South Africa’s NHI Act puts lives at risk

Solidarity has rejected Finance Minister Enoch Godongwana’s call for critics of the National Health Insurance (NHI) to bury the hatchet, saying it puts lives at risk.

On Tuesday, Godongwana said that he wanted parties to settle their legal challenges to the NHI out of court.

He criticised medical associations challenging the NHI Act, arguing that the legal action will further delay universal access to healthcare.

One of the biggest opponents of South Africa’s National Health Insurance Act is trade union Solidarity.

Solidarity has launched several high-profile court cases against the Act and its precursor regulations, with notable victories.

In July 2024, the Pretoria High Court ruled in favour of Solidarity, declaring sections of the National Health Act unconstitutional.

Shortly after President Ramaphosa signed the NHI Bill into law in May 2024, Solidarity filed a major application to have the entire Act declared unconstitutional.

Godongwana’s call for litigants, including Solidarity, to settle out of court to avoid further delays in achieving universal healthcare did not sit well with the trade union.

Solidarity said it will not abandon its opposition to the NHI Act (NHI), despite Godongwana’s call for critics to bury the hatchet.

It stated that this will only be possible if a sustainable alternative is seriously considered, rather than any version of the NHI.

Solidarity submitted an alternative piece of legislation

In early 2025, Solidarity submitted an alternative piece of legislation, the Healthcare Funding Reform Bill, to Parliament.

This Bill provides a practical and equitable alternative to the NHI, and it is the only basis on which Solidarity is prepared to engage in further discussions.

Theuns du Buisson, a researcher affiliated with the Solidarity Research Institute, said no meaningful consideration has thus far been given to this workable solution.

He added that this rendered the latest calls for engagement on alternatives questionable. “No form of the NHI is acceptable to us,” said Du Buisson.

“As long as the NHI remains the Minister’s point of departure, reconciliation is simply not possible.”

“Our proposal is already on the table and offers a realistic path to universal healthcare without stripping people of their existing benefits.”

Du Buisson said their opposition to NHI is in the interest of all South Africans, as healthcare cannot be entrusted to a state.

The existing public healthcare system is already failing, and fears that NHI will suffer the same fate are justified.

“As the legislation stands, medical practitioners and patients will be stripped of any right of choice and left at the mercy of bureaucratic decision-making,” he said.

“This will result in people who currently have access to healthcare being subjected to the decisions of an unworkable NHI system.”

“This will place lives at risk, and Solidarity cannot and will not reconcile with a policy that carries such consequences.”

The alternative proposed by Solidarity entails that all working South Africans obtain their own private health cover.

This would significantly relieve pressure on the public healthcare system and, in doing so, make better healthcare possible for all.