President Cyril Ramaphosa says government will continue laying the foundations for National Health Insurance despite legal challenges against the scheme.
Speaking at the opening of King Nyabela Hospital in Mpumalanga, Ramaphosa said the state was working to improve healthcare access by building and refurbishing facilities.
Government also plans to expand primary healthcare services, modernise health systems and improve access to essential medicines.
“We are working to put in place the critical building blocks of the National Health Insurance,” Ramaphosa said.
He described the NHI as a way to ensure access to quality healthcare is not determined by where someone lives or their ability to pay.
Legal challenges delay key provisions
Ramaphosa signed the NHI Act into law in May 2024, but its key provisions have not yet commenced.
In February 2026, the president agreed not to proclaim provisions of the Act while a constitutional challenge linked to Parliament’s handling of the legislation was pending.
Other litigants challenging the NHI agreed to pause their cases under the arrangement.
However, Ramaphosa has maintained that the undertaking does not stop government from strengthening the public health system or preparing for the NHI.
No confirmed date has been announced for the scheme to become fully operational.
Billions allocated to health reforms
The 2026 Budget allocated about R9.3 billion in direct and indirect NHI-related funding over the medium term.
Close to R1.5 billion was allocated through direct provincial NHI grants over three years.
These grants support preparations such as testing health reforms, improving primary healthcare services and aligning infrastructure with government policy.
A further R7.8 billion was allocated indirectly for programmes including infrastructure upgrades and the modernisation of healthcare systems.
The funding supports NHI preparations but does not mean the insurance fund is already operating.
Hospital supports healthcare expansion
King Nyabela Hospital replaces the old Middelburg Hospital and is expected to serve more than 240,000 people.
The 220-bed district facility forms part of government’s broader programme to improve public healthcare infrastructure.
Ramaphosa said the NHI would require strong leadership, skilled healthcare workers and cooperation between the public and private sectors.
For now, government is continuing its preparatory work while the future implementation of the Act remains tied to unresolved legal proceedings.