South Africa’s Certificate of Need Ruling has reset the policy debate on where health professionals may practise. On Monday, 18 May 2026, the Constitutional Court confirmed that provisions allowing the state to control where doctors and nurses work are unconstitutional. The court ordered that the provisions be removed from the legislation.
The legal challenge was brought by Solidarity, the Alliance ff South African Independent Practitioners Association, the South African Private Practitioners Forum, several doctors, and the Hospital Association of South Africa. They asked the apex court to confirm a 2024 High Court decision by Judge Anthony Millar, which found the scheme unconstitutional.
For private providers and independent practitioners, the judgment removes a major regulatory risk. It also forces the government to find other levers to address persistent workforce imbalances.
Health Workforce Gaps Still Drive Policy Pressure
The certificate-of-need scheme was designed to tackle the uneven distribution of clinicians and specialists. The imbalance shows up between public and private care. It also shows up between urban and rural settings, and between provinces.
The Department of Health has stressed that the judgment does not invalidate the National Health Insurance (NHI) Act. The department says the broader reform agenda remains intact, even if one tool has fallen away. ([Daily Maverick][1])
In practice, the department currently has limited ability to purchase services from private doctors through conditional grants when public facilities cannot provide them. Officials argue that a more structured approach is still needed.
Certificate Of Need Ruling: What Comes Next
The Health Department says it is considering alternative regulatory models that focus on licensing facilities, rather than directing individual professionals. Spokesperson Foster Mohale pointed to structured licensing approaches used in Canada and Denmark. Under these models, health facilities are licensed according to planning priorities, and practitioners apply to work at approved establishments. ([Daily Maverick][3])
For healthcare businesses, this matters. A shift to facility-based licensing could affect:
- Where new practices or hospital units can be opened.
- How capacity expansions are approved.
- How payer contracts and service-line growth are planned.
Parliament has also signalled it will assess the fallout from the judgment. That indicates more legislative work may be coming, even if it looks different to the original certificate-of-need design. ([moonstone.co.za][4])
Doctors Welcome The Judgment But Warn Against Centralised Power
The Universal Healthcare Access Coalition (UHAC) welcomed the Constitutional Court outcome. It framed the judgment as a push for better reform, not a defence of the status quo. UHAC argues that reform must be lawful, evidence-based, and workable.
The coalition also linked the decision to wider concerns about NHI design. It warned that vague, highly centralised powers can create uncertainty. It says uncertainty slows implementation and weakens capability.
UHAC has proposed a national framework for strategic workforce planning. It wants regular workforce data from both public and private sectors. It also wants structured engagement to identify shortages and surpluses, backed by long-term technical planning.
A key funding proposal is to ring-fence remuneration for in-service training and supervision posts through specific-purpose conditional grants. UHAC argues this would protect critical training pipelines from provincial budget cuts.