South African President Cyril Ramaphosa has decided to postpone the proclamation of certain provisions of the National Health Insurance (NHI) law, due to ongoing legal challenges before the constitutional court. In a statement released on February 24, 2026, the presidency indicates that this decision was made following consultations between the head of state and the Health Minister, Dr. Aaron Motsoaledi. The dispute revolves around the legislative process that led to the adoption of the law.
The proclamation of the relevant sections is therefore suspended until the South African Constitutional Court makes its decisions, expected following the scheduled hearings from May 5 to 7, 2026.
While the presidency assures that this delay will not impact the overall timeline for the reform deployment, some observers believe it could exacerbate tensions between the public and private healthcare systems in a country where access to healthcare remains unequal.
However, the Ministry of Health specifies that preparatory work continues, including strengthening healthcare infrastructure and improving service quality, in preparation for the gradual implementation of the system.
A landmark reform for universal health coverage
Enacted on May 15, 2024 by President Ramaphosa, the National Health Insurance law is the cornerstone of South Africa’s strategy to establish universal health coverage.
The mechanism involves the creation of a centralized national insurance fund, responsible for purchasing health services from public and private providers. Ultimately, a single fund will finance all healthcare services, with a mandatory prepayment system aimed at ensuring equitable access to care.
According to the official framework defined by the 2024 law, the implementation of the reform revolves around two main phases: Phase 1 (2023 – 2026), establishment of the National Health Insurance Fund, setting up governance structures, and adoption of key regulations; Phase 2 (2026 – 2028), operationalization of the Fund as a strategic purchaser of care and deployment of the mandatory prepayment system; finally, from 2028 onwards, full implementation of the system, with a fully operational National Health Insurance.
Pending the decision of the Constitutional Court, the South African government remains committed to this major reform, while navigating a sensitive legal and political environment.
