South Africa's certificate of need ruling has landed a major setback for government plans to direct where health services can operate. The Constitutional Court has declared the “certificate of need” provisions in the National Health Act unconstitutional. The decision ends a long legal fight that has run for more than two decades.
The unanimous ruling confirms a 2024 Pretoria High Court judgment. It strikes down sections 36 to 40 of the Act as irrational and invalid. Those clauses would have allowed the Health Minister to control where doctors, nurses, and health facilities may practise. They also covered private hospital wards and the location of specialised equipment.
Acting Justice Kate Savage, writing for the court, accepted that South Africa faces deep healthcare inequality. But she found the law did not show a rational link between the certificate-of-need system and the stated goal of improving equitable access. In short, the policy aim was clear. The legislative route was not.
South Africa Certificate Of Need Ruling Limits Centralised Health Planning
The court was particularly concerned about how much power the scheme placed in the Minister’s hands. It found the provisions gave overly broad authority without clear rules on how decisions would be made. That absence of detail mattered. It created uncertainty for the whole sector.
Justice Savage warned that reckless implementation could have caused “lasting damage” to the provision of health services across the country. The judgment also held that the provisions unjustifiably limited the constitutional right to choose a trade, occupation, or profession. Practitioners’ rights and interests were not properly weighed in the legislation.
Crucially, the Constitutional Court did not send the matter back to Parliament to fix. It permanently severed the provisions from the National Health Act. As the highest court, it has final authority.
Department Of Health Says NHI Unaffected By Certificate Of Need Ruling
The judgment reignited debate about the National Health Insurance (NHI) Act and how the state intends to plan services. During the case, lawyers for the Department of Health described the certificate-of-need system as a “central pillar” for implementing NHI.
After the ruling, the department took a different line. Spokesperson Foster Mohale said the court did not find any part of the NHI Act unconstitutional. He also stressed that the certificate-of-need provisions were never implemented.
Mohale said there is no direct impact on NHI. He accused certain political voices and private-sector stakeholders of misleading the public about what the judgment means. The department said it will continue preparations for universal health coverage through the NHI framework.
Industry And Opposition Frame Decision as a Win Against State Overreach
The case was brought by Solidarity, the Alliance of South African Independent Practitioners Association, the South African Private Practitioners Forum, the Hospital Association of South Africa, and individual doctors.
Solidarity deputy CEO Anton van der Bijl said the ruling collapses “one of NHI’s central pillars”. He argued the state wanted to move practitioners “like pawns” to cover governance failures.
Opposition parties and industry groups welcomed the clarity. The DA’s Michele Clark said the decision sets a constitutional precedent against excessive centralisation. ActionSA MP Kgosi Letlape called it a victory against state overreach.
Private practitioner groups also see wider implications. SAPPF CEO Simon Strachan said many arguments about doctors’ rights mirror those raised in challenges to the NHI Act. The Hospital Association of South Africa welcomed finality on a policy first introduced when the National Health Act was signed in 2004.
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