The National Health Insurance (NHI) programme faced renewed legal pressure yesterday. Constitutional Court justices questioned whether the public had enough information to participate meaningfully in the law-making process. At the centre of the dispute is NHI Funding Transparency. There is debate over whether Parliament should have provided clearer cost and funding details before passing the bill.
The NHI Act aims to create a single, centralised fund. This fund would provide free, universal healthcare for all South African residents. The legislation was signed into law by President Cyril Ramaphosa in 2024. Now, the Board of Healthcare Funders (BHF) is asking the court to set the act aside on procedural grounds. They argue that the public participation process was defective.
NHI Funding At The Heart Of The Challenge
Bruce Leech, appearing for the BHF, argued that Parliament approved the NHI Bill “blindly”. He said lawmakers did not know the true costs of implementation. Nor did they have enough detail on what benefits the universal health coverage scheme would include. In his view, the absence of this information meant that Parliament could not consult the public meaningfully on legislation with major financial consequences.
Leech stressed that the BHF is not challenging the substance of the act’s provisions. Instead, the application targets the process that preceded the President’s signing the act into law. If the BHF succeeds, the court could set aside the NHI Act. Then it could direct Parliament to remedy the shortcomings in public participation.
Parliament Defends NHI Funding Transparency Approach
Ngwako Maenetje, representing Parliament, argued that the public was given sufficient information to participate. He said it was not possible to estimate the true costs with precision because NHI could take up to 10 years to implement. These costs would also depend on shifting economic conditions. He told the court Parliament acted on advice from the World Health Organisation (WHO). He added that the lack of final, overall figures did not make the process unlawful.
Maenetje also said the government had still provided useful information. This included cost indicators and possible funding models, such as taxation. He added that in 2022, the Health Department disclosed that South Africa spends about 8.5% of GDP on health. The stated objective of NHI, he argued, is to keep spending at or below 8.5% of GDP. Meanwhile, it aims to reduce administrative overheads.
Justice Dambuza Mayosi pressed the point directly, asking whether cost and funding details were not central to public participation. Maenetje responded that demanding exact figures would set a higher bar than in previous public participation cases.
Extensive Consultations Cited By Health Minister’s Team
Kameshni Pillay, representing the health minister, argued that Parliament did not rush the NHI consultation process. She said it took almost four years, from August 2019 to June 2023, to process the bill. They also consulted the public before a final decision.
Pillay said the public participation process led to 35 changes to the bill. More than 11,500 people attended meetings, more than 950 oral submissions were made, and 338,891 written submissions were received. She told the court that the majority of written submissions supported implementing NHI.
The hearing continues today. The court is expected to interrogate further what “meaningful” public participation requires when a law carries national-scale funding implications.
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