Ramaphosa halts NHI Act implementation pending Constitutional Court ruling

President Cyril Ramaphosa has formally undertaken not to promulgate any provisions of the contentious National Health Insurance (NHI) Act pending a ruling by the Constitutional Court of South Africa in ongoing legal challenges.

In a letter dated February 20, 2026, the Office of the State Attorney, acting on behalf of the President, confirmed to the parties contesting the NHI that no sections of the Act will be brought into operation before the apex court hands down judgment in two matters collectively referred to as the “public participation challenges.”

The cases were brought by parties including Solidarity, Board of Healthcare Funders of Southern Africa (BHF), South African Private Practitioners Forum (SAPPF), and the Premier of the Western Cape, among others.

Ramaphosa’s undertaking follows a separate letter from the Minister of Health, Aaron Motsoaledi dated February 19, 2026, in which the minister committed not to request the President to promulgate any sections of the Act until the Constitutional Court has resolved the pending matters.

Earlier this month, the Constitutional Court issued directions removing applications for leave to appeal and direct access lodged by both the Minister of Health and the President in related proceedings. Those applications—described as the “Presidential assent challenges”—were postponed indefinitely pending the outcome of the public participation cases.

The Court has scheduled the public participation challenges for hearing from 5 to 7 May 2026 and issued directions for the filing of further pleadings and written submissions.

In confirming the undertaking, Ramaphosa indicated that the decision was aimed at ensuring orderly procedural conduct.

“In order to ensure the orderly procedural conduct of the pending challenges and to avoid parallel proceedings overlapping, the President confirms the undertaking set out below. 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,” the letter read.

The letter further reiterates that Ramaphosa does not act independently in bringing legislation into force. According to the correspondence, implementation decisions are influenced by various factors, including the readiness of the responsible department—particularly in the case of legislation as far-reaching as the NHI Act.

The NHI is a cornerstone of the government’s healthcare reform agenda and seeks to establish a system of universal health coverage in the country. Its implementation has been met with both support and sustained legal opposition from various healthcare sector stakeholders and civil society groups.

The Constitutional Court’s upcoming hearing is expected to play a decisive role in determining the immediate future of the legislation.

sinenhlanhla.masilela@iol.co.za

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