Health Minister Aaron Motsoaledi has begun fresh engagement with one of his fiercest critics on the National Health Insurance (NHI). He met with the South African Medical Association (Sama) recently to discuss what he called “things we have in common”, despite Sama being among the organisations challenging the National Health Insurance Act in court.
The NHI aims to establish a large, state-controlled funding pool. Under the plan, all South Africans would belong to a single NHI Fund. Public and private providers would need to contract with the Fund to be paid. Existing private medical aids, in their current form, would fall away.
National Health Insurance: Talks Restart With Sama
Sama chairperson, Mvuyisi Mzukwa, confirmed the meeting but said it did not allow for detailed discussion on specific issues. He said the Minister wants monthly engagements, with each meeting focused on a single topic to allow deeper debate and clearer outcomes.
Motsoaledi defended the value of dialogue, saying that the key question is what the discussions are aiming to achieve.
Ramaphosa Plans Further Talks With Big Business
Motsoaledi also said President Cyril Ramaphosa is planning another engagement with Business Unity South Africa (Busa). Busa is the country’s largest business umbrella body. It previously met Ramaphosa in 2024, where alternatives to NHI were discussed.
One proposal raised in those talks was mandatory membership in private medical aid for people earning above a certain threshold. The argument is that this could reduce the number of people the state must fund for basic health needs. Busa remains worried about the NHI’s potential impact on healthcare quality, taxpayers, the economy and investor confidence.
Governance Scrutiny Grows as NHI Fund Questions Mount
The push for a trillion-rand NHI Fund is facing growing scrutiny. This month, Motsoaledi placed three senior health department officials on precautionary leave over alleged corruption. They are the director general, Sandile Buthelezi; deputy director general for hospital services and HR, Percy Mahlathi; and chief financial officer, Phaswa Mamogale.
They allegedly misused donor money intended for COVID-19 activities in 2023. The funds were reportedly used to pay for an allegedly irregular appointment of a chair and an investigator linked to a disciplinary process involving an employee who helped uncover corruption in the North West health department.
Most NHI litigation is effectively paused
For now, the NHI rollout and most litigation are effectively paused. Ten of the 12 court cases are on hold while the Constitutional Court considers two challenges focused on whether public participation processes were fair.
Those cases include an application by the Board of Healthcare Funders of Southern Africa against the National Assembly’s portfolio health committee, and a case brought by the Western Cape government against the National Council of Provinces.
Public interest law organisation SECTION27 says consultation did happen over years, including provincial roadshows and parliamentary submissions. However, it argues that many submissions did not appear to shape the final law. If the Constitutional Court finds that public participation was inadequate, the Act could be returned to Parliament. If the process is upheld, the remaining cases may proceed, possibly as a consolidated matter, which most challengers are expected to oppose.