Community groups and healthcare providers have expressed deep concern over the halt in South Africa’s National Health Insurance (NHI) rollout, warning that millions of vulnerable citizens could face delays in accessing essential medical care.
The pause follows legal challenges to the NHI Act, prompting President Cyril Ramaphosa to postpone the proclamation of certain sections of the law until the Constitutional Court delivers judgments on hearings scheduled for May 5–7, 2026.
The cases centre on the public participation process that led to the adoption of the NHI Bill in Parliament.
While the delay is procedural, organisations working on the ground say its impact is immediate. Community-based primary healthcare providers, including the non-profit Rhiza Babuyile, argue that practical, scalable models already exist to bridge the healthcare gap, but access cannot wait.
“Many South Africans cannot afford to wait to see a nurse or doctor today,” says Alef Meulenberg, founder and executive chairman of Rhiza Babuyile to the Saturday Star.
“Healthcare cannot be placed on hold while long-term investments are still being structured.”
Meulenberg says a fully implemented NHI would remove cost barriers, strengthen primary care, and expand service availability for underserved communities.
“Even though operational implementation is paused, the government’s current NHI-related investments already point to what full implementation would achieve. In 2026, R9.3 billion is allocated for groundwork, including upgrading clinics, modernising digital health systems, and preparing provinces for universal coverage. For rural, peri-urban, and township communities, this means better-equipped clinics, more consistent medicine supply, improved referral systems, and a more equitable distribution of healthcare resources.”
He adds that NHI aims to ensure every South African can receive care without paying at the point of service, reducing catastrophic health expenditure and improving health-seeking behaviour in poorer households.
Regarding the 2026 budget, Meulenberg notes it does not provide new NHI funding streams but focuses on stabilising and expanding the public health system that underpins universal coverage.
While attention was on the Budget speech, Finance Minister Enoch Godongwana did not announce a dedicated funding stream or timeline for full NHI implementation on Wednesday.
Instead, his focus remained on stabilising provincial health services, expanding access within existing systems, and managing new pressures through reprioritisation rather than introducing new taxes.
Meulenberg emphasises the importance of adequate infrastructure: “Universal healthcare cannot succeed without facilities that support patient volume, infection control, and quality care. Many rural and township clinics face equipment shortages, space constraints, and structural deterioration. Digital transformation, such as electronic patient records, requires upgraded facilities. Human resources can only function effectively within safe, functioning environments.”
He warns that prolonged delays in NHI implementation expose South Africans, especially the poor to widening inequality in healthcare access, continued financial hardship, stagnation in health system reforms, and unnecessary deaths.
Healthcare providers and civil society have a critical role in mitigating these risks. “Providers must drive service innovation and readiness to scale, while civil society must amplify the voices of communities who are often left unheard,” Meulenberg says. “Even before NHI is fully implemented, we have to ensure the budget delivers tangible improvements in public health.”
Adding another layer to the debate, Solidarity welcomed the provisional suspension of the NHI while also expressing concern over government spending.
In a press statement, the labour union said it had sent letters of demand to the Presidency, the Department of Health, National Treasury, and relevant ministers, warning against any contravention of the court order.
“This court ruling is a major breakthrough in our opposition to the NHI. It is beyond comprehension that taxpayers’ money is being used to establish a system that faces such extensive litigation,” says Theuns du Buisson, economic researcher at the Solidarity Research Institute (SRI).
“The NHI will never be realised. It is simply unworkable, unaffordable, and irrational. It is deeply concerning that anyone could regard it as a sound policy, particularly given that billions of rands have already been spent on it. Yet these billions of rands in costs would be only a fraction of the far greater sums and the irreversible loss of life that the NHI package would entail if implemented,” he adds.
Adding a political perspective, ActionSA is calling it a responsible step. The party, however, stressed that Parliament should ensure the NHI is constitutionally sound, procedurally fair, practically implementable, and fully funded.
“The fact that multiple parties have approached the courts over concerns relating to the public participation process underscores the seriousness of the issues at hand,” ActionSA said in a statement.
“While government insists that preparatory work continues and that implementation timelines remain unaffected, the reality is that the NHI in its current form raises profound concerns about governance, funding, centralisation of power, and the potentially devastating impact on both public and private healthcare systems.”