. More analysis sits in Regulatory & Policy.
